Stage I Cervical Cancer

Overview

Stage I cancer of the cervix is commonly detected from an abnormal Pap smear or pelvic examination. Following a staging evaluation, a stage I cancer is said to exist if the cancer is confined to the cervix. Stage I cervical cancer is curable for the majority of patients if surgery, radiation, and chemotherapy are appropriately used.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the diagnosis and treatment of stage I cervical cancer. Recent advances in treatment have resulted in new treatment options that reduce symptoms and improve survival. Each person with stage I cervical cancer is different, and the specific characteristics of your condition will determine how it is managed. The information on this Web site is intended to help educate you about treatment options and to facilitate a shared decision-making process with your treating physician.

Stage IA Cervical Cancer

Treatment of stage IA cervical cancer typically consists of surgical removal of the cancer. This can be accomplished with a hysterectomy or a conization procedure. A simple hysterectomy involves surgical removal of the uterus, including the cervix and a small amount of surrounding normal tissue. This can be performed through a low abdominal incision (below the belly button and above the pelvic bone) or through the vagina, which avoids an abdominal incision. A simple hysterectomy is very effective therapy for most stage IA cervical cancers.

Women with stage IA cervical cancer who wish to have children in the future may elect to undergo a procedure called a conization. In a conization procedure, the surgeon removes only a portion of the cervix in the operating room. If the cancer is completely removed, no additional surgery is necessary. If cancer is detected at the edge of the removed specimen, a complete hysterectomy is required. To learn more about surgical treatment and its side effects, go to Surgical Management of Cervical Cancer.

Some patients do not want to or cannot undergo an operation such as a hysterectomy because of co-existing medical conditions. For these patients, radiation therapy can be used to treat the cancer. The possible complications and the relative inconvenience usually determine whether surgery or radiation is the most appropriate treatment. For example, surgery is a one-time procedure, whereas external beam radiation therapy requires 3-6 weeks of daily treatments and implant radiation may require additional hospitalization time.

Implant radiation is a procedure that is performed in the operating room and involves the placement of radioactive material or seeds in or near the cancer. This process may be repeated depending on the necessary radiation dose. Radiation therapy appears to be as effective as surgery in curing stage IA cervical cancer. To learn more about radiation therapy and its side effects, go to Radiation Therapy for Cervical Cancer.

Approximately 95% of patients with stage IA cervical cancer survive without evidence of cancer recurrence 10 years after surgery or radiation therapy. Less than 5% of patients with stage IA cervical cancer experience recurrence.

Stage IB Cancer of the Cervix

Small stage IB cervical cancers can be successfully cured with hysterectomy or radiation therapy in approximately 90% of patients. Bulky stage IB cancers (greater than 4 centimeters in size) are only cured in 70-75% of patients when surgery or radiation therapy is administered alone. Bulky stage IB cancers are best treated with combined modality therapy using radiation, surgery and chemotherapy.

Before a hysterectomy is performed in a patient suspected of having a stage IB cancer, the doctor will often remove the lymph nodes in the pelvis to see if they contain cancer. This is called a pelvic lymph node dissection. If the lymph nodes contain cancer, the surgeon will not usually proceed with a hysterectomy because treatment over a larger area is necessary to destroy all the cancer cells. Radiation therapy and chemotherapy are generally recommended.

Even with surgical removal of all visible cancer, 10% of patients with small stage IB and 30-40% of patients with bulky stage IB cancers will experience a recurrence. This is because some patients already have small amounts of cancer that spread outside the cervix and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the cervix are referred to as micrometastases. The presence of micrometastases or residual cancer causes the relapses that follow treatment with surgery alone.

In order to improve the cure rate of cervical cancer, it is important to develop strategies to cleanse the body of micrometastases and prevent recurrences. Adjuvant therapy is additional treatment that increases the effectiveness of a primary therapy. The goal of adjuvant treatment is to improve the chance of a cure, prevent cancer from recurring and/or to improve the duration of overall survival. Adjuvant therapy may consist of radiation, chemotherapy or other treatments. The role of adjuvant treatment for small stage IB cancers is not clear; however, patients with bulky stage IB cancers have improved survival if treated with adjuvant therapy.

A clinical study conducted by the Gynecologic Oncology Group demonstrated a reduction in cancer recurrence when radiation therapy was used after radical hysterectomy for patients with high-risk stage IB cancer of the cervix. Patients treated with external beam radiation therapy to the pelvis were directly compared with a group of patients who received no radiation therapy. The results indicated that patients treated with adjuvant radiation therapy after surgery experienced a cancer recurrence rate of 12%, compared to 21% in patients treated with surgery alone. The addition of adjuvant radiation therapy reduced the chance of cancer recurrence by almost 50% in this study.

Adjuvant therapy can also consist of combined treatment with external beam radiation therapy and chemotherapy. Patients with cancer cells in the pelvic lymph nodes or cancer at the edge of the surgical specimen may additionally benefit from treatment with combined radiation therapy and chemotherapy. Several chemotherapy drugs such as Platinol® and 5-fluorouracil have the ability to kill cancer cells directly and increase the effectiveness of radiation therapy in killing cancer cells.

In April of 1999, the New England Journal of Medicine published the results of a clinical study that compared adjuvant treatment with radiation only to treatment with radiation and concurrently administered Platinol® chemotherapy following surgical hysterectomy in patients with high-risk stage IB cancers. Patients treated with chemotherapy and radiation after surgery were more likely to survive without cancer recurrence. At 3 years from treatment, 80% of patients receiving combined radiation and chemotherapy were alive without recurrence, compared to only 63% of patients treated with radiation alone. Currently, the combination of surgery, radiation and Platinol® chemotherapy appears to produce the best results for treatment of patients with high-risk stage IB cervical cancer.

Strategies to Improve Treatment

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