What should I do if I find out about cervical cancer? Surgery, or radiotherapy?

  Cervical cancer is the most common gynecological malignant tumor, and its incidence is increasing year by year in China. 2015 China Cancer Annual Report reported that among female malignant tumor patients, its incidence rate ranks 5th after breast cancer, lung cancer, gastric cancer and colorectal cancer, which is a serious threat to women’s health and life. In gynecological clinics, we often encounter patients with cervical cancer hesitating and indecisive about treatment choice: surgery, or radiotherapy? My answer is: the appropriate treatment is the best treatment.  1.Surgery is one of the main means of cervical cancer treatment. Many patients and their family members think that surgery is the best treatment, and once cancer occurs, everything will be over. In fact, only early stage cervical cancer is suitable for surgery, specifically stage I and IIa cervical cancer is suitable for surgery, and about 80% of these patients can get better results, but a small number of patients may have tumor recurrence, metastasis, or even distant metastasis, such as lung metastasis, retroperitoneal, subclavian lymph node metastasis, etc. The main reason for this occurrence may be related to the biological characteristics of the tumor, and of course, sometimes it is also related to whether the surgery is standardized and the reasonable choice of postoperative adjuvant treatment. Usually, a comprehensive assessment of the patient’s condition based on the pathology of surgery is required after surgery. For those patients with high-risk factors prone to recurrence, postoperative radiotherapy is often required to reduce recurrence and improve prognosis. The advantage of surgery is that it preserves the patient’s ovarian function and also avoids vaginal scarring and loss of elasticity, ensuring efficacy and quality of life at the same time. For young cervical cancer patients with stage Ib1 and tumor diameter less than 50px, extensive hysterectomy can also be chosen to completely remove the lesion but preserve the body of the uterus, preserving the patient’s reproductive function and satisfying the patient’s dream of becoming a mother. The disadvantages of surgery are the large extent of surgery, slow postoperative recovery, and the possibility of obstructed bowel movements and urination. In addition, older patients and patients with serious medical and surgical diseases should not undergo surgery because they cannot tolerate it.  It should be said that radiotherapy is suitable for any stage of cervical cancer, especially for those patients with advanced stage, and also for those patients who are too old and combined with serious medical and surgical diseases to tolerate surgery. However, many patients have the inherent concept that “the tumor must be removed”, but in reality, radiotherapy is a very mature treatment method with reliable efficacy. Radiotherapy has its own adverse effects, such as radiation cystitis, radiation proctitis, etc. With the advancement of radiotherapy technology and the introduction of conformal intensity modulated radiotherapy, the incidence of these adverse effects has decreased. In addition, radiotherapy destroys ovaries and scarring contracture of vagina, which has a greater impact on the quality of life of young patients.  Chemotherapy is an auxiliary means of cervical cancer treatment. Generally speaking, chemotherapy is mainly applied to patients with advanced stage and distant metastasis; in addition, giving chemotherapy at the same time of radiotherapy can obviously enhance the sensitivity of radiation to tumor and improve the efficacy of radiotherapy; in recent years, chemotherapy is used in the first stage chemotherapy of cervical cancer, that is, for some patients with early stage but large tumor that cannot be operated, the tumor can be shrunk through chemotherapy and then operated. This method is proven to be feasible. For some advanced patients with tumors in the pelvis, some doctors also use chemotherapy to shrink or even disappear the tumors, which is called down-staging chemotherapy, and then perform radical cervical cancer surgery, so that those patients who have no chance of surgery can win the possibility of surgery again, especially for young patients.  In addition, for some advanced or recurrent cervical cancer patients, we can try to add targeted drug therapy, such as bevacizumab, Endo, etc., which can improve the efficacy for some patients, but it is still in clinical trial stage.  In conclusion, the above methods are currently applied in cervical cancer treatment. It should be emphasized that these methods are not isolated, especially for patients with advanced or recurrent cervical cancer, they can be combined with each other to give full play to their respective advantages while compensating for their respective shortcomings, which is the so-called comprehensive treatment.