This document summarizes the surgical management and classification of stages of carcinoma of the cervix. It outlines the different types of surgical procedures used to treat various stages of cervical cancer, from conization for stage IA1 to radical hysterectomy for stage IB and chemoradiation for stages II-IV. It describes 5 types of surgical procedures ranging from simple hysterectomy to exenteration based on the extent of resection. Radical trachelectomy is mentioned as a fertility-preserving option for early stage disease in younger patients.

1. SURGICAL MANAGEMENT OF
CARCINOMA CERVIX
PRESENTED BY
DR.AYUSH GARG
PG JR I
RADIOTHERAPY

2. Management of Invasive Cancer of the
Cervix
Stage Ia1
≤3 mm invasion, no LVSI Conization or Type I Hysterectomy
No excision of parametrium
≤3 mm invasion, with LVSI Radical Trachelectomy or Type I/Type II
Radical Hysterectomy
with pelvic lymph node dissection
la2 3–5 mm invasion Radical Trachelectomy or Type II Radical
Hysterectomy
with BPLND or RT for inoperable patients
lb1 >5 mm invasion, <2 cm Radical Trachelectomy or Type III Radical
Hysterectomy
with BPLND
>5 mm invasion, >2 cm Type III Radical Hysterectomy
with BPLND

3. lb2 >5 mm invasion,>4cm Type III radical hysterectomy with pelvic
and paraaortic lymphadenectomy
or primary chemoradiation
Stage IIa Type III Radical Hysterectomy with pelvic
and paraaortic
lymphadenectomy or primary
chemoradiation
IIb, IIIa, IIIb Primary Chemoradiation
Stage IVa Primary Chemoradiation or primary
exenteration
IVb Primary Chemotherapy ± Radiation

4. Classification of extent of operation
1.(Type I ) Extrafascial Hysterectomy
2.(Type II) Modified Radical Hysterectomy/ Wertheim
Hysterectomy
3.(Type III) Radical Hysterectomy/ Meigs-Wertheim
Hysterectomy
4.(Type IV) Extended Radical Hysterectomy
5.Type V Operation: Exenteration

5. Simple Hysterectomy (Type I)
• Also known as an extrafascial hysterectomy,
removes the uterus and cervix, but does require
excision of the parametrium.
• It is appropriately selected for stage IA1 cervical
cancer.

6. Modified Radical Hysterectomy
(Type II)
• Modified radical hysterectomy removes the cervix, proximal vagina(1-2cm), and
parametrial and paracervical tissue.
• This hysterectomy is well suited for tumors with 3- 5mm
depths of invasion and smaller stage IB tumors.

7. Radical Hysterectomy (Type III)
• Requires greater resection of the parametria, and excision extends to the pelvic sidewall .
• In addition, at least 2 to 3 cm of proximal vagina is resected.
• This procedure is performed for larger IB lesions/IIA lesions, and for patients with relative
contraindications to radiation such as diabetes, pelvic inflammatory disease, hypertension,
collagen disease or adnexal masses.

8. Type IV - Extended radical hysterectomy
Removal of all periureteral tissue, superior vesicle artery
and ¾ of vagina.
Differ
from the type III procedure—three fourths of the
vagina and paravaginal tissue are excised.
Type V - Exenteration
The terminal ureter or a segment of the bladder or rectum is removed
along with the uterus and parametria
(supralevatorial).

9. Radical Trachelectomy
• Also known as cervicectomy, is a surgical removal of
the uterine cervix.
• As the uterine body is preserved, this type of surgery is
a fertility preserving surgical alternative to a radical
hysterectomy and applicable in selected younger
women with early cervical cancer
• It is appropriately selected for stage IA1/IA2/IIA cervical
cancer.

10. Conization
It is used both for diagnostic and therapeutic purpose
Removal of cone of the cervix which includes Squamocolumnar junction,stroma with glands and
endocervical mucous membrane
Methods: Cold Knife,CO2 laser, Laser diathermy loop

11. THANK YOU