Surgery, radiotherapy, chemotherapy, biologic targeted therapy and combination therapy are the main treatments for tumors, but it is not easy to choose the appropriate treatment according to the early and late stage of tumors and patients’ specific conditions. Generally speaking, radiotherapy is suitable for all cervical cancer patients; surgery is suitable for early stage patients; chemotherapy is mainly used in combination with radiotherapy, postoperative adjuvant therapy and treatment of recurrent cervical cancer patients; targeted therapy is still in the exploration stage and is mainly used for treatment of advanced or recurrent cervical cancer; and comprehensive therapy is the development direction of tumor treatment. At the same time, personalized treatment plans should be formulated according to the general condition of patients, the presence or absence of comorbidities, and whether patients have fertility requirements. The principles of treatment for each stage are briefly described as follows:
1.Pre-cancerous lesions
CINI close follow-up, at least once a year TCT examination, if there are abnormalities, colposcopy and other further examination; combined with HPV infection, TCT once every 6 months.
If CINII is HPV negative, close follow-up should be performed once every 6-12 months; if HPV positive, LEEP or cold knife conization should be performed.
For CINIII or in situ cancer with fertility requirements, cold knife conization is performed.
2.Stage I
For stage IA1 with fertility requirement, cold knife cone excision and close postoperative follow-up; for those without fertility requirement, total hysterectomy is feasible, and young patients can keep both ovaries.
Stage IA2 sub extensive total hysterectomy, pelvic lymph node dissection or total hysterectomy, young patients can preserve ovarian function; for those with fertility requirements, cold knife conization, postoperative pathology with vascular tumor emboli, laparoscopic pelvic lymph node dissection. Close postoperative follow-up.
For stage IB1 patients without fertility requirements, extensive total hysterectomy and pelvic lymph node dissection should be performed; for young patients with squamous carcinoma, ovarian suspension should be performed; for patients with fertility requirements, radical cervical hysterectomy and pelvic lymph node dissection should be performed (cervical tumor less than 2CM, no lymph node metastasis in preoperative imaging).
Stage IB2 radical total hysterectomy and pelvic lymph node dissection after preoperative neoadjuvant chemotherapy or radiotherapy to shrink the tumor, and ovarian suspension is feasible in young patients to preserve ovarian function. No ovarian preservation is recommended for patients with adenocarcinoma.
Stage I patients with serious comorbidities, high risk of surgery or stage IB2 tumor shrinkage is not obvious and surgery is difficult, radiation therapy can be chosen and its effect is comparable to surgery.
3.Stage II
Stage IIA radical total hysterectomy and pelvic lymph node dissection. Whether to preserve the ovaries is the same as the previous.
4.Stage IIB and above patients are treated with radiotherapy.
5.Post-operative adjuvant therapy for cervical cancer
6.Patients with cervical cancer found after surgical removal of uterus for other reasons
(1) Supplementary surgical pelvic lymph node dissection, supplementary resection of parametrium and vaginal stump, postoperative radiotherapy.
2）Direct radiotherapy.
7.Radiation therapy for cervical cancer
It should be noted that except for in situ cancer and stage IA patients who can be treated with intracavitary radiotherapy alone, all other patients should be treated with external irradiation + intracavitary irradiation. It is especially emphasized that external irradiation alone, regardless of the irradiation technique, cannot cure cervical cancer.
It is found that the therapeutic effect of simultaneous radiotherapy combined with chemotherapy is better than that of radiotherapy alone; therefore, simultaneous radiotherapy and chemotherapy are the standard treatment protocols.