Clinical and operative staging of cervical cancer.

Clinical staging is inaccurate in about 50% of patients with cervical cancer. Most patients will be upstaged on the basis of surgical exploration, usually because of occult nodal metastases. Data from surgical staging indicate that the incidence of positive para-aortic nodes is about 7% for patients with Stage I disease, about 17% for Stage II, and 28% for Stage III. Extended field radiation, to the level of T12, can salvage about 25% of patients with positive para-aortic nodes. About 40% of patients having extended field radiation develop distant metastases, and about 25% develop a pelvic recurrence. These data suggest the need for prospective clinical trials to evaluate the role of chemoradiation for improved local control, prophylactic extended field radiation for improved regional control, and prophylactic chemotherapy for improved systemic control.