Surgery as diagnostic and therapeutic moment in the management of cervical cancer.

Therapeutical program in cervical cancer usually include surgical or radiotherapeutical interventions or a combination of the two, variously integrated with techniques and sequences of application. Treatment planning and evaluation of results are normally based on the classification into clinical stages codified by the FIGO. But this classification, though providing useful prognostic standards of judgement, has proved to be inadequate to identify specific therapeutical guidance. Within a single clinical stage different risk factors have been identified which influence prognosis thus determining the therapeutical treatment more than staging itself. Furthermore clinical staging has failed to predict the surgical stage correctly in a significant number of cases. The index of correction after surgical staging shows discrepancy in about 1/3 of cases. In these cases a therapeutical program based on clinical examination exclusively may prove to be inadequate. The results reported by Authors warrant a rational resort to operative staging in cervical cancer in order to establish the real topography of the original focus more correctly. This indication is further strengthened by the need to identify lymphatic involvement, notably of para-aortic nodes, in locally advanced cases since such an occurrence bears a significant influence on the patient's prognosis and possibility of treatment. On the bases of these considerations the Authors suggest surgery as primary treatment in the management of cervical cancer.