B21. Cervical cancer; FIGO classification and therapy

FIGO classification

Stage	Description
0	Carcinoma in situ
I	Tumour strictly confined to the cervix
Ia1	Stromal invasion < 3 mm in depth
Ia2	Stromal invasion 3 – 5 mm in depth
Ib	Stromal invasion > 5 mm in depth
II	Tumour invades beyond the uterus, but not into the pelvic wall or lower third of the vagina
IIa	Tumour does not invade parametrium, invades upper 2/3 part of vagina
IIb	Tumour invades the parametrium, but not the pelvic wall
III	Tumour invades pelvic wall or lower third of the vagina or causes hydronephrosis or pelvic lymph nodes or paraaortic lymph nodes
IVa	Tumour invades adjacent organs in the pelvis
IVb	Distant metastasis

(I’ve excluded some of the substages for simplicity)

Surgical treatment

Surgery is the mainstay of treatment of cervical cancer.

• Conisation or total/simple hysterectomy for stage Ia1
• Radical (Wertheim) hysterectomy up until and including stage IIa

Hysterectomy obviously takes away the woman’s fertility, but cervical cancer often affects women in their fertile age. A fertility-preserving surgical alternative to hysterectomy for cervical cancer is trachelectomy (see also topic B3).

Surgery is not the main treatment in stage IIb and beyond (i.e., when the parametrium is involved). However, it may be part of the adjuvant treatment.

Chemotherapy and radiotherapy

For stages IIb to IVa radiochemotherapy is the main treatment. Treatment for stage IVb is palliative and is mostly chemotherapy. Radiochemotherapy may be used as adjuvant treatment after surgery.

The standard chemotherapy regimen is cisplatin-based. Chemotherapy is rarely used alone in the treatment of cervical cancer; it’s almost always combined with radiotherapy.

Radiotherapy may be used as primary therapy in early stages (I – IIa) in cases where surgery is not an option.