The first 60 days: Early cervical cancer and fertility-sparing surgery
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. Below, week by week, is what OnCo's record of Early cervical cancer and fertility-sparing surgery says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Stage IA1 without lymphovascular invasion, Stage IA2 to IB1 up to 2 cm, low risk, Prevention and detection.
- RadiologistNamed in the standard of care for: Stage IA2 to IB1 up to 2 cm, low risk, Fertility preservation.
- SurgeonNamed in the standard of care for: Stage IA1 without lymphovascular invasion, Stage IA2 to IB1 up to 2 cm, low risk, Stage IB1 to IB2, standard, Fertility preservation and 1 more.
- Medical oncologistNamed in the standard of care for: Adjuvant after surgery.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Adjuvant after surgery.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
HPV vaccination and HPV-based screening with colposcopy for positives.
Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it.
Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria.
Cone biopsy with clear margins or simple hysterectomy; no node assessment needed.
Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC.
Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example 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), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Stage IA1, Stage IA2 to IB1 up to 2 cm, low risk, Stage IB1 to IB2.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Stage IA1 without lymphovascular invasion
- For my situation (stage ia1 without lymphovascular invasion), which of the standard options do you recommend and why?Guideline options include: Cone biopsy with clear margins or simple hysterectomy; no node assessment needed.
Stage IA2 to IB1 up to 2 cm, low risk
- For my situation (stage ia2 to ib1 up to 2 cm, low risk), which of the standard options do you recommend and why?Guideline options include: Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it.
- How do the results of SENTICOL III apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Stage IB1 to IB2, standard
- For my situation (stage ib1 to ib2, standard), which of the standard options do you recommend and why?Guideline options include: Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC.
- How do the results of LACC (Laparoscopic Approach to Cervical Cancer) apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Fertility preservation
- For my situation (fertility preservation), which of the standard options do you recommend and why?Guideline options include: Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm.
Adjuvant after surgery
- For my situation (adjuvant after surgery), which of the standard options do you recommend and why?Guideline options include: Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Prevention and detection
- For my situation (prevention and detection), which of the standard options do you recommend and why?Guideline options include: HPV vaccination and HPV-based screening with colposcopy for positives.
Any stage
- Are there clinical trials I could join, for example of SENTICOL III, HPV DNA testing and self-sampling, HPV & HBV vaccination, HPV circulating tumour DNA to guide cervical cancer therapy?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether sentinel node biopsy alone can replace lymphadenectomy (SENTICOL III)”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Safe fertility-sparing options for tumours of two to four centimetres”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Early cervical cancer and fertility-sparing surgery: the full pageEarly 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Minimally invasive surgery (laparoscopic, robotic, VATS): Any operation done through small incisions with cameras and long instruments, including robot-assisted surgery; the cancer operation is the same, the wound is smaller.
- HPV status (HPV-positive / HPV-negative): Whether a cancer is caused by human papillomavirus.
- Hysterectomy: Removing the uterus (womb), often with the cervix, tubes and ovaries.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.