Management of stage IA cervical carcinoma

Approximately 10%-15% of women with stage I cervical cancer have microinvasive lesions (stage IA). In studying these patients, we aim to identify the cancers that have little or no chance of harboring metastatic disease from the primary site. These patients may be treated by more conservative means, thereby lowering morbidity and cost and preserving the women's fertility. The diagnosis of stage I cervical cancer is surrounded by controversies concerning the diagnostic criteria, the low level of agreement among pathologists interpreting the same material, and the limited evidence in the literature for definitions of risk factors. The available information suggests that women with squamous cell lesions that invade at a 3-mm depth or less and who have no evidence of lymph-vascular invasion may be successfully treated with cervical conization. Women with a depth of invasion of more than 3 mm or with lymph-vascular invasion should be treated with methods that address the potential for disease in the lymph nodes and paravaginal tissues.