Early cervical cancer

Abstract

Early cervical cancer includes a broad range of disease, from clinically undetectable microinvasive cancer to large, bulky tumors that replace the entire cervix. Further subgrouping of this category is therefore necessary to define the optimal treatment approach for individual cases. The International Federation of Gynecology and Obstetrics (FIGO) staging system stratifies stage I tumors into two broad categories, stage IA (microinvasive) and stage IB (gross tumor). Management of women with stage IA disease is controversial. In the United States, patients with stromal invasion of less than 3 mm and no lymphvascular involvement are usually treated conservatively with simple hysterectomy. In selected patients who desire fertility, cone biopsy with negative surgical margins is also considered. Patients with invasion of more than 3 mm or lymphvascular space involvement are at risk for pelvic lymph node metastasis and are most often treated with radical hysterectomy and pelvic lymphadenectomy. Stage IB1 cervical cancer is managed by either radical surgery or radiotherapy with equivalent recurrence and survival rates. In patients with tumors less than 4 cm in diameter, the decision between radical surgery and radiotherapy is guided by patients' overall health and treatment preferences. For younger women, radical surgery is preferred because ovarian function can be preserved and vaginal stenosis secondary to radiation can be avoided. Radiation therapy is preferred for women who may not tolerate radical surgery. We always prefer primary radiation therapy for patients with tumors larger than 4 cm in diameter. Recent data convincingly demonstrate that the addition of cisplatin-based chemotherapy significantly improves overall survival rates in cervical cancer patients who undergo radiation therapy.

Adjuvant platinum-based chemotherapy for early stage cervical cancer

“…Eight papers found were reviews on the proposed subject (Hansgen 2001;Koh 2000;Lai 1999;Lu 2000;Morton 1996;Park 1997;Shimizu 1995). Seventeen studies were retrospective (Buxton 1990;Frigerio 1994;Ikeda 1994;Killackey 1993;Kim 2007;Lin 1998;Lin 2000;Mossa 2003;Ng 1995;Park 2001;Ryu 2005;Sivanesaratnam 1987;Sivanesaratnam 1989;Sivanesaratnam 1998;Wada 1995;Wertheim 1985;Yessaian 2004), seven were non-randomised clinical trials (Argenta 2006;Linghu 2003;Dimpfl 1996;Lahousen 1990;Lai 1989;Russel 1995;Zanetta 1995), three were phase II studies (Hansgen 2002;Rushdan 2004; and one was a phase I study (Watanabe 2006).…”

Characterization of the Tumor-Microenvironment in Patient-Derived Cervix Xenografts (OCICx)

“…[10,11,12]. Once established, invasive cancer is best managed either surgically or with radical radiotherapy depending on extent of tumor invasion [13]. Radical radiotherapy generally administered concurrently with cisplatin chemotherapy, is the preferred treatment option for locally advanced cervix cancer and results in 5-year disease-free survival rates of over 60% [14,15].…”

Targeting the CXCL12/CXCR4 pathway and myeloid cells to improve radiation treatment of locally advanced cervical cancer

“…Nearly half of cervical cancer cases are diagnosed at locally advanced stages, for which primary surgical treatment is not an option . These cases are, however, potentially curable with radiation therapy (RT).…”