Treatment of Stage I Cervical Cancer

In some cases, Stage IA cervical cancer can be treated with conization:

• Conization - The doctor removes a cone-shaped piece of tissue using a surgical scalpel (cold knife cone biopsy) or laser. Conization can also be done by passing an electrical current through a wire loop (loop electrosurgical excision procedure, or LEEP). Conization lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix.

However, Stage IA1 cervical cancer is usually treated by a simple hysterectomy:

• Simple hysterectomy - The surgeon removes the uterus (womb) and cervix but not the structures next to the uterus (parametria and uterosacral ligaments) or pelvic lymph nodes (bean-shaped structures that help fight infections). The uterus is removed through a surgical incision in the front of the abdomen or through the vagina. The ovaries (pair of female reproductive organs that produce eggs and hormones) and fallopian tubes (two hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization) are usually left in place unless they are affected by some other disease or the patient is at least 45 to 50 years old. When both ovaries and fallopian tubes are removed during the hysterectomy, this process is known as bilateral salpingo-oophorectomy.

If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, a method of examining the inside of the abdomen and pelvis through a tube inserted into a very small surgical incision, the operation is called a total laparoscopic hysterectomy.

The treatment for Stage IA2 and Stage IB cervical cancer is usually a radical hysterectomy and pelvic lymph node dissection:

• Radical hysterectomy and pelvic lymph node dissection - Like a simple hysterectomy, this operation removes the entire uterus. But unlike a simple hysterectomy, the tissues next to the uterus (parametria and uterosacral ligaments), the upper part (about 1 inch) of the vagina next to the cervix and lymph nodes from the pelvis are also removed. The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so. When both ovaries and fallopian tubes are removed during the hysterectomy, this process is known as bilateral salpingo-oophorectomy. 

Radical trachelectomy is an option for women with Stage IA2 or Stage IB cervical cancer who want to have children in the future:

• Radical trachelectomy - The surgeon removes the cervix and the upper part of the vagina and places a "purse-string" stitch that acts as an artificial internal opening of the cervix inside the uterine cavity. The surgeon also removes the nearby lymph nodes. The operation is done either through the vagina or the abdomen.

If cancer cells are found in the edges of the organs or lymph nodes removed, you may be given radiation therapy or radiation and chemotherapy (cisplatin with or without 5-fluorouracil) after surgery.

• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
• Adrucil ^® or Efudex ^® (5-fluorouracil or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes, over 20 to 60 minutes, or continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated weekly, every other week, or every 3 weeks. The dose depends on your size.

Another treatment option for Stage IA2 and IB cervical cancer is high-dose internal and external radiation therapy instead of radical hysterectomy. Cure rates (about 85 percent to 90 percent) are about the same for high-dose radiation therapy as for radical hysterectomy with pelvic lymph node dissection.

• Internal radiation therapy (brachytherapy) - This technique uses a small pellet of radioactive material placed directly in the vagina near the tumor or in the tumor using thin needles. The radioactive material is left in place while you stay in the hospital for 1 to 3 days. This process might be repeated. This treatment is also known as interstitial radiation therapy.
• External beam radiation therapy (EBRT) - Radiation from outside the body is focused on the cancer. Most people are treated with EBRT 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation.

This content has been reviewed and approved by Myo Thant, MD.