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Cervical cancer — staging and treatment
Early cervical cancer (up to IB2) is treated with radical surgery, and locally advanced disease (IB3 to IVA) with chemoradiation using weekly cisplatin and brachytherapy — and finishing in a short overall time matters as much as the dose.
Why it matters in the exam
Cervical cancer appears in the radiation and gynaecology parts of the exam. Stems give a woman with a FIGO stage, tumour size and nodal status, and ask about standard treatment, the role of PET-CT in staging, adjuvant treatment after surgery and treatment of recurrent or metastatic disease.
It is important to master the FIGO changes of 2018: tumour size splits stage IB into three groups, and hydronephrosis or nodal involvement raise the stage to III. A common distractor is choosing surgery for a locally advanced tumour, or choosing a minimally invasive approach that showed poorer survival.
Key points
- Up to stage IB2 open radical surgery, and from stage IB3 chemoradiation with weekly cisplatin and brachytherapy.
- In stage III–IVA pembrolizumab is added to chemoradiation, because the addition improved survival compared with chemoradiation alone.
- PET-CT detects para-aortic nodes and distant metastases, so it changes the radiation field and sometimes the whole goal of treatment.
- All radiation, including brachytherapy, must be completed within 8 weeks, because breaks and prolonged treatment let the tumour repopulate.
- In recurrent or metastatic disease: platinum with paclitaxel and bevacizumab, and pembrolizumab when PD-L1 is positive.
Summary table
| FIGO stage | Definition | Treatment |
|---|---|---|
| IA1 | Invasion up to 3 mm | Conisation for fertility preservation or simple hysterectomy |
| IA2 to IB2 | Tumour confined to the cervix up to 4 cm | Open radical hysterectomy with pelvic node removal; tumour up to 2 cm — radical trachelectomy for fertility is possible |
| IB3 to IVA | Tumour above 4 cm, parametrial, pelvic wall, hydronephrosis, nodes or bladder or rectal mucosa | Chemoradiation with weekly cisplatin 40 mg/m² and brachytherapy; in stage III–IVA add pembrolizumab |
| IIIC | Pelvic (C1) or para-aortic (C2) nodes | Extended-field radiation to the para-aortic area for C2 nodes; PET-CT detects them |
| After surgery | Positive margins, parametrium or nodes — chemoradiation; intermediate factors — radiation | Intermediate factors: size, depth of invasion and lymphovascular space invasion |
| Recurrent or metastatic disease | Platinum with paclitaxel and bevacizumab, with pembrolizumab when PD-L1 is positive | Tisotumab vedotin in second line |
| Treatment duration | Complete all radiation including brachytherapy within 8 weeks | Prolonging overall treatment time lowers local control and survival |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
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Sources
- NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer, 2026 — Primary treatment and principles of radiation therapy
- FIGO Staging of Cancer of the Cervix Uteri, 2018 — Staging rules
- ESGO-ESTRO-ESP Guidelines for the Management of Patients with Cervical Cancer, 2023 — Treatment recommendations
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.