This is pre-cancer stage where the cancer cells are limited to the surface layer of the cervix. Treatment depends on the need to preserve fertility. For those who plan future pregnancy, the options include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization. Each of these procedures (surgeries) have their advantages and disadvantages that will be discussed you by your surgeon. When woman in concern does not desire to be pregnant in future or has gone through manopause, the best treatment is surgical removal of uterus (hysterectomy). This surgery can be performed laparoscopically with several advantages to the patient.

At this stage the cancer has invaded beyond the surface layer of cervix into its substance, but, has not reached outside the cervix. The diameter of the disease is not more than 7mm in width and invading no deeper than 5 mm. This stage is further divided into stage IA1 & IA2. The management between the two groups varies slightly and your surgeon will discuss this with you.

Broadly, for this stage you have 4 options:

• Standard of care is radical hysterectomy along with removal of lymph nodes in the pelvis (Radical Hysterectomy or Wertheim’s Operation). This surgery can be performed laparoscopically with several advantages to the patient. (laparoscopic radical hysterectomy).
• If you still want to be able to have children (early disease only), first the cancer is removed with a cone biopsy, and then you are watched closely to see if the cancer comes back. If the cone biopsy doesn’t remove all of the cancer (or if you are done having children), the uterus will be removed (laparoscopic hysterectomy).
• Internal with or without external beam radiation therapy to the pelvis
• Radical trachelectomy with removal of pelvic lymph nodes can be done if you still want to be able to have children.

If the cancer is found in any pelvic lymph nodes during surgery, some of the lymph nodes that lie along the aorta (the large artery in the abdomen) may be removed as well. All tissue removed at surgery will be examined microscopically. Further treatment is based on the results of the microscopy findings.

The disease is larger than stage IA, however, has not spread outside the cervix into vagina or pelvis. This stage is further divided in to B1 & B2 based on the size of the disease. Stage B2 includes all cases that are larger than 4cm in diameter and whereas, smaller ones are categorized as stage IB1.

Stage IB1: There are 3 options available:

• The standard treatment is a radical hysterectomy with removal of lymph nodes in the pelvis (Laparoscopic Radical Hysterectomy or Wertheim’s Operation) and sometimes from higher up in the abdomen (called para-aortic lymph nodes). This surgery can be performed laparoscopically with several advantages to the patient.
• The second treatment option is radiation therapy. Laparoscopic pelvic lymph node dissection before this can increase effectiveness of this treatment.
• Radical trachelectomy with removal of pelvic (and some para-aortic) lymph nodes is an option if the patient still wants to be able to have children.

There are 3 options available

 The standard treatment is the combination of chemotherapy and radiation therapy.

• Another choice is radical hysterectomy (Laparoscopic Radical Hysterectomy or Wertheim’s Operation) with removal of pelvic (and some para-aortic) lymph nodes. If cancer cells are found in the lymph nodes removed, or in the margins, radiation therapy may be given, possibly with chemotherapy, after surgery.
• Some doctors advise radiation given with chemotherapy (first option) followed by a laparoscopic hysterectomy. Laparoscopic pelvic lymph node dissection before radiotherapy can increase effectiveness of this treatment.

It is divided into stage IIA and stage IIB

Stage IIA: The cancer is extended into upper 2/3 of vagina. Treatment for this stage depends on the size of the tumor.

• One choice for treatment is internal (brachytherapy) and external radiation therapy. Some experts recommend removing the uterus after the radiation therapy is done. Laparoscopic pelvic lymph node dissection before this can increase effectiveness of this treatment.
• If the cancer is not larger than 4 cm, it may be treated with a laparoscopic radical hysterectomy and removal of lymph nodes in the pelvis (and some in the para-aortic area). If the tissue removed at surgery shows cancer cells in the margins or cancer in the lymph nodes, radiation treatments to the pelvis will be given with chemotherapy.

Stage IIB: The cancer is extended into the tissue next the uterus but not reached the wall of the pelvis. Combined internal and external radiation therapy along with chemotherapy is the usual treatment. Laparoscopic pelvic lymph node dissection before this can increase effectiveness of this treatment.

Stage III and IVA: Combined internal and external radiation therapy given with chemotherapy is the recommended treatment. Laparoscopic pelvic lymph node dissection before this can increase effectiveness of this treatment especially when the nodes are positive.

Stage IVB: At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy to relieve the symptoms of cancer that has spread to the areas near the cervix or to distant sites (such as the lungs or bone). Chemotherapy is often recommended.