Dear OncoLink "Ask The Experts,"
Please tell me why hysterectomy is not usually performed and not recommended as initial treatment of adenocarcinoma of the cervix, Stage IIA or higher?
Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:
The treatment of early stage invasive cervical cancer often begins with surgery, which can be used in most cases of Stage IB disease (when the tumor is confined to the cervix) and in some cases of Stage IIA disease (when the tumor involves the upper vagina).
Because adenocarcinomas (gland-forming cancers) of the cervix usually begin inside the cervix, they often grow to a larger size before detection by Pap test or other means. An adenocarcinoma that involves the upper vagina (Stage IIA) may be too extensive to remove surgically. Although in some cases surgery may still be possible as the initial part of the treatment, chemotherapy is often given first to try to shrink the tumor some, followed by surgery to remove the remaining tumor. More chemotherapy can also be given after surgery.
Cervical cancer treatment is not one-size-fits-all, but rather is tailored to each case. You should be sure to consult with an experienced gynecologic oncologist to get the most appropriate recommendations for your individual situation.