Improving quality of cervical cancer care with (inter)national cancer registry data

Cervical cancer is relatively rare in the Netherlands, with ‘just’ eight hundred diagnoses per year. However, it is the fourth most common cancer-related cause of death worldwide. In this thesis, we showed that survival rates of women with cervical cancer have increased in the Netherlands, over the past decades. Unfortunately, this does not go for older women. If cervical cancer is detected at an early stage, treatment usually consists of a radical hysterectomy. This thesis shows that, for the prognosis, it does not matter whether that surgical procedure is performed by a large incision into the abdominal cavity, or by keyhole surgery. In one-third of the surgical procedures, a complication occurs within 30 days, although percentages differ among medical centres.Whether a patient with cervical cancer will survive, depends for an important part on whether the disease has spread to the lymph nodes. So-called lymph node metastases negatively impact prognosis. Therefore, it is customary to remove the pelvic lymph nodes during radical hysterectomy. Research in this thesis shows that a particular group of women seems to have such a low risk of lymph node metastasis, that they could probably do with less extensive lymph node surgery. If there is a strong suspicion of lymph node metastasis before surgery, the patient is often not treated surgically, but by radiotherapy. In case, unexpectedly, lymph node metastases are found during surgery, it does not seem to matter, for the prognosis of the patient, whether the radical hysterectomy is completed or not