Staging laparotomy and radical hysterectomy for XXXX .

@entity1 @entity5
Clinical staging does not define the true extent of disease in approximately one-third of the @entity1 with early cervical @entity5 . Unless clear nodular @entity5 extension into the parametria is palpable a @entity1 should be considered for surgical therapy. This involves a thorough staging laparotomy, including the exploration of the pelvic retroperitoneal spaces and para-aortic node dissection. If the disease appears to be confined to the cervix a radical hysterectomy and pelvic lymphadenectomy is performed. If gross @entity5 invasion into the parametria, the bladder, or rectum muscularis is documented, the @entity1 is treated with pelvic radiation. If microscopic distant metastases to the para-aortic nodes are found, extended field radiation and possible chemotherapy is the treatment of choice. Survival is determined mostly by the extent of disease at the time of treatment. Therapy has to encompass the whole region affected by disease in order to provide the @entity1 with a chance of cure. For disease beyond the cervix, regional radiation makes more sense. Just as in the study published by Zander's group (Zander et al, 1980), we add radiation if microscopic disease beyond the cervix is found after a radical hysterectomy. However, additional radiation adds morbidity, length of therapy, and cost. Unless there is clear proof that adequate primary radiation is inferior to surgery and postoperative radiation we recommend radiation for @entity5 with proven Stages IIb and above. The benefit of systemic chemotherapy as an alternative to postoperative radiation needs to be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)
