Management of Early Stage Cervical Cancer

Early cervical cancer includes a broad range of disease, from clinically undetectable micro invasive cancer to large, bulky tumours. The International Federation of Gynaecology and Obstetrics (FIGO) staging system stratifies stage I tumours into two categories, stage IA (microinvasive) and stage IB (gross tumour). There are several options for the treatment of early stage cervical cancer. Decisions about treatment depend on age, performance status and the stage of the cancer. Patients with stromal invasion of less than 3 mm (stage IA1) with no lymphovascular involvement are treated conservatively with simple hysterectomy and in selected patients who desire fertility, cone biopsy with negative surgical margins is an option. Patients with invasion of more than 3 mm or lymphovascular space involvement are at risk for pelvic lymph node metastasis and are treated with radical hysterectomy and pelvic lymphadenectomy. Stage IB1 cervical cancer is managed by either radical hysterectomy or radiotherapy with similar recurrence and survival rates. In patients with tumour less than 4 cm in diameter, the decision between radical surgery and radiotherapy depends on patient's overall health and treatment choices. For younger women, radical surgery is preferred because ovarian function can be preserved and vaginal stenosis secondary to radiation can be avoided. Radiation therapy is preferred for women who may not tolerate radical surgery. Primary radiation therapy with or without concurrent chemotherapy is preferred for patients with tumour larger than 4 cm in diameter. Recent studies demonstrate that the addition of cisplatin-based chemotherapy given concurrently with radiation significantly improves overall survival rates.