Controversies in the treatment of carcinoma of cervix

Abstract

Carcinoma of the cervix is the most common female lower genital tract cancer in Hong Kong. Traditional treatment of early stage disease by radiotherapy or surgery or combination of both showed a 5-year survival rate of 80%-85%. However, there are subgroups of early stage patients which do better and subgroups that do worse. Hence, there has been controversy as to whether one should use more conservative treatment for the former group (stage Iai cervical cancer) and adopt a more aggressive approach in the latter group (stage Iaii and Ib disease with poor prognostic factors). In this article, the following controversies are discussed: (1) the treatment of stage Iai and stage Iaii cervical cancer; (2) treatment for subgroup of stage Ib cervical cancer with poor prognostic factors; (3) the usefulness of post-operative radiotherapy in patients with early stage cervical cancer who had positive pelvic nodes; and (4) adjuvant therapy in advanced and recurrent cervical cancer. Multicentre control trials are called for to settle some of these controversies.