Stage T1a cervical cancer has well-defined surgical management criteria. Evidence shows that definitive treatment at this stage can be achieved without hysterectomy, which does not improve outcomes over more tissue-sparing approaches.

Clinical scenario

This protocol addresses patients with cervical cancer staged at T1a. Treatment planning is guided by the specific substage — T1a1 versus T1a2 — and by lymphovascular space involvement (LVSI) status, which together determine the appropriate lymph node evaluation strategy.

Treatment approach (partial)

The protocol identifies a definitive cervical surgical procedure as the primary intervention. Lymph node assessment — including whether and how regional lymph nodes are evaluated — is tailored to substage and LVSI findings.

The complete decision algorithm, including the full lymph node evaluation pathway and fallback strategies, is available in the structured protocol.

References

Conization can be considered a definitive treatment in the T1a stage, as hysterectomy does not improve the outcome.
Sentinel lymph node biopsy without additional pelvic lymph node dissection can be considered in T1a1 lymphovascular space involvement-positive, T1a2 lymphovascular space involvement-negative, and should be performed in T1a2 lymphovascular space involvement-positive patients.
If indocyanine green is not available, detection techniques using other tracers (radioactive tracer or blue dye) should be used.
If no detection technique can be established, systematic pelvic lymphadenectomy should be considered in T1a2 lymphovascular space involvement-positive tumors.

DOI: 10.1016/j.ijgc.2025.102747

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Treatment of Cervical Cancer at Stage T1a