Squamous cell carcinoma and adenocarcinoma are generally treated in similar ways. Radical surgery and radiation therapy are equally effective treatments for early stage disease (Stage Ia, Ib and small IIa).
For carcinomas more advanced than Stage IIa, treatment is with radiation therapy alone or radiotherapy and chemotherapy . Higher stages are generally treated with higher doses of radiation therapy as well.
Surgery For younger women surgery is usually recommended because it preserves ovarian function
and it avoids the atrophy of the upper vagina and the vaginal scarring that can result from radiation. There is also a small chance that women who survive many years after radiation therapy will develop a second malignancy in the radiated area.
Radical exenterative surgery—removal of the rectum and/or bladder and the cervix , uterus and vagina—is reserved for recurrent carcinoma confined to the central pelvis.
Surgery may also be used to stage the disease, since other methods, even using CT and MRI scans, are notoriously inaccurate in detecting lymph node metastasis and intra-abdominal spread in the more advanced stages. Unfortunately, there is no reliable way to diagnose microscopic metastases to the pelvic and para-aortic nodes without removing them. Therefore, many gynecologic oncologists will occasionally recommend a surgical staging procedure before any radiation therapy is given to evaluate the intra-abdominal surfaces and the status of the pelvic and aortic lymph nodes.
