Treatment of recurrence after extensive excision of cervical cancer

My mother was diagnosed with mid-to-late stage cervical cancer three years ago and underwent extensive excision surgery at the time. However, this year she went to the hospital for a check-up due to vaginal bleeding and found that the cancer had recurred. The location of the recurrence was in the middle and lower part of the vagina, close to the vulva, and was already as big as an egg yolk. How should this situation be treated?

For patients with recurrence after extensive resection of cervical cancer, the current treatment is still mainly radiotherapy. For larger recurrences, chemotherapy and radiotherapy can be combined. The overall treatment principle is still based on extensive resection of the recurrence location. Commonly used treatment options are as follows:

1. Postoperative recurrence of the vaginal stump: Postoperative recurrence of the vaginal stump is generally treated with a combination of external irradiation and intracavitary radiotherapy. The external whole-pelvic irradiation tumor dose (DT) can be 40-45Gy/5-6 weeks, and the total dose of intravaginal afterloading therapy is 20Gy/3-4 weeks.

2. Recurrence in the middle and lower 1/3 of the vagina: Recurrence in the middle and lower 1/3 of the vagina is also treated with a combination of external irradiation and intracavitary radiotherapy, but intracavitary radiotherapy is the main method, supplemented by external irradiation. The treatment dose should be appropriately controlled based on the volume of the recurrent tumor, tumor regression, and the tolerance of surrounding normal tissues.

3. Postoperative pelvic recurrence: Postoperative pelvic recurrence is mainly treated with external radiotherapy, or chemotherapy combined with radiotherapy. External radiotherapy usually uses whole pelvis irradiation, with a tumor dose (DT) of 40-45Gy/5-6 weeks. Depending on the tumor shrinkage and radiotherapy side effects, the local dose can be increased by 5-10Gy after field reduction.

Summary: The patient's tumor is close to the vulva and should undergo a comprehensive examination. If resection is possible, surgical resection should be performed first, followed by intracavitary radiotherapy.