Cervical cancer develops when cells in the cervix, the lower part of the uterus, grow abnormally. Understanding the cancer’s extent, known as staging, guides treatment decisions. This article details Stage 1 cervical cancer, including its characteristics, detection, and treatment.
Defining Stage 1 Cervical Cancer
Stage 1 cervical cancer means the cancer is confined to the cervix and has not spread to nearby lymph nodes or distant sites. This early stage is categorized into substages, 1A and 1B, based on the depth of invasion and tumor size.
Stage 1A involves microscopic invasion, visible only under a microscope. This substage is divided into 1A1 and 1A2. Stage 1A1 means the cancer has invaded 3 millimeters (mm) or less into cervical tissue. Stage 1A2 indicates invasion from more than 3 mm but not exceeding 5 mm.
Stage 1B includes cases where the cancer has invaded deeper than 5 mm, or is clinically visible. This substage is further broken down by tumor size. Stage 1B1 describes a tumor more than 5 mm deep but no larger than 2 centimeters (cm). Stage 1B2 refers to a tumor larger than 2 cm but not exceeding 4 cm. The largest Stage 1 substage, 1B3, applies when the tumor is greater than 4 cm, but remains confined to the cervix.
Signs and Diagnosis
Stage 1 cervical cancer often presents with no noticeable symptoms, making routine screening important for early detection. When symptoms do occur, they can be subtle and may include abnormal vaginal bleeding, such as bleeding after sexual intercourse, between menstrual periods, or after menopause.
Regular Pap tests, also known as Papanicolaou tests, and Human Papillomavirus (HPV) tests are important screening tools that can detect precancerous changes or early cancer before symptoms appear. An abnormal screening result prompts further investigation to confirm a diagnosis.
Following an abnormal screening, a colposcopy is performed, which involves examining the cervix with a magnifying instrument to identify suspicious areas. If abnormal areas are found, tissue samples are taken through a biopsy for pathological examination. This might involve a punch biopsy, endocervical curettage, or a cone biopsy, which removes a cone-shaped piece of tissue. Imaging techniques like MRI or CT scans may be used in some cases to help assess the extent of the cancer before treatment.
Treatment Options
Treatment for Stage 1 cervical cancer is often effective and primarily involves surgery. The choice depends on the cancer’s substage and the individual’s desire to preserve fertility, aiming to remove cancer while minimizing impact on reproductive health.
For very early Stage 1A cases, especially if fertility preservation is desired, a cone biopsy (conization) or Loop Electrosurgical Excision Procedure (LEEP) may suffice. These procedures remove a cone-shaped piece of the cervix containing abnormal cells.
Hysterectomy, the removal of the uterus and cervix, is a common option, especially for larger Stage 1 tumors or when fertility preservation is not a concern. A simple hysterectomy may be performed, though radical hysterectomy might be considered based on the substage.
For individuals with Stage 1A2 or small 1B1 tumors who wish to preserve their ability to have children, a radical trachelectomy might be an option. This procedure removes the cervix, the upper part of the vagina, and surrounding tissues, while leaving the main body of the uterus intact. Radiation therapy or chemotherapy are not primary treatments for Stage 1 cervical cancer. However, they may be considered if cancer cells are found in lymph nodes, at the margins of removed tissue, or if surgery is not feasible.
Outlook and Follow-up
Stage 1 cervical cancer has a favorable outlook due to early detection and limited spread. The 5-year relative survival rate for cervical cancer diagnosed at an early stage is approximately 91%.
After treatment, regular follow-up appointments are important to monitor for any signs of recurrence and to support long-term health. These appointments involve pelvic examinations, Pap tests, and HPV tests. Imaging studies may also be utilized if there are concerns about recurrence. Maintaining a healthy lifestyle and adhering to recommended screening schedules contribute to overall well-being and continued monitoring.