Colposcopy and management of microinvasive squamous cell carcinoma

In the last decades both the relative proportion and absolute incidence of micro invasive cervical cancer (MIC) have ten times increased in developed Countries mainly in young women aged less than 40 years. Despite the controversial views expressed about the selection criteria, there has been an increasing recent trend to treat MIC patients with a conservative, less radical, fertility-sparing approach. Several histologic tumor-related features have to be considered in planning conservative treatment: depth of infiltration (DI), lymph-vascular involvement (LVSI) width of the lesion and the number of quadrants involved at colposcopy are the most important factors in predicting disease persistence or recurrence in multivariate survival analysis. Furthermore MIC can be considered safely treated only when surgical limits of the cone are completely in sano, since there is a high chance that residual disease remains behind. Moreover a close long-term surveillance should be scheduled for the MIC patients conservatively treated and, in the absence of specific guidelines, 10 years should be the current accepted follow up for stage IA disease.