Can surgery be performed in the middle and late stages of cervical cancer?

It is usually not recommended for patients with mid-to-late stage cervical cancer to undergo surgery directly. A comprehensive evaluation is required based on the extent of tumor spread and the patient’s physical condition. The main treatments for intermediate and advanced cervical cancer include radiotherapy, chemotherapy, targeted therapy, immunotherapy and palliative surgery.

1. Radiotherapy

Radiotherapy is the core treatment method for intermediate and advanced cervical cancer, including external radiotherapy and intracavitary brachytherapy. External radiotherapy uses high-energy rays to kill tumor cells, while intracavitary radiotherapy places the radioactive source directly on the cervix to increase the local dose. Radiotherapy can be used alone or combined with chemotherapy to control both the primary tumor focus and regional lymph node metastasis. Adverse reactions such as radiation enteritis and cystitis may occur during treatment, and nutritional support and symptom management are required.

2. Chemotherapy

Platinum-based combination chemotherapy regimens are commonly used for intermediate and advanced cervical cancer, such as cisplatin injection combined with paclitaxel injection. Chemotherapy drugs act throughout the body through blood circulation and can control distant micro-metastasis. They are often performed simultaneously with radiotherapy to enhance the efficacy. Chemotherapy may cause side effects such as bone marrow suppression and gastrointestinal reactions, and blood routine and liver and kidney functions need to be monitored regularly. For patients with recurrent or metastatic disease, second-line drugs such as gemcitabine may be an option.

3. Targeted therapy

Anti-angiogenic drugs such as bevacizumab can delay disease progression by inhibiting tumor blood vessel formation and are suitable for recurrent or metastatic cervical cancer. PD-1 inhibitors such as pembrolizumab have immunomodulatory effects on PD-L1-positive patients. Targeted therapy requires genetic testing or biomarker screening. Common adverse reactions include hypertension, proteinuria, etc., and must be used under the guidance of a professional doctor.

4. Immunotherapy

Programmed death receptor 1 inhibitors such as nivolumab can fight tumors by activating T cell immune function and are suitable for patients with high PD-L1 expression or high microsatellite instability. Immunotherapy may cause immune-related pneumonia, colitis and other adverse reactions, which require close monitoring and timely treatment. This therapy is often used as a second-line or combination treatment option, and the indications need to be strictly evaluated.

5. Palliative surgery

For some patients with local progression but no distant metastasis, radical hysterectomy may be considered after tumor shrinkage with neoadjuvant chemotherapy. If complications such as ureteral obstruction and vaginal bleeding occur, palliative surgeries such as urinary diversion or embolization to stop bleeding may be performed. Surgical decision-making requires evaluation by a multidisciplinary team, and postoperative comprehensive treatments such as radiotherapy and chemotherapy are still required.

Patients with intermediate and advanced cervical cancer should maintain a balanced diet, properly supplement high-quality protein and vitamins, and avoid spicy and irritating foods. Low-intensity exercise such as walking, yoga, etc. can be performed during treatment, but excessive fatigue must be avoided. Regularly review tumor markers and imaging examinations, and pay close attention to changes in symptoms such as vaginal bleeding and pain. Psychological counseling and family support are particularly important to improve the quality of life. You can seek professional psychological consultation or join a patient support group.