Long-term experience in the surgical management of cancer of the uterine cervix.

Cancer of the uterine cervix is the seventh most common malignancy among women and the fifth most common cause of cancer mortality worldwide. In the United States, the use of the Papanicolaou (Pap) smear for screening has meant a significant decline in the incidence and mortality from cervical cancer over the past five decades. However, there are still approximately 12,800 new cases diagnosed per year in the U.S. and 4,800 deaths are estimated in 1999. Both surgery and radiation therapy have long-established roles in management. Surgery has the advantages of shorter treatment time, removal of the primary tumor, more limited tissue injury, and the potential to preserve ovarian function; radiation therapy has the capacity to treat tumor that involves the bladder and/or rectum while preserving their function. Therefore, the role of surgery is more suited to the management of early-stage disease and centrally located recurrences that occur after radiation therapy. Studies from our institution have played an integral role in the development of the modern surgical approach to cervical cancer. Reviews on early-stage disease helped define the role of conization and simple hysterectomy for microinvasive cervical cancer and identified patients who were at high risk for recurrence after radical hysterectomy. The classic work of Brunschwig has given gynecologic surgeons the ability to offer hope and life to select patients who previously could have expected only pain and death. Future investigation into the techniques of intra-operative radiation therapy may increase the pool of patients for whom surgically based salvage therapy may be offered.