Invasive cancer of the cervix

Invasive cervical cancer remains the second commonest female malignancy worldwide. Early-stage disease may be asymptomatic. Advances in imaging techniques have improved selection of the appropriate treatment approach. Treatment options vary for each stage. An excisional cone is sufficient for treatment of micro-invasive disease (Ia1) provided the margins are clear. The management of stage Ia2 disease is more controversial. Surgery and radiation have similar survival rates for stage Ib–IIa disease, while the combination of both increases morbidity. Later stage tumours (IIb–IV) should be treated with chemoradiation as this is related to improved survival but also higher short- and medium-term toxicity in comparison to radiotherapy alone. Fertility-sparing surgical techniques such as radical trachelectomy may be appropriate in selected cases. Management of recurrent disease depends on the initial treatment, the individual characteristics and the presence of distant disease. Management of cervical cancer during pregnancy remains a challenge and appropriate counselling on individual patient basis is necessary. As the disease usually affects young women, psychological morbidity is significant and emotional support is essential.