Cervical cancer is the fourth most common cancer in women worldwide, and it has the fourth highest mortality rate among cancers in women. Most cases of cervical cancer are preventable by routine screening and by treatment of precancerous lesions. As a result, most of the cervical cancer cases are diagnosed in women who live in regions with inadequate screening protocols.
Incidence and Mortality
Estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in...
If the depth of invasion is less than 3 mm, no vascular or lymphatic channel invasion is noted, and the margins of the cone are negative, conization alone may be appropriate in patients who wish to preserve fertility.
If the depth of invasion is less than 3 mm, which is proven by cone biopsy with clear margins, no vascular or lymphatic channel invasion is noted, and the frequency of lymph-node involvement is sufficiently low, lymph-node dissection at the time of hysterectomy is not required. Oophorectomy is optional and should be deferred for younger women.
Standard Treatment Options for Stage IA2 Cervical Cancer
Standard treatment options for stage IA2 cervical cancer include the following:
Modified radical hysterectomy with lymphadenectomy.
Modified radical hysterectomy with lymphadenectomy
For patients with tumor invasion between 3 mm and 5 mm, modified radical hysterectomy with pelvic-node dissection has been recommended because of a reported risk of lymph-node metastasis of as much as 10%. Radical hysterectomy with node dissection may also be considered for patients for whom the depth of tumor invasion was uncertain because of invasive tumor at the cone margins.
Other Treatment Options
Intracavitary radiation therapy.
Patients with stages IA2 to IB disease who desire future fertility may be candidates for radical trachelectomy. In this procedure, the cervix and lateral parametrial tissues are removed, and the uterine body and ovaries are maintained. Most centers utilize the following criteria for patient selection:
Desire for future pregnancy.
Age younger than 40 years.
Presumed stage IA2 to IB1 disease and a lesion size no greater than 2 cm.
Preoperative magnetic resonance imaging that shows a margin from the most distal edge of the tumor to the lower uterine segment.
Squamous, adenosquamous, or adenocarcinoma cell types.
Intraoperatively, the patient is assessed in a manner similar to a radical hysterectomy; the procedure is aborted if more advanced disease than expected is encountered. The margins of the specimen are also assessed at the time of surgery, and a radical hysterectomy is performed if inadequate margins are obtained.[3,4,5,6,7]