Treatment of Cervical Cancer at Stage T1b1, T1b2, or T2a1
Patients with cervical cancer at stage T1b1, T1b2, or T2a1 represent a group where surgical management is a primary consideration. The extent of surgery and the role of alternative definitive treatment are determined by tumour characteristics identified before and during the operation.
Clinical Scenario
This protocol addresses localised cervical cancer staged at T1b1, T1b2, or T2a1 — tumours that are confined or have limited local extension. Key preoperative and intra-operative findings, including tumour size, stromal invasion depth, and lymphovascular involvement, shape the management pathway.
Approach Overview
Surgical management begins with bilateral sentinel lymph node biopsy as the first step, with intra-operative frozen-section assessment of lymph node status. Depending on tumour size and stromal invasion findings, the extent of the hysterectomy — from a less radical to a more extensive parametrial resection — is determined by the patient's risk profile. For patients in whom preoperative risk factors indicate that adjuvant treatment would be required, a non-surgical definitive approach is considered instead of primary radical pelvic surgery.
The full protocol details the complete decision algorithm, criteria thresholds, and step-by-step management — available via the link below.
References
DOI: 10.1016/j.ijgc.2025.102747
- Lymph node assessment should be performed as the first step of surgical management.
- Intra-operative assessment of lymph node status (evaluated by frozen section) is recommended.
- Simple hysterectomy should be performed in patients who meet "SHAPE trial criteria" after conization or on preoperative staging, including tumor size ≤ 2 cm and a limited stromal invasion.
- In tumors exceeding the SHAPE criteria, the type of radical hysterectomy (extent of parametrial resection, type A-C2) should be based on the presence of prognostic risk factors identified preoperatively, such as tumor size, maximum stromal invasion, and lymphovascular space involvement, which are used to categorize patients at high, intermediate, and low risk of treatment failure.
- If a combination of risk factors is known at diagnosis, which would require an adjuvant treatment, definitive chemoradiotherapy and brachytherapy should be considered without previous radical pelvic surgery.
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