Management of Early-Stage Cervical Cancer: A Literature Review

Abstract

Cervical cancer (CC) remains a public health issue worldwide despite preventive measures. Surgical treatment in the early-stage CC has evolved during the last decades. Our aim was to review the advances in the literature and summarize the ongoing studies on this topic. To this end, we conducted a literature review through PubMed focusing on English-language articles on the surgical management of early-stage CC. The emergent topics considered here are the FIGO 2018 staging system update, conservative management with less radical procedures for selected patients, lymph node staging, fertility preservation, preferred surgical approach, management of tumors up to 2 cm, and prognosis. In terms of updating FIGO, we highlight the inclusion of lymph node status on staging and the possibility of imaging. Regarding the preferred surgical approach, we emphasize the LACC trial impact worldwide in favor of open surgery; however, we discuss the controversial application of this for tumors < 2 cm. In summary, all topics show a tendency to provide patients with tailored treatment that avoids morbidity while maintaining oncologic safety, which is already possible in high-income countries. We believe that efforts should focus on making this a reality for low-income countries as well.

Sentinel Node Biopsy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery in a Patient with Early-Stage Cervical Cancer: A Case Report

“…In contrast, this extensive intervention should be avoided in the case of lymphonodal involvement [2]. Lymphonodal staging is therefore of critical relevance and should be performed through radiological examinations (computed tomography scan, MRI, and/or positron emission tomography/computed tomography scan) and when negative, by more sensitive SLNBs to assess for possible subclinical metastases [2, 11]. At present, 2 main surgical strategies comprising SLNBs exist: (1) SLN mapping by laparotomy with intraoperative pathological assessment and radical hysterectomy with lymphadenectomy in the case of negative SLNs or (2) a two-step approach with SLN mapping by conventional laparoscopy and definitive pathological analyses with ultrastaging and an eventual second intervention with a laparotomic radical surgery if SLNs are negative.…”

“…SLN mapping by retroperitoneal vNOTES could be a valuable tool to be integrated into future two-step strategies aimed at reducing the morbidity associated with surgical treatment of cervical cancer. Although we should wait for the results of clinical trials such as PHENIX, SENTIX, and SENTICOL III, systematic pelvic lymphadenectomy will probably be replaced by SLN mapping [11], and vNOTES could represent an interesting option in selected patients. In addition, recently described predictive models based on conization specimens and SLN histopathological analyses could determine low-risk patients, for whom less invasive surgeries such as simple hysterectomy or trachelectomy could be indicated [15, 16].…”

Prognosis Analysis and Validation of Fatty Acid Metabolism-Related lncRNAs and Tumor Immune Microenvironment in Cervical Cancer

“…Cervical cancer (CC) is as one of the most common gynecological malignant tumors worldwide and has become a prominent public health issue [ 1 ]. The most recent global data to be released by the International Agency for Research on Cancer indicates that there were 569,847 newly diagnosed cases of cervical cancer in the world in 2018, and that the disease was responsible for the deaths of 311,365 people [ 2 , 3 ]. The presence of a persistent infection with a high-risk human papillomavirus (HPV) is a primary determinant in the development of cervical cancer, but it is not a necessary condition [ 4 ].…”

Immune checkpoint inhibitors in cervical cancer: Current status and research progress

“…Generally, the prognosis of early-stage cervical cancer is good, with an overall 5-year survival rate of approximately 70%-90% ( 3 ). However, the prognosis of locally advanced cervical cancer and recurrent/metastatic cervical cancer is still poor ( 4 ).…”