How should unexpectedly discovered cervical cancer be treated?

  Unexpectedly detected cervical cancer is defined as invasive cervical cancer found unexpectedly after simple extra-fascia hysterectomy. Management of these cases includes history, physical examination, routine blood and liver and kidney function tests. Optional imaging tests include chest radiograph, CT and PET-CT, and MRI if indicated. for stage IB1 or smaller tumors, imaging is not routinely required.  1. For stage IA1 patients without lymphatic vascular space infiltration, they can be followed up and monitored.  2. For stage IA1 or stage IA2 or higher tumors with lymphovascular interstitial infiltration, pelvic radiotherapy + cisplatin-containing concurrent chemotherapy ± individualized brachytherapy is recommended if the cut margins are positive and imaging is negative.  3. If there are moderate to high risk factors (e.g. large primary tumor, deep interstitial infiltration, lymphovascular interstitial infiltration), pelvic radiotherapy ± vaginal brachytherapy is recommended. Concurrent radiotherapy is recommended for patients with residual lesions visible to the naked eye, positive imaging, positive lymph nodes ± parametrium, and/or positive surgical margins. Individualized brachytherapy is recommended for those with positive vaginal margins.