Invasive cancer of the cervix

Invasive cervical cancer remains the second most common malignancy affecting women worldwide. Early-stage disease may be asymptomatic. Advances in imaging techniques have improved selection of the appropriate treatment modality. Treatment options vary for each stage. Cone biopsy 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 stages Ib–IIa disease, while the combination of both increases morbidity. Later stage tumours (IIb–IV) should be treated with chemo-radiation as it appears to improve survival but also toxicity in comparison to radiotherapy alone. More recent fertility-sparing surgical techniques such as radical trachelectomy may be appropriate in selected cases. Management of recurrent disease depends on the initial treatment modality used, 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.