The document discusses surgical treatment options for cervical cancer ranging from stage IA1 to IIA1. For early stage IA1 cancer with no lymphovascular invasion, conization or simple hysterectomy may be performed. For stage IA1 with invasion or IA2, a radical trachelectomy with pelvic lymph node dissection is an option to preserve fertility. For stages IB1 and below, a radical hysterectomy with pelvic and paraortic lymph node sampling is performed. More advanced stages IIA1 and beyond receive a radical hysterectomy with pelvic lymph node dissection. Post-operative management depends on risk factors such as tumor size, margins, lymph node involvement, and parametrial involvement.

1. Surgical Treatment of CA
Cervix
SRUTHI LAKSHMANAN
RA1841002010134

2. TREATMENT MODALITIES
IN CA CERVIX
• SURGERY
(from IA1 to IIA1)
• RADIOTHERAPY
(>/=4cm or beyond cervix)
From IIB onwards (IB3 and IIA2
included)
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3. Stepwise Surgical treatment
FAMILY NOT
COMPLETED
STAGE
FAMILY
COMPLETED
CONIZATION
IA1 and No Lympho-
vascular invasion
SIMPLE HYSTERECTOMY
RADIAL
TRACHELECTOMY+
PELVIC
LYMPHADENECTOMY
IA1+ Lympho-vascular
invasion
IA2
WERTHEIM’S
HYSTERECTOMY+
PELVIC LYMPH NODE
DISSECTION
RADIAL
TRACHELECTOMY+
PELVIC
LYMPHADENECTOMY+PA
RAAORTIC LN SAMPLING
ONLY TILL STAGE IB1
IB1
IB2
IIA1
RADICAL
HYSTERECTOMY+
PELVIC LYMPH NODE
DISSECTION

4. o Option for women with stage IA1 (fertility
preserving)
o The operation involves removal of cone of
the cervix which includes entire
squamocolumnar junction, stroma with
glands and endocervical mucous
membrane.
o It is being done with the help of CO2 laser
used as scalpel under colposcopic guidance
o The excised cervical tissue is sent for
histological examination
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CONIZATION

5. 26/9/2022 Surgical treatment of CA Cervix 5
RADICAL TRACHELECTOMY
• option for women with stage IA2 and
IB1 disease who desire uterine
preservation and fertility
• Radical trachelectomy-involves
removal of 80% cervix, parametria
(Mackenrodts ligaments) and vaginal
cuff along with pelvic
lymphadenectomy <ureters deroofed>
• A cerclage is done between uterus and
vagina after the procedure

6. HYSTERECTOMY
CLASS DESCRIPTION
TYPE 1 SIMPLE HYSTERECTOMY
(IA1)
TYPE 2 MODIFIED RADICAL HYSTERECTOMY
(WERTHEIM’S)(MEIG’S OBAYASHI)
(IA2)
TYPE 3 RADICAL HYSTERECTOMY
(IB AND IIA)
TYPE 4 EXTENDED RADICAL HYSTERECTOMY
(SCHAUTA’S)(MITRA)
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7. RADICAL HYSTERECTOMY
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En-block removal of uterus with
upper 1/3 of vagina with
paravaginal and paracervical
tissues. The uterine
vessels are ligated at their origin.
Removal of entire width of
parametria and as much of
uterosacral ligaments are done

8. Pelvic
Lymphadenectomy
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Injection of blue dye into
cervical tissue before surgery.
Identifies lymph nodes during
surgery(sentinel lymph node)
Negative sentinel lymph node
(obturator nodes) helps avoid
extensive pelvic
lymphadenectomy

9. Post OP Management of CA
Cervix
INTERMEDIATE RISK
FACTORS
HIGH RISK FACTORS
Large tumour size Positive or close margins
Cervical stromal invasion
to middle or
deep one third (> 1 cm)
Positive lymph nodes
Lymph vascular space
invasion
Microscopic parametrial
involvement

10. Thank You