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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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.
Two 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.
| Setting | Approach | Guideline |
|---|---|---|
| Stage IA1 without lymphovascular invasion | Cone biopsy with clear margins or simple hysterectomy; no node assessment needed. | not mapped |
| Stage IA2 to IB1 up to 2 cm, low risk | Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it. | not mapped |
| Stage IB1 to IB2, standard | Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC. | not mapped |
| Fertility preservation | Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm. | not mapped |
| Adjuvant after surgery | Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria. | not mapped |
| Prevention and detection | HPV vaccination and HPV-based screening with colposcopy for positives. | not mapped |