Why do we continue to overtreat stage Ia carcinoma of the cervix?

Am J Obstet Gynecol. 2017 Oct;217(4):413-417. doi: 10.1016/j.ajog.2017.05.020. Epub 2017 May 15.

Abstract

The current recommended treatment for stage Ia2 cervical cancer is a radical or modified radical hysterectomy. Although in the United States the incidence of cervical cancer is low and declining, almost 50% of the >4000 new cases will present in early stages. An estimated 2200 women each year will undergo radical hysterectomy and many will have both early- and late-onset complications. The purpose of this review is to examine if there is still a role for radical hysterectomy in the proper treatment of stage Ia2 cervical cancer given most recent data. Sufficient histological evidence suggests that although parametrial involvement and lymph node metastases can increase the risk for recurrence, they are relatively uncommon at early stages. Worldwide data that challenge radical hysterectomy as standard of care have shown that conservative management of stage Ia2 cervical cancer results in similar survival and recurrence rates. It is the recommendation based on all reviewed data that radical hysterectomy should no longer be considered standard of care in all cases of stage Ia2 cervical cancer.

Keywords: cervical cancer; radical hysterectomy; staging; treatment.

Publication types

  • Review

MeSH terms

  • Female
  • Humans
  • Hysterectomy*
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery*