# Early cervical cancer and fertility-sparing surgery

Source: https://onco.cc/cancers/early-cervical-cancer/  
OnCo record `early-cervical-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Early cervical cancer is confined to the cervix and is usually cured by surgery. Recent trials have shown that open surgery is safer than keyhole surgery for radical hysterectomy, that a simple hysterectomy is enough for the smallest tumours, and that young women with small tumours can keep their uterus with a trachelectomy.

## Summary

FIGO 2018 defines stage IA as microscopic invasion up to five millimetres and stage IB as a visible or deeper tumour confined to the cervix, split into IB1 (up to two centimetres), IB2 (two to four centimetres) and IB3 (over four centimetres, treated as locally advanced). Squamous carcinoma and HPV-associated adenocarcinoma behave similarly at this stage, while HPV-independent gastric-type adenocarcinoma is more aggressive. Diagnosis comes from colposcopic biopsy or an excisional cone after abnormal screening, and MRI and PET-CT stage the tumour and nodes. Stage IA1 without lymphovascular invasion is treated by cone biopsy or simple hysterectomy alone; IA2 to IB2 has traditionally required radical hysterectomy with pelvic lymphadenectomy, followed by chemoradiation when nodes, margins or parametria are involved.

Two trials have reshaped the surgery. LACC randomised women with stage IA1 with lymphovascular invasion to IB1 disease between minimally invasive and open radical hysterectomy and stopped early when disease-free survival at four and a half years was 86.0 percent with keyhole surgery against 96.5 percent with open surgery, and deaths were more frequent; open surgery became the standard again and guidelines reversed a decade of practice. SHAPE then asked the opposite question for the lowest-risk tumours: in stage IA2 to IB1 disease up to two centimetres with limited stromal invasion, simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence and caused far fewer urinary and sexual complications, so simple hysterectomy is now an accepted option for these women. Sentinel node biopsy, validated for detection in SENTICOL I and II, is being tested against full lymphadenectomy in SENTICOL III.

Fertility-sparing surgery follows the same logic. Cone biopsy or simple trachelectomy suffices for IA1 and selected IA2 tumours, and radical vaginal or abdominal trachelectomy with node assessment preserves the uterus in IB1 tumours up to two centimetres, with recurrence rates comparable to hysterectomy and live births in a majority of women who try to conceive, though preterm delivery is common. Neoadjuvant chemotherapy to shrink tumours of two to four centimetres before trachelectomy is investigational. HPV vaccination and HPV-based screening are shrinking this whole group of patients, which is the ultimate aim.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Stage IA to IB2 cervical cancer; Early-stage cervical cancer; Fertility-sparing cervical cancer surgery; Radical trachelectomy candidates
- Tags: subtype-page
- Group: gynaecologic
- Burden: In screened populations about half of cervical cancers are found at stage I, often in women in their thirties and forties who have not completed their families; cure rates exceed ninety percent, so the questions are how little surgery is safe and how to preserve fertility.
- Subtypes: Stage IA1 (cone biopsy or simple hysterectomy); Stage IA2 to IB1 up to 2 cm, low risk (simple hysterectomy after SHAPE, or radical trachelectomy for fertility); Stage IB1 to IB2 (open radical hysterectomy after LACC); Squamous cell carcinoma of the cervix; HPV-associated adenocarcinoma; HPV-independent gastric-type adenocarcinoma (higher risk); FIGO 2018 stage IB with intermediate risk factors (Sedlis criteria, adjuvant radiotherapy)
- Biomarkers: FIGO 2018 stage from clinical examination, MRI and PET-CT; Tumour size and depth of stromal invasion; Lymphovascular space invasion; Sentinel or pelvic node status; HPV type and p16 (HPV-associated versus independent); Margin and parametrial status after surgery

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/early-cervical-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/early-cervical-cancer/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/early-cervical-cancer/#what-it-is [7 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/early-cervical-cancer/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/early-cervical-cancer/#treating-it [6 settings, 4 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/early-cervical-cancer/#evidence [3 trials, 2 key papers, 6 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/early-cervical-cancer/#science
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/early-cervical-cancer/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/early-cervical-cancer/#living-with-it [18 questions, 3 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/early-cervical-cancer/coming/ [1 medicine, 3 trials, 1 idea, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/early-cervical-cancer/data/ [26 connected records]

## Standard of care

- Stage IA1 without lymphovascular invasion: Cone biopsy with clear margins or simple hysterectomy; no node assessment needed. ([Colposcopy and excisional treatment (LEEP/LLETZ, cone)](https://onco.cc/technologies/colposcopy-excision/), [Hysterectomy](https://onco.cc/terms/hysterectomy/))
- Stage IA2 to IB1 up to 2 cm, low risk: Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it. ([Hysterectomy](https://onco.cc/terms/hysterectomy/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [SENTICOL III](https://onco.cc/trials/senticol-iii/), [MRI](https://onco.cc/technologies/mri/))
- Stage IB1 to IB2, standard: Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC. ([LACC (Laparoscopic Approach to Cervical Cancer)](https://onco.cc/trials/lacc/), [Caution: minimally invasive radical hysterectomy for early cervical cancer](https://onco.cc/pairings/caution-mis-radical-hysterectomy/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Minimally invasive surgery (laparoscopic, robotic, VATS)](https://onco.cc/terms/minimally-invasive-surgery/))
- Fertility preservation: Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm. ([Colposcopy and excisional treatment (LEEP/LLETZ, cone)](https://onco.cc/technologies/colposcopy-excision/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [MRI](https://onco.cc/technologies/mri/))
- Adjuvant after surgery: Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/))
- Prevention and detection: HPV vaccination and HPV-based screening with colposcopy for positives. ([HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/), [Colposcopy and excisional treatment (LEEP/LLETZ, cone)](https://onco.cc/technologies/colposcopy-excision/), [HPV status (HPV-positive / HPV-negative)](https://onco.cc/terms/hpv-status/))

## State of the art

- LACC reversed the move to keyhole radical hysterectomy, a rare example of a surgical trial changing practice against the trend.
- SHAPE showed that less surgery is safe for the smallest tumours.
- Radical trachelectomy lets young women keep their fertility with equivalent cure.

## Open problems

- Whether sentinel node biopsy alone can replace lymphadenectomy (SENTICOL III).
- Safe fertility-sparing options for tumours of two to four centimetres.
- Why minimally invasive surgery did harm, and whether protective techniques can restore it.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cervical_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Cervical_cancer

## Connected records

- cancers: [Adenosquamous carcinoma of the cervix](https://onco.cc/cancers/cervical-adenosquamous-carcinoma/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Locally advanced cervical cancer](https://onco.cc/cancers/locally-advanced-cervical-cancer/), [Recurrent or metastatic cervical cancer](https://onco.cc/cancers/recurrent-metastatic-cervical-cancer/)
- trials: [LACC (Laparoscopic Approach to Cervical Cancer)](https://onco.cc/trials/lacc/), [SENTICOL III](https://onco.cc/trials/senticol-iii/), [SHAPE (CCTG CX.5)](https://onco.cc/trials/shape/)
- key papers: [LACC: minimally invasive versus open radical hysterectomy for early cervical cancer](https://onco.cc/key-papers/paper-lacc-nejm-2018/), [SHAPE: simple versus radical hysterectomy in low-risk early cervical cancer](https://onco.cc/key-papers/paper-shape-nejm-2024/)
- technologies: [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Colposcopy and excisional treatment (LEEP/LLETZ, cone)](https://onco.cc/technologies/colposcopy-excision/), [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRD / molecular residual disease testing](https://onco.cc/technologies/mrd-testing/), [MRI](https://onco.cc/technologies/mri/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/)
- ideas: [HPV circulating tumour DNA to guide cervical cancer therapy](https://onco.cc/ideas/idea-hpv-ctdna-cervical/)
- terms: [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Depth of invasion (DOI)](https://onco.cc/terms/depth-of-invasion/), [HPV status (HPV-positive / HPV-negative)](https://onco.cc/terms/hpv-status/), [Hysterectomy](https://onco.cc/terms/hysterectomy/), [Minimally invasive surgery (laparoscopic, robotic, VATS)](https://onco.cc/terms/minimally-invasive-surgery/)
- pairings: [Caution: minimally invasive radical hysterectomy for early cervical cancer](https://onco.cc/pairings/caution-mis-radical-hysterectomy/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/)
- people: [Marie Plante](https://onco.cc/people/marie-plante/)

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JSON: https://onco.cc/api/v1/entities/early-cervical-cancer.json