Treatment Options in Stage IB Cervical Cancer: Radical Hysterectomy and Radiotherapy

The long-term survival of women with stage I cervical cancers is excellent. Microinvasive tumors can be acceptably treated with low morbidity by simple extrafascial hysterectomy. Tumors beyond the microscopic stage require more aggressive therapy with either radical hysterectomy or radiotherapy. Within stage I, tumor volume is the major predictor of complete response and cure. Most often, this is estimated by the clinical measurement of cervical diameter. Lymph node spread is also correlated with risk of treatment failure and death from disease. Patients with tumor diameters of 4 cm or less can usually be offered either therapy option. Although different complications are associated with each modality, the overall incidence of severe problems is small for both. We favor radical hysterectomy for premenopausal women who wish to retain natural hormonal function and who have no major contraindications to surgery. Postmenopausal patients, those with larger tumors, and, perhaps, those with high-grade tumors may be better treated by irradiation. Women with very large tumors and those with lymph node metastases represent significant treatment challenges and should be considered for experimental protocols.