Stage 1 cervical cancer
Stage 1 means that the cancer is only in the neck of the womb (cervix).
The main treatment is surgery. You may, very rarely, also have combined radiotherapy and chemotherapy (chemoradiotherapy).
What is stage 1 cervical cancer?
The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need.
Doctors use the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer. There are 4 stages, numbered 1 to 4.
Stage 1 means that your cancer is within the neck of the womb (cervix). It hasn’t spread to nearby tissues or other organs. It is divided into:
- stage 1A
- stage 1B
Stage 1A
In stage 1A the growth is so small that it can only be seen with a microscope or colposcope. It can be divided into 2 smaller groups:
- stage 1A1
- stage 1A2
Stage 1A1 means the cancer has grown 3 millimetres (mm) or less into the tissues of the cervix.
Stage 1A2 means the cancer has grown between 3 and 5 mm into the cervical tissues.
Stage 1B
In stage 1B 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 5mm. It can usually be seen without a microscope, but not always. It can be divided into 3 groups:
- stage 1B1
- stage 1B2
- stage 1B3
In stage 1B1 the cancer is deeper than 5mm but no more than 2cm in size.
In stage 1B2 the cancer is at least 2cm but not bigger than 4cm in size.
In stage 1B3 the cancer is larger than 4cm but is still only in the cervix.
Treatment
The stage of your cancer helps your doctor to 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
- other health conditions that you have
Stage 1 cervical cancer is usually treated with:
- cone biopsy or surgery
- combined chemotherapy and radiotherapy (chemoradiotherapy)
Surgery
Stage 1A1
For stage 1A1 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.
If the cone biopsy has positive margins (the border around the tumour contains cancer cells), you will have another cone biopsy.
Some people with stage 1A1 cancer may also have lymph nodes removed if there is a risk that the cancer cells may spread to lymph nodes. Your doctor may offer this if the cancer cells show lymphovascular space invasion (LVSI).
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
- fallopian tubes
Stage 1A2
If you wish to preserve your fertility, your doctor may offer you one of the following treatments for stage 1A2 cancer:
- 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’d 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 tumour)
- no lymph nodes with cancer cells are found
If the above treatments are not possible, you might have a simple or radical hysterectomy. Which surgery you will have, will depend on your individual circumstances.
A simple hysterectomy includes the removal of the:
- cervix
- womb
- fallopian tubes
A radical hysterectomy includes the above, as well as the:
- tissue around the cervix
- the upper part of the vagina
- lymph nodes in the area between the hip bones (pelvis)
- it might include removal of the ovaries
Stage 1B1 and 1B2
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
- it might include the removal of the ovaries
During surgery, your surgeon may also remove the lymph nodes in the area between the hip bones (pelvis).
Combined radiotherapy and chemotherapy (chemoradiotherapy)
With this treatment, you have chemotherapy during your course of radiotherapy.
You might have chemoradiotherapy if:
- you have cancer cells in lymph nodes or the tissues around the cervix
- the border around the tumour contains cancer cells (positive margins)
- there is a high level of lymphovascular space invasion
- your tumour is larger than 4cm (stage 1B3)
- you are not fit for surgery but your doctor think you are fit enough for chemoradiotherapy
You have daily external radiotherapy for 5 days every week for 5 to 5 and a half weeks.
During your course of radiotherapy, you also have chemotherapy once a week.
You also have a boost of internal radiotherapy (brachytherapy) at the end of your course of external radiotherapy.
