Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Vaginal bleeding started on Feb. 10. She was diagnosed with grade II squamous cell carcinoma [moderate to low differentiation] at our county hospital and was admitted to Nanjing Military General Hospital on April 1 for vaginal patency. The upper lip was lightly eroded. About 3CM cauliflower-like lesion was seen on the lower lip. The surface was hard and uneven. There was blood on palpation. The posterior vault was shallow. The uterine body is anteriorly positioned with normal size and medium quality with poor mobility. There is no painful adnexal mass. The tricuspidation shows slight tightness of the right main ligament. Ultrasound showed an anterior-posterior cervical diameter of 38.2 mm. 18.5*24 mm irregularly shaped solid light masses were seen on the posterior lip of the uterus. On April 20, he was admitted to the oncology hospital and no abnormality was seen in the upper abdomen on CT. Small lymph nodes in the groin bilaterally. Systemic intravenous paclitaxel 240mg plus cisplatin 60mg D2 was administered on April 2. Extensive uterine + bilateral adnexal + pelvic lymphatic dissection surgery was performed on April 26. Intraoperatively, negative ascites was seen. No abnormality was seen in the upper abdomen. The uterus was normal in size with no bilateral adnexal masses. There were no obvious lymph nodes in the pelvis and abdominal aorta. The ureter was not dilated. The postoperative autopsy specimen showed a mass of approximately 3 cm. The cervical canal was involved upwards. Pathology showed an endophytic nature. It was 2.5*1*0.9 cm in size and infiltrated the upper 1/3 of the fibromuscular wall of the cervix. No definite cancerous thrombus was seen in the vasculature. No cancer involvement was seen in bilateral adnexa. Lymph {left pelvis 0/8, right pelvis 0/18. left iliac 0/5. right iliac 0/4. tissue is non-keratinizing squamous cell carcinoma}. The non-neoplastic cervix is excavated cell formation [warts] with an atrophic morphology of the uterine body. Myxomatosis. Do you want to do follow-up treatment according to the pathology report? The chemotherapy and surgery were done in two hospitals on the way. The surgeon who performed the surgery did not know the actual situation before chemotherapy, so I am worried that the pathology report may contain some high level factors. Since it’s been 40 days since the surgery, and since it’s hypofractionated and infiltrating cervical muscle wall 1/3, I’m not sure what to expect. I would like to ask for your help. Hospital: According to NCCN guidelines: local tumor larger than 4cm, deep myometrial invasion, and choroidal aneurysm embolus are indications for postoperative radiotherapy. The above patient does not have these postoperative high-risk factors, and hypofractionation and infiltration of the cervical vermis 1/3 is not an indication for postoperative radiotherapy. However, the patient had 1 course of preoperative chemotherapy, which may have altered some potential high-risk factors, and follow-up treatment is recommended according to the physical condition and the opinion of the treating physician. Patient: Thank you for your answer. I’m sorry to trouble you. Our primary care doctor said at first that we should have three more courses of chemotherapy. But the day after, he said the tumor is less than 3cm. But I am not sure. I consulted some other doctors. Some of them said chemotherapy. Some said radiotherapy. Some said follow up. It’s a lot of confusion for me. My mother is still in good health. Just a little low on energy. There is also a little discomfort in the back and thighs. You are the authority on this. Please help me to understand with your professional eyes. This may be difficult for you. But please help me. Thank you. Patient: {Posterior vault is shallow and the tricuspidation shows a slightly tight right main ligament. The posterior cervical lip is 18. 5*24MM irregularly shaped solid light mass} This is the wording that appeared in the internal gynecological examination at the time of admission to Nanjing General Hospital. Is this a factor to be considered for follow-up treatment? Hospital: Hello! Your question is universal and I can fully understand your confusion. I can fully understand your confusion, because there is no definite international opinion on how to treat this condition. At present, domestic clinic often chooses preoperative chemotherapy for cervical cancer with large local tumor and surgery after tumor shrinkage, but there is no unified standard for how to carry out adjuvant therapy after surgery. Whether adjuvant therapy is needed for hypofractionation is still controversial. Some physicians advocate that adjuvant chemotherapy is beneficial for prolonging survival and reducing recurrence, but because of the lack of evidence-based medical evidence, the latest NCCN guidelines do not recommend it. It is recommended to follow the advocacy of the primary care physician.