Cervix Carcinoma Stage I
Stage I cervical cancer means the cancer is found only in the cervix and has not spread to nearby tissues or other organs. This early stage of the disease is usually treated with surgery, and in more than 90 percent of cases, treatment is successful.
Table of contents
What is stage I cervical cancer?
Stage I cervical cancer means that the cancer is found only in the cervix (the neck of the womb). At this stage, the cancer has not spread to nearby tissues or other organs in the body[1]. The stage of a cancer tells you how big it is and whether it has spread. This information helps your doctor decide which treatment you need[1].
Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer. There are 4 stages, numbered 1 to 4[1]. Stage I is considered an early stage of the disease, and cervical cancer is highly treatable when found at this stage[3].
Subtypes of stage I
Stage I cervical cancer is divided into two main groups: stage IA and stage IB. These are further divided based on the size of the tumor and the deepest point of tumor invasion[2].
Stage IA means the growth is so small that it can only be seen with a microscope or colposcope (a special device to examine the cervix)[1]. This stage is divided into two smaller groups:
- Stage IA1: The cancer has grown 3 millimeters or less into the tissues of the cervix[1].
- Stage IA2: The cancer has grown more than 3 millimeters but not more than 5 millimeters into the cervical tissues[1].
Stage IB means the cancerous areas are larger, but the cancer is still only in the tissues of the cervix and has not spread. It has grown deeper than 5 millimeters. It can usually be seen without a microscope, but not always[1]. This stage can be divided into 3 groups:
- Stage IB1: The cancer is deeper than 5 millimeters but no more than 2 centimeters in size[1].
- Stage IB2: The cancer is at least 2 centimeters but not bigger than 4 centimeters in size[1].
- Stage IB3: The cancer is larger than 4 centimeters but is still only in the cervix[1].
Symptoms and warning signs
Early stages of cervical cancer often do not cause symptoms and are hard to detect[3]. The first signs of cervical cancer may take time to develop. When symptoms do appear, they can include[3]:
- Watery or bloody vaginal discharge that may be heavy and can have a foul odor
- Vaginal bleeding after sex, between menstrual periods, or after menopause
- Pain during sex (called dyspareunia)
If you experience abnormal bleeding, unusual vaginal discharge, or any other unexplainable symptoms, you should contact a healthcare provider[3].
Treatment options
The stage of your cancer helps your doctor decide which treatment you need. Treatment also depends on your type of cancer (the type of cells the cancer started in), where the cancer is, and other health conditions that you have[1].
Stage I cervical cancer is usually treated with surgery. You may very rarely also have combined radiotherapy and chemotherapy (called chemoradiotherapy)[1]. More than 90 percent of early-stage cancers are treated successfully with surgical procedures and do not require any further treatment[16].
Surgery for stage IA1
For stage IA1 cancers, it might be possible to remove all of the cancer with a cone biopsy or a large loop excision of the transformation zone (LLETZ). These treatments are also used for women with abnormal cervical cells that are picked up through cervical screening[1].
If the cone biopsy has positive margins (meaning the border around the tumor contains cancer cells), you will have another cone biopsy. Some people with stage IA1 cancer may also have lymph nodes removed if there is a risk that the cancer cells may spread to lymph nodes[1].
If you have completed your family or preserving fertility is not a concern for you, treatment might be a simple hysterectomy. This includes removal of the cervix, womb, and fallopian tubes[1].
Surgery for stage IA2
If you wish to preserve your fertility, your doctor may offer you one of the following treatments for stage IA2 cancer[1]:
- A cone biopsy
- Removal of the cervix only (simple trachelectomy)
- Removal of the cervix, tissue around the cervix, and upper part of the vagina (radical trachelectomy)
Whether you would be able to have these treatments will depend on whether the surgeon can achieve a clear margin (a border with no cancer cells around the tumor) and whether no lymph nodes with cancer cells are found[1].
If the above treatments are not possible, you might have a simple or radical hysterectomy (surgery to remove the uterus). A simple hysterectomy includes removal of the cervix, womb, and fallopian tubes. A radical hysterectomy includes these organs as well as the tissue around the cervix, the upper part of the vagina, and lymph nodes in the area between the hip bones (pelvis). It might also include removal of the ovaries[1].
Surgery for stages IB1 and IB2
Your doctor might offer you to participate in a clinical surgery trial. If not, the standard treatment is a radical hysterectomy. This includes the removal of the cervix, womb, fallopian tubes, tissue around the cervix, the upper part of the vagina, and lymph nodes in the pelvis. It might also include removal of the ovaries[1].
Radiation therapy
You may be offered radiation therapy for stage I cervical cancer. It is used as the main treatment if you cannot have surgery or choose not to have surgery. It is also used after surgery if there are cancer cells in or close to the edges of the removed tissue, in blood vessels or lymph vessels in the removed tissue, or in lymph nodes[10].
When radiation is used, it may be given as external radiation therapy only or as a combination of external and internal radiation therapy. Chemotherapy drugs, such as cisplatin or carboplatin, may be given at the same time as radiation therapy. Giving chemotherapy at the same time as radiation therapy helps the radiation therapy work better[13].
Fertility preservation
An important factor for some women is fertility preservation. If you would like to retain the ability to become pregnant, ask your doctor about fertility-sparing treatment options (treatments for cervical cancer that preserve the uterus and ovaries). Such treatments may be an option for some small cancers that are only in the cervix[13].