Management of early-stage cervical cancer
- J Michael Straughn, Jr, MD
J Michael Straughn, Jr, MD
- Division of Gynecologic Oncology
- University of Alabama at Birmingham
- Catheryn Yashar, MD
Catheryn Yashar, MD
- Associate Professor of Radiation Medicine and Applied Sciences
- University of California San Diego
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Arno J Mundt, MD
Arno J Mundt, MD
- Section Editor — Radiation Therapy
- Chairman of Radiation Oncology
- University of California, San Diego
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Director, Editorial Relations — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Instructor of Obstetrics, Gynecology and Reproductive Biology, Part-time
- Harvard Medical School
Women with cervical cancer limited to the uterus have early-stage disease. Treatment options for these women include definitive surgery (modified radical hysterectomy), fertility-sparing surgery, or primary radiation therapy (RT; with or without chemotherapy). The choice of therapy depends on tumor- and patient-defined factors.
The approach to women with early-stage cervical cancers is reviewed here. Treatment of more advanced disease and specific issues regarding the management of cervical adenocarcinomas and small cell cancers are reviewed elsewhere.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Dec 08, 2015.References
- Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol 2008; 9:297.
- http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf (Accessed on July 09, 2012).
- Bansal N, Herzog TJ, Shaw RE, et al. Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation. Am J Obstet Gynecol 2009; 201:485.e1.
- Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 1974; 44:265.
- Shimada M, Kigawa J, Nishimura R, et al. Ovarian metastasis in carcinoma of the uterine cervix. Gynecol Oncol 2006; 101:234.
- Suprasert P, Srisomboon J, Charoenkwan K, et al. Twelve years experience with radical hysterectomy and pelvic lymphadenectomy in early stage cervical cancer. J Obstet Gynaecol 2010; 30:294.
- Mota F. Microinvasive squamous carcinoma of the cervix: treatment modalities. Acta Obstet Gynecol Scand 2003; 82:505.
- Ostor AG. Pandora's box or Ariadne's thread? Definition and prognostic significance of microinvasion in the uterine cervix: squamous lesions. In: Pathology Annual, Part II., Melbourne: Department of Pathology, Melbourne 1995. p.103.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Sedlis A, Bundy BN, Rotman MZ, et al. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999; 73:177.
- Rotman M, Sedlis A, Piedmonte MR, et al. A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 2006; 65:169.
- Rogers L, Siu SS, Luesley D, et al. Radiotherapy and chemoradiation after surgery for early cervical cancer. Cochrane Database Syst Rev 2012; :CD007583.
- Okazawa M, Mabuchi S, Isohashi F, et al. Impact of the addition of concurrent chemotherapy to pelvic radiotherapy in surgically treated stage IB1-IIB cervical cancer patients with intermediate-risk or high-risk factors: a 13-year experience. Int J Gynecol Cancer 2013; 23:567.
- Peters WA 3rd, Liu PY, Barrett RJ 2nd, et al. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 2000; 18:1606.
- Monk BJ, Wang J, Im S, et al. Rethinking the use of radiation and chemotherapy after radical hysterectomy: a clinical-pathologic analysis of a Gynecologic Oncology Group/Southwest Oncology Group/Radiation Therapy Oncology Group trial. Gynecol Oncol 2005; 96:721.
- Feng SY, Zhang YN, Liu JG. [Risk factors and prognosis of node-positive cervical carcinoma]. Ai Zheng 2005; 24:1261.
- Folkert MR, Shih KK, Abu-Rustum NR, et al. Postoperative pelvic intensity-modulated radiotherapy and concurrent chemotherapy in intermediate- and high-risk cervical cancer. Gynecol Oncol 2013; 128:288.
- Klopp A, Moughan J, Portelance L, et al. Hematologic toxicity on RTOG 0418: a phase II study of post-operative IMRT for gynecologic cancer. Int J Radiat Oncol Biol Phys 2010; 78:S121.
- Quinn MA, Benedet JL, Odicino F, et al. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006; 95 Suppl 1:S43.
- Delgado G, Bundy B, Zaino R, et al. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990; 38:352.
- Averette HE, Nguyen HN, Donato DM, et al. Radical hysterectomy for invasive cervical cancer. A 25-year prospective experience with the Miami technique. Cancer 1993; 71:1422.
- Lee YN, Wang KL, Lin MH, et al. Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases. Gynecol Oncol 1989; 32:135.
- Lovecchio JL, Averette HE, Donato D, Bell J. 5-year survival of patients with periaortic nodal metastases in clinical stage IB and IIA cervical carcinoma. Gynecol Oncol 1989; 34:43.
- Tinga DJ, Timmer PR, Bouma J, Aalders JG. Prognostic significance of single versus multiple lymph node metastases in cervical carcinoma stage IB. Gynecol Oncol 1990; 39:175.
- Grigsby PW, Lu JD, Mutch DG, et al. Twice-daily fractionation of external irradiation with brachytherapy and chemotherapy in carcinoma of the cervix with positive para-aortic lymph nodes: Phase II study of the Radiation Therapy Oncology Group 92-10. Int J Radiat Oncol Biol Phys 1998; 41:817.
- Grigsby PW, Vest ML, Perez CA. Recurrent carcinoma of the cervix exclusively in the paraaortic nodes following radiation therapy. Int J Radiat Oncol Biol Phys 1994; 28:451.
- Tanaka Y, Sawada S, Murata T. Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix. Acta Radiol Oncol 1984; 23:455.
- Marchiolé P, Buénerd A, Benchaib M, et al. Clinical significance of lympho vascular space involvement and lymph node micrometastases in early-stage cervical cancer: a retrospective case-control surgico-pathological study. Gynecol Oncol 2005; 97:727.
- Silva LB, Silva-Filho AL, Traiman P, et al. Sentinel node detection in cervical cancer with (99m)Tc-phytate. Gynecol Oncol 2005; 97:588.
- Lentz SE, Muderspach LI, Felix JC, et al. Identification of micrometastases in histologically negative lymph nodes of early-stage cervical cancer patients. Obstet Gynecol 2004; 103:1204.
- Juretzka MM, Jensen KC, Longacre TA, et al. Detection of pelvic lymph node micrometastasis in stage IA2-IB2 cervical cancer by immunohistochemical analysis. Gynecol Oncol 2004; 93:107.
- Creasman WT, Kohler MF. Is lymph vascular space involvement an independent prognostic factor in early cervical cancer? Gynecol Oncol 2004; 92:525.
- Vistad I, Fosså SD, Dahl AA. A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer. Gynecol Oncol 2006; 102:563.
- Greimel ER, Winter R, Kapp KS, Haas J. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology 2009; 18:476.
- Kirwan JM, Symonds P, Green JA, et al. A systematic review of acute and late toxicity of concomitant chemoradiation for cervical cancer. Radiother Oncol 2003; 68:217.
- Eighamrawi KA, Haggag MH, Habib EE. Treatment complications among long-term survivors of cervical cancer: treated by surgery or radiotherapy. Oncol Rev 2011; 5:261.
- Ferenczy A, Gelfand MM, Franco E, Mansour N. Human papillomavirus infection in postmenopausal women with and without hormone therapy. Obstet Gynecol 1997; 90:7.
- Ploch E. Hormonal replacement therapy in patients after cervical cancer treatment. Gynecol Oncol 1987; 26:169.
- Singh P, Oehler MK. Hormone replacement after gynaecological cancer. Maturitas 2010; 65:190.
- Bergmark K, Avall-Lundqvist E, Dickman PW, et al. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999; 340:1383.
- Wenzel L, DeAlba I, Habbal R, et al. Quality of life in long-term cervical cancer survivors. Gynecol Oncol 2005; 97:310.
- Jensen PT, Groenvold M, Klee MC, et al. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2003; 56:937.
- Klee M, Thranov I, Machin D. Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer. Gynecol Oncol 2000; 76:5.
- Perez CA, Grigsby PW, Camel HM, et al. Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys 1995; 31:703.
- Hsu WC, Chung NN, Chen YC, et al. Comparison of surgery or radiotherapy on complications and quality of life in patients with the stage IB and IIA uterine cervical cancer. Gynecol Oncol 2009; 115:41.
- Lammerink EA, de Bock GH, Pras E, et al. Sexual functioning of cervical cancer survivors: a review with a female perspective. Maturitas 2012; 72:296.
- DEFINITION OF EARLY-STAGE CERVICAL CANCER
- APPROACH TO TREATMENT
- Primary therapy
- - Surgery versus primary RT
- - Surgical treatment
- Radical hysterectomy
- Extrafascial hysterectomy or conization
- Fertility-sparing surgery
- - Primary radiation therapy
- Adjuvant therapy indications
- - Intermediate-risk disease
- Treatment of intermediate-risk disease
- - High-risk disease
- Treatment of high-risk disease
- RT technique
- POSTTREATMENT SURVEILLANCE
- QUALITY-OF-LIFE ISSUES IN CERVICAL CANCER SURVIVORS
- Ovarian failure
- Fertility preservation
- Hormone replacement therapy
- Sexual dysfunction
- SPECIAL CIRCUMSTANCES
- Incidentally diagnosed cancer
- Adenocarcinoma and small cell cancers
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS