Diagnosis of Cervical Cancer

Treatment Options by Stage of Cervical Cancer

Cervical Intraepithelial Neoplasia (CIN)

• CIN-1 - Because most cases of CIN-1 spontaneously regress without therapy, many experts advocate monitoring without treatment. Some protocols monitor with cytology alone, while some use a combination of cytology and periodic colposcopy. Follow-up intervals vary from 3 to 12 months. In women with biopsy confirmed CIN-1 and an unsatisfactory colposcopic examination, a diagnostic excisional procedure is usually recommended.

• CIN-2 (Previously referred to as "Moderate dysplasia") - It has been found that 43% of untreated CIN-2 lesions will regress in the absnce of treatment, whereas 35% will persist and 22% will progress to carcinoma in situ or invasive cervical cancer.

• CIN-3 (Previously referred to as "Severe dysplasia" or Carcinoma in situ) - Studies have shown that 32% of CIN-3 lesions spontaneously regress, 56% persist, and 14% progress.

Recommendations for treatment of CIN-2 and CIN-3 are the same and may include either ablation or excision techniques. Some have recommended that excisional procedures be used for the management of large lesions that are at increased risk of undetected microscopic or invasive disease.

Cervical Cancer Stages I-IV

• Stage I - There is no standard treatment for women with early stage disease (microscopic but invasive). Three management options are available:
  • Surgery alone
  • Combined radiation therapy plus surgery
  • Radiation therapy alone

Women treated with a simple hysterectomy alone have 5-year survival rates of 85-95%. However, most women are found to have Stage IB or IIA at time of diagnosis, and require either a radical hysterectomy or radiation therapy. Five year survival rates for this group are between 80-90%.

• Stages II-IV - Invasive cervical cancer and metastatic cervical cancer are usually treated with surgery (radical hysterectomy and possibly lymphadenectomy - removal of lymph nodes), radiation (external beam radiation and/or brachytherapy), and/or chemotherapy.

Treatment of locally advanced cervical cancer can generally be divided into three approaches depending on the stage of the disease.

• Significant local disease (based on tumor size and extent of surrounding invasion) but without any high-risk factors is usually treated with radiation therapy following hysterectomy.
• Earlier-stage disease treated with radical hysterectomy with either spread to the lymph nodes or surrounding areas, or involvement of the surgical margins, is at high risk for recurrence. Therefore, follow-up chemoradiation is usually used to improve survival and quality of life.
• Advanced-stage disease is generally treated with a combination of platinum-based chemotherapy and radiation (chemoradiation) without surgery. There is no standard chemotherapy treatment available for women with stage IVB cervical cancer that enhances comfort and quality of life. These women however, are appropriate candidates for clinical trials and should discuss this option with their provider.