Treatment of cervical cancer according to clinical staging

For patients with stage I and stage II cervical cancer, surgery is the preferred treatment method. As long as the surgical indications are met, surgical treatment is recommended. Generally, treatment can be based on the specific invasion range of stage I and stage II lesions.

1. Stage IA1: No cancer lesions are visible to the naked eye, only invasive cancer can be seen under a microscope, the depth of interstitial invasion is less than 3mm, and the width is less than 7mm. It is recommended to perform a total abdominal or vaginal hysterectomy, and the corresponding vaginal segment can be removed or the cervical cone can be performed according to the situation. Follow-up cervical cytology smears are performed 4 to 10 months after surgery. If both smears are negative, a cervical smear examination is performed once a year thereafter.

2. Stage IA2: The depth of stromal invasion is 3-5 mm and the width is less than 7 mm. Modified radical hysterectomy is recommended, and cytological smears are performed for follow-up at 4 and 10 months after surgery. After both smears are normal, smear examinations are performed once a year.

3. Stage IB1, IIA ≤ 4 cm: Stage IB1 cancer is confined to the cervix, with superficial invasive cancer visible to the naked eye, and the lesion diameter is ≤ 4 cm. Stage IIA cancer has extended beyond the cervix and is generally treated with surgery or radiotherapy. Radical surgery and radiotherapy should be avoided when initially selecting a treatment plan.

4. Stage IB2, IIA (>4cm): Clinically, the lesion diameter is >4cm. Stage IIA (>4cm) is accompanied by obvious parametrial infiltration. Depending on the situation, patients can choose concurrent chemoradiotherapy, radical hysterectomy and bilateral pelvic lymph node dissection + adjuvant radiotherapy, or radical hysterectomy and pelvic lymph node dissection after chemotherapy.

5. For patients in stage IVA with no infiltration of the pelvic wall, especially those with combined vesicovaginal fistula or rectovaginal fistula, pelvic organ dissection can be performed.