Small FIGO stage IB cervical cancer

The International Federation of Gynecology and Obstetrics (FIGO) currently defines stage IA cervical cancer as lesions invading up to 5 mm into the stroma and with no more than 7 mm width; vascular invasion does not affect the stage assignment. The Society of Gynecologic Oncology (SGO) definition of stage IA is more restrictive with regard to depth of invasion but ignores width. We reviewed 69 patients with lesions exceeding the FIGO definition of stage IA treated between 1958 and 1991; 46 patients also exceeded the SGO criteria for stage IA. The frequency of vascular invasion showed no correlation with the depth of invasion but was correlated with the width of the lesion. Treatment consisted of conization or simple hysterectomy only (n = 27), radical abdominal hysterectomy with lymphadenectomy (n = 25), radical vaginal hysterectomy (n = 13), and conization followed by radiotherapy (n = 4). No patient developed a recurrence during a follow-up of 2-35 years. Two of the 25 patients with lymphadenectomy had one positive lymph node each. The first patient had a primary lesion with 3 mm invasion and 17 mm width, no vascular invasion, and one node metastasis 2 mm in diameter; the second had a lesion with 4 mm invasion and 10 mm width, vascular invasion, and a tumor-cell embolus in the marginal sinus of a node. These results indicate that the problems involved in treating microinvasive carcinoma of the cervix also apply to cases of small stage IB disease. It will not be possible to devise a staging system that simultaneously serves as a guideline for treatment. The current FIGO classification of stage IA2 should be expanded rather than restricted.