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
III Tumour invades pelvic wall and/or lower third of the vagina and/or causes hydronephrosis
IVa Tumour invades adjacent organs
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

Surgery is not the main treatment in stage IIb and beyond. However, it may be part of the adjuvant treatment.

Chemotherapy and radiotherapy

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

For stages IIb to IVa radiochemotherapy is the main treatment. Treatment for stage IVb is palliative and is mostly chemotherapy.

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.

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