Why is my cervical cancer not suitable for surgery?

Surgery is a key treatment modality for various cancer types, including cervical cancer. However, sometimes patients expect surgery, whereas surgery is not in their best interest for various reasons.

The decision on whether surgery is a suitable option for treating cervical cancer depends on various factors, including the stage of the cancer, the extent of its spread, and the overall health of the patient.

Surgery is likely to be successful if the tumour can be removed completely without the surgical margins being involved and without spillage of tumour.

In some cases, surgery is not a great treatment option for patients with cervical cancer due to the following reasons:

Large Tumour Size: If the tumour is too large or invasive, it may not be possible to remove it completely with surgery without causing significant damage to surrounding organs. For example, if a cervical cancer is larger than 3 cm (as measured from left to right; or from the front to the back) on an MRI scan, the chances that surgical tumour margins will be involved is high and the chances of lymph nodes being involved is also high. In such cases, other treatments may be considered.

Surgeons operating on patient

Advanced Stage of Cancer: If cervical cancer is diagnosed at an advanced stage where it has spread beyond the cervix to other pelvic organs or distant sites, and the cancer has invaded the tissue next to it (the parametria) or nearby organs such as the bladder or rectum, surgical removal will be detrimental to the patient.

Positive lymph nodes: If the preoperative PET CT scan suggests involvement of pelvic or aortic lymph nodes, surgical treatment of cervical cancer is suboptimal because the patient will require chemoradiation treatment post-surgery, which ideally should be avoided.

In such cases, a combination of treatments, such as radiation therapy, chemotherapy, or a combination of both, may be recommended.

Medical Contraindications: Some individuals may have pre-existing health conditions that make surgery a high-risk option. In such cases, the potential risks of surgery may outweigh the benefits, and alternative treatments may be recommended.

Patient Preference: In some cases, a patient may choose not to undergo surgery for personal or medical reasons. Treatment decisions should be made in consultation with the healthcare team, taking into consideration the individual's preferences and values.

Treatment decisions for cervical cancer are individual to the patient’s circumstances, and what is suitable for one person may not be the best option for another. The healthcare team, which may include gynaecologic oncologists, radiation oncologists, medical oncologists, and other specialists, will carefully evaluate the specific characteristics of the cancer and the overall health of the patient, weigh the pros and cons of treatments and recommend a treatment plan.

They can provide detailed information about the specific reasons for the recommended treatment plan and discuss other options, potential side effects, and expected outcomes. Seeking a second opinion from another qualified healthcare professional can also be a valuable step in ensuring that all available treatment options have been considered.

If you wish to receive regular information, resources, reassurance and inspiration for up-to-date care that is safe and sound and in line with the latest research, please subscribe to my blog via the form above, or like Dr Andreas Obermair on Facebook.

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