{"entity":{"id":"early-cervical-cancer","kind":"cancer","name":"Early cervical cancer and fertility-sparing surgery","aka":["Stage IA to IB2 cervical cancer","Early-stage cervical cancer","Fertility-sparing cervical cancer surgery","Radical trachelectomy candidates"],"tldr":"Early cervical cancer is confined to the cervix and is usually cured by surgery. Recent trials have shown that open surgery is safer than keyhole surgery for radical hysterectomy, that a simple hysterectomy is enough for the smallest tumours, and that young women with small tumours can keep their uterus with a trachelectomy.","summary":"FIGO 2018 defines stage IA as microscopic invasion up to five millimetres and stage IB as a visible or deeper tumour confined to the cervix, split into IB1 (up to two centimetres), IB2 (two to four centimetres) and IB3 (over four centimetres, treated as locally advanced). Squamous carcinoma and HPV-associated adenocarcinoma behave similarly at this stage, while HPV-independent gastric-type adenocarcinoma is more aggressive. Diagnosis comes from colposcopic biopsy or an excisional cone after abnormal screening, and MRI and PET-CT stage the tumour and nodes. Stage IA1 without lymphovascular invasion is treated by cone biopsy or simple hysterectomy alone; IA2 to IB2 has traditionally required radical hysterectomy with pelvic lymphadenectomy, followed by chemoradiation when nodes, margins or parametria are involved.\n\nTwo trials have reshaped the surgery. LACC randomised women with stage IA1 with lymphovascular invasion to IB1 disease between minimally invasive and open radical hysterectomy and stopped early when disease-free survival at four and a half years was 86.0 percent with keyhole surgery against 96.5 percent with open surgery, and deaths were more frequent; open surgery became the standard again and guidelines reversed a decade of practice. SHAPE then asked the opposite question for the lowest-risk tumours: in stage IA2 to IB1 disease up to two centimetres with limited stromal invasion, simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence and caused far fewer urinary and sexual complications, so simple hysterectomy is now an accepted option for these women. Sentinel node biopsy, validated for detection in SENTICOL I and II, is being tested against full lymphadenectomy in SENTICOL III.\n\nFertility-sparing surgery follows the same logic. Cone biopsy or simple trachelectomy suffices for IA1 and selected IA2 tumours, and radical vaginal or abdominal trachelectomy with node assessment preserves the uterus in IB1 tumours up to two centimetres, with recurrence rates comparable to hysterectomy and live births in a majority of women who try to conceive, though preterm delivery is common. Neoadjuvant chemotherapy to shrink tumours of two to four centimetres before trachelectomy is investigational. HPV vaccination and HPV-based screening are shrinking this whole group of patients, which is the ultimate aim.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Cervical_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Cervical_cancer"}],"tags":["subtype-page"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"gynaecologic","burden":"In screened populations about half of cervical cancers are found at stage I, often in women in their thirties and forties who have not completed their families; cure rates exceed ninety percent, so the questions are how little surgery is safe and how to preserve fertility.","subtypes":["Stage IA1 (cone biopsy or simple hysterectomy)","Stage IA2 to IB1 up to 2 cm, low risk (simple hysterectomy after SHAPE, or radical trachelectomy for fertility)","Stage IB1 to IB2 (open radical hysterectomy after LACC)","Squamous cell carcinoma of the cervix","HPV-associated adenocarcinoma","HPV-independent gastric-type adenocarcinoma (higher risk)","FIGO 2018 stage IB with intermediate risk factors (Sedlis criteria, adjuvant radiotherapy)"],"biomarkers":["FIGO 2018 stage from clinical examination, MRI and PET-CT","Tumour size and depth of stromal invasion","Lymphovascular space invasion","Sentinel or pelvic node status","HPV type and p16 (HPV-associated versus independent)","Margin and parametrial status after surgery"],"standardOfCare":[{"setting":"Stage IA1 without lymphovascular invasion","approach":"Cone biopsy with clear margins or simple hysterectomy; no node assessment needed.","refs":["colposcopy-excision","hysterectomy"]},{"setting":"Stage IA2 to IB1 up to 2 cm, low risk","approach":"Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it.","refs":["hysterectomy","sentinel-node","senticol-iii","mri"]},{"setting":"Stage IB1 to IB2, standard","approach":"Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC.","refs":["lacc","caution-mis-radical-hysterectomy","robotic-surgery","minimally-invasive-surgery"]},{"setting":"Fertility preservation","approach":"Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm.","refs":["colposcopy-excision","sentinel-node","mri"]},{"setting":"Adjuvant after surgery","approach":"Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria.","refs":["imrt-igrt","cisplatin","brachytherapy","chemoradiation"]},{"setting":"Prevention and detection","approach":"HPV vaccination and HPV-based screening with colposcopy for positives.","refs":["hpv-vaccine","hpv-testing","colposcopy-excision","hpv-status"]}],"stateOfArt":["LACC reversed the move to keyhole radical hysterectomy, a rare example of a surgical trial changing practice against the trend.","SHAPE showed that less surgery is safe for the smallest tumours.","Radical trachelectomy lets young women keep their fertility with equivalent cure."],"history":[{"year":1898,"title":"Wertheim performs the first radical abdominal hysterectomy for cervical cancer","refs":[]},{"year":1994,"title":"Dargent describes radical vaginal trachelectomy for fertility preservation","refs":[]},{"year":1999,"title":"Sedlis criteria define intermediate-risk features that warrant adjuvant radiotherapy","refs":[]},{"year":2018,"title":"LACC: minimally invasive radical hysterectomy inferior to open surgery","refs":["lacc"]},{"year":2018,"title":"FIGO 2018 staging splits IB by tumour size and adds imaging and nodal status","refs":[]},{"year":2024,"title":"SHAPE: simple hysterectomy non-inferior to radical hysterectomy in low-risk early disease","refs":[]}],"pipeline":["senticol-iii","hpv-testing","hpv-vaccine","idea-hpv-ctdna-cervical","mrd-testing"],"openProblems":["Whether sentinel node biopsy alone can replace lymphadenectomy (SENTICOL III).","Safe fertility-sparing options for tumours of two to four centimetres.","Why minimally invasive surgery did harm, and whether protective techniques can restore it."],"parent":"cervical"},"route":"/cancers/early-cervical-cancer/","neighbours":{"trial":[{"id":"lacc","kind":"trial","name":"LACC (Laparoscopic Approach to Cervical Cancer)","route":"/trials/lacc/"},{"id":"senticol-iii","kind":"trial","name":"SENTICOL III","route":"/trials/senticol-iii/"}],"technology":[{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/"},{"id":"colposcopy-excision","kind":"technology","name":"Colposcopy and excisional treatment (LEEP/LLETZ, cone)","route":"/technologies/colposcopy-excision/"},{"id":"hpv-vaccine","kind":"technology","name":"HPV & HBV vaccination","route":"/technologies/hpv-vaccine/"},{"id":"hpv-testing","kind":"technology","name":"HPV DNA testing and self-sampling","route":"/technologies/hpv-testing/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"robotic-surgery","kind":"technology","name":"Robotic & minimally invasive surgery","route":"/technologies/robotic-surgery/"},{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"}],"idea":[{"id":"idea-hpv-ctdna-cervical","kind":"idea","name":"HPV circulating tumour DNA to guide cervical cancer therapy","route":"/ideas/idea-hpv-ctdna-cervical/"}],"term":[{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"hpv-status","kind":"term","name":"HPV status (HPV-positive / HPV-negative)","route":"/terms/hpv-status/"},{"id":"hysterectomy","kind":"term","name":"Hysterectomy","route":"/terms/hysterectomy/"},{"id":"minimally-invasive-surgery","kind":"term","name":"Minimally invasive surgery (laparoscopic, robotic, VATS)","route":"/terms/minimally-invasive-surgery/"}],"pairing":[{"id":"caution-mis-radical-hysterectomy","kind":"pairing","name":"Caution: minimally invasive radical hysterectomy for early cervical cancer","route":"/pairings/caution-mis-radical-hysterectomy/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"}]}}