When cervical cancer is caught at stage I, treatment options are often highly effective. This early stage means the cancer is still confined to the cervix itself, and doctors can work with patients to choose approaches that fit their individual needs—including their hopes for future fertility and overall health goals.

Understanding Your Treatment Journey

Finding out you have stage I cervical cancer can feel overwhelming, but knowing what happens next can make the path ahead clearer. At this early stage, the disease has not spread beyond the cervix, which opens the door to several treatment possibilities. The main goal of treatment is to remove the cancer completely or destroy it, giving you the best chance for a full recovery and return to normal life.

Treatment decisions depend on many factors that are unique to you. These include how deeply the cancer has grown into cervical tissue, the size of the tumor, your age, whether you want to have children in the future, and your overall health. Your doctor will also consider the specific type of cancer cells you have and whether the cancer shows signs of spreading into blood vessels or lymph vessels within the cervix—a feature called lymphovascular space invasion, which means cancer cells have entered small vessels that could carry them elsewhere.^[1]

Stage I cervical cancer is divided into smaller groups based on how large the tumor is and how deeply it has grown. Stage 1A cancers are very small and can only be seen under a microscope or through a special viewing instrument. Stage 1B cancers are larger or have grown deeper into the cervical tissue. These distinctions matter because they guide which treatment approach will work best for you.^[2]

Standard Surgical Treatments

Surgery is the most common treatment for stage I cervical cancer. The type of surgery offered depends on the size and depth of your tumor and whether preserving your ability to have children is important to you.

For the Smallest Cancers: Cone Biopsy

For women with stage 1A1 cervical cancer—the very earliest form, where the cancer has grown no more than 3 millimeters into cervical tissue—a cone biopsy may be all that’s needed. This procedure removes a cone-shaped piece of tissue from the cervix. The removed tissue is carefully examined in a laboratory. If the edges of the removed tissue are completely free of cancer cells, you might not need any further treatment. This option is especially suitable for women who want to keep the possibility of becoming pregnant in the future.^[10]

Sometimes, a similar procedure called LLETZ (large loop excision of the transformation zone) may be used instead. Both are relatively simple procedures that can remove early cancers while preserving the womb and fertility. However, if cancer cells are found at the edges of the removed tissue, or if there are signs of spread into blood or lymph vessels, further treatment will be necessary.^[1]

Hysterectomy: Removing the Cervix and Womb

A hysterectomy is surgery that removes the uterus (womb) and cervix. For many women with stage I cervical cancer who have completed their families or do not wish to become pregnant, a hysterectomy is the most common treatment.

There are different types of hysterectomy depending on the stage of your cancer. A simple hysterectomy removes the cervix, womb, and usually the fallopian tubes. This may be enough for stage 1A1 cancer. For slightly larger stage 1A2 cancers, a modified radical hysterectomy may be recommended, which removes the cervix, womb, fallopian tubes, and some surrounding tissue. For stage 1B cancers, a radical hysterectomy is often performed. This more extensive surgery also removes tissue around the cervix, the upper part of the vagina, and lymph nodes from the pelvis. Sometimes the ovaries are also removed.^[10]

The surgeon’s goal is to remove all cancer while trying to preserve as much healthy tissue as possible. After a hysterectomy, you will no longer have menstrual periods and cannot become pregnant. If your ovaries are removed and you have not yet gone through menopause, you will experience menopause immediately, which can cause symptoms like hot flashes and mood changes.^[1]

Fertility-Sparing Surgery: Radical Trachelectomy

For women with stage 1A2 or small stage 1B1 cervical cancer (less than 2 centimeters) who want to preserve their ability to have children, a radical trachelectomy may be an option. This surgery removes the cervix, the upper part of the vagina, and some of the tissue around the cervix, but leaves the womb in place. Lymph nodes in the pelvis are also removed to check for any spread of cancer.^[10]

This procedure allows some women to carry a pregnancy after treatment, although there may be an increased risk of miscarriage or premature birth. Not everyone is a candidate for this surgery—it depends on the size and location of the tumor and whether cancer is found in the lymph nodes. Your surgeon will discuss whether this is a safe option for you.^[1]

Lymph Node Removal

During surgery for stage I cervical cancer, doctors often remove lymph nodes from the pelvis to check whether cancer has spread beyond the cervix. This is called a pelvic lymph node dissection. Lymph nodes are small bean-shaped structures that filter fluid from tissues and can trap cancer cells. Checking them helps doctors understand if the cancer has started to spread and whether additional treatment is needed.^[10]

Some surgeons perform a sentinel lymph node biopsy instead of removing all pelvic lymph nodes. The sentinel lymph node is the first lymph node to which cancer cells are most likely to spread. A special dye or radioactive substance is injected near the tumor, and the surgeon follows it to identify and remove only the sentinel lymph node or nodes. If these are free of cancer, it’s less likely that other lymph nodes are affected, and fewer lymph nodes need to be removed. This approach can reduce side effects such as leg swelling (lymphedema).^[10]

Radiation Therapy as Standard Treatment

Radiation therapy uses high-energy beams to kill cancer cells. It may be offered as the main treatment for stage I cervical cancer if you cannot have surgery due to other health conditions, or if you choose not to have surgery. Radiation can also be used after surgery if there are concerns that cancer cells were not completely removed or if cancer was found in the lymph nodes or blood vessels.^[10]

There are two main types of radiation therapy used for cervical cancer. External radiation therapy involves directing radiation beams at the pelvis from a machine outside your body. Internal radiation therapy, also called brachytherapy, involves placing a radioactive source inside the vagina, close to the cervix, for a short period. Often, both types are used together to maximize effectiveness.^[13]

Radiation therapy is often given together with chemotherapy, a combination called chemoradiotherapy. The chemotherapy makes the radiation more effective at killing cancer cells. The chemotherapy drugs used are usually cisplatin or carboplatin, which are given in lower doses than when chemotherapy is used alone.^[13]

Radiation therapy for cervical cancer typically lasts several weeks. You will have daily external radiation sessions, usually five days a week, for about five to six weeks. Internal radiation treatments are given less frequently, often once or twice a week. Your medical team will guide you through the schedule and help manage any side effects that arise.^[1]

Side Effects of Radiation and Chemoradiotherapy

Radiation therapy can cause side effects because it affects both cancer cells and some healthy cells in the treatment area. Common side effects include fatigue, diarrhea, bladder irritation (causing frequent or painful urination), and skin changes in the pelvic area. Some women experience vaginal dryness or narrowing after radiation, which can affect sexual comfort. Your medical team can suggest ways to manage these effects, such as using vaginal dilators to prevent narrowing and moisturizers for dryness.^[10]

Chemotherapy given alongside radiation can add to side effects. You may experience nausea, increased fatigue, and a higher risk of infection because chemotherapy can lower your white blood cell count. Your doctors will monitor your blood counts regularly and provide medications to help control nausea and other symptoms.^[13]

Most side effects improve after treatment ends, although some—like vaginal changes or bowel and bladder sensitivity—can be long-lasting. It’s important to talk openly with your care team about any symptoms you experience so they can help you manage them effectively.

Treatments Being Tested in Clinical Trials

While surgery and radiation therapy are well-established treatments for stage I cervical cancer, researchers are constantly looking for new and better ways to treat the disease. Clinical trials are research studies that test promising new treatments to see if they are safe and effective. Some of these new approaches may one day become part of standard care.

Immunotherapy: Helping Your Immune System Fight Cancer

Immunotherapy is a type of treatment that helps your own immune system recognize and attack cancer cells. One immunotherapy drug that has been tested in cervical cancer is pembrolizumab, which works by blocking a protein called PD-1 on immune cells. When PD-1 is blocked, immune cells can better recognize and destroy cancer cells.^[13]

Pembrolizumab is currently approved for more advanced cervical cancers, but researchers are studying whether it could also help patients with earlier stages, including stage I. Clinical trials are testing whether adding immunotherapy to surgery or radiation can improve outcomes or reduce the chance of cancer coming back. These trials are being conducted in hospitals across the United States, Europe, and other regions.^[13]

Immunotherapy has different side effects than chemotherapy or radiation. Because it activates the immune system, it can sometimes cause the immune system to attack healthy tissues, leading to inflammation in organs like the lungs, liver, intestines, or thyroid gland. However, many patients tolerate immunotherapy well, and serious side effects can often be managed with medications like corticosteroids.

Less Radical Surgery for Low-Risk Cancers

Researchers are also exploring whether some women with small, low-risk stage I cervical cancers could be treated with less extensive surgery. Traditional treatment for early-stage cervical cancer has been radical hysterectomy, which removes a significant amount of tissue. However, recent studies suggest that for very small tumors with favorable features—such as tumor size less than 2 centimeters, depth of invasion less than 10 millimeters, and no spread into blood or lymph vessels—a simple hysterectomy or even just a cone biopsy might be enough.^[14]

The idea behind this research is to reduce the side effects and complications of surgery without compromising cancer control. Radical hysterectomy can lead to more bladder and bowel problems and sexual difficulties compared to simpler surgeries. Clinical trials are comparing outcomes between women who have radical surgery and those who have less extensive procedures. Some of these trials also include sentinel lymph node biopsy to check for spread while avoiding removal of all pelvic lymph nodes.^[14]

These trials are still ongoing, and the approach is not yet standard care. However, preliminary results are promising and suggest that carefully selected patients may benefit from less radical treatment in the future. If you have a small, early-stage cervical cancer, ask your doctor whether you might be eligible for a clinical trial testing less invasive surgery.

Targeted Therapy

Targeted therapy uses drugs that specifically attack cancer cells by targeting particular molecules involved in cancer growth. One targeted therapy drug used in cervical cancer is bevacizumab, which blocks a protein called VEGF that helps tumors grow new blood vessels. By cutting off the blood supply to the tumor, bevacizumab can slow cancer growth.^[13]

Bevacizumab is currently used for advanced cervical cancer and is being studied in combination with chemotherapy and immunotherapy. Clinical trials are exploring whether it could also benefit women with earlier-stage disease who are at high risk of recurrence. Side effects of bevacizumab can include high blood pressure, bleeding, and problems with wound healing, so it must be used carefully and monitored closely.

Participating in a Clinical Trial

Taking part in a clinical trial means you receive either a new treatment being tested or the current standard treatment (which serves as a comparison). Trials are carefully designed to protect participants and are monitored by ethics committees and regulatory agencies. Before joining a trial, you will be given detailed information about what the study involves, the potential benefits and risks, and what will be expected of you. You can ask questions and take time to decide whether it’s right for you.^[13]

Clinical trials are conducted in many locations, including major cancer centers in the United States, Europe, and other countries. Your doctor can help you find trials that you might be eligible for, or you can search for trials online through resources like ClinicalTrials.gov. Participating in a trial not only gives you access to cutting-edge treatments but also contributes to advancing knowledge that may help future patients.

Most common treatment methods

• Surgery
  • Cone biopsy or LLETZ to remove small early cancers while preserving fertility
  • Simple hysterectomy to remove the cervix, womb, and fallopian tubes for stage 1A1 cancer
  • Modified radical hysterectomy with removal of pelvic lymph nodes for stage 1A2 cancer
  • Radical hysterectomy with removal of the cervix, womb, surrounding tissue, upper vagina, and pelvic lymph nodes for stage 1B cancers
  • Radical trachelectomy to preserve fertility by removing the cervix but leaving the womb in place for select stage 1A2 and small 1B1 cancers
  • Sentinel lymph node biopsy or pelvic lymph node dissection to check for cancer spread
• Radiation Therapy
  • External radiation therapy directed at the pelvis from outside the body
  • Internal radiation therapy (brachytherapy) with radioactive sources placed inside the vagina near the cervix
  • Used as main treatment if surgery is not possible or after surgery if cancer cells remain or are found in lymph nodes or blood vessels
• Chemoradiotherapy
  • Combination of radiation therapy and chemotherapy (usually cisplatin or carboplatin) given at the same time
  • Chemotherapy helps radiation work more effectively
  • Used after surgery for high-risk features or as main treatment if surgery is not suitable
• Immunotherapy (in clinical trials)
  • Pembrolizumab, which blocks the PD-1 protein to help immune cells attack cancer
  • Being tested in clinical trials for early-stage cervical cancer to see if it can improve outcomes
• Targeted Therapy (in clinical trials)
  • Bevacizumab, which blocks VEGF to cut off blood supply to tumors
  • Being studied in combination with other treatments for high-risk early-stage disease