Cervix Cancer

Uterine cervix is the lowermost part of uterus (womb). This is the portion which has highest risk of cancer. Cervical cancer is one of the most common cancers in the world (more so in the developing world). This cancer is easily preventable due to the availability of a vaccine that reduces the risk as well the presence of easy way to detect early cancers (simple tests). Treatment is also simple when detected early (refer to table).

Laparoscopic Radical Hysterectomy: Radical hysterectomy is the surgical treatment for cervical cancer. This involves the removal of uterus, cervix, tissue besides the uterus (parametrial tissues) and adequate upper vagina. It is usually combined with pelvic lymphadenectomy. The extent of parametrial tissue (tissue besides the uterus) removed depends on the stage of the disease. Radical hysterectomy is a more complex procedure than a simple hysterectomy and is undertaken by appropriately trained surgeons.

Completion Laparoscopic Hysterectomy: The combined treatment of radical surgery and postoperative radiotherapy increases overall morbidity compared to either alone. To minimise post-surgical morbidity, before doing an radical hysterectomy the size of primary tumour should be accurately assessed radiologically using MRI or CT scan and efforts should be made to ensure that there is no lymphadenopathy. For tumours measuring more than 4 cm the incidence of lymph node metastases is high. Presence of nodal metastasis is an indication for using adjuvant chemoradiotherapy or radiotherapy which increases the morbidity due to radiation to bowel. The evidence suggests that there is no difference in survival of these patients when treated by either radical hysterectomy or chemoradiotherapy. So, today the preferred treatment for these cases is chemoradiotherapy. When there is residual disease after chemoradiation a laparoscopic completion hysterectomy is advisable. Open technique is not recommended due to its morbidity.

Laparoscopic Lymphadenectomy in Advanced Cancers: When there is evidence of lymphnodal metastasis on CT or MRI scanning in patients with locally advanced disease, it is preferable to remove these nodes laparoscopically & then give chemoradiation to the cervical disease. Open surgery is not recommended due to its morbidity. This way the therapy can be focused on primary tumor with fewer side effects.

Laparoscopic Exenteration: The patients are placed in followup to detect recurrences as early as possible. In most of the cases of recurrence, exenteration is indicated. This can be performed by open or laparoscopic technique.

Presently available evidence indicates that laparoscopic radical hysterectomy to be a safe procedure