Cervical Cancer · By FIGO Stage + Approach

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] FIGO stage + fertility wish
   FIGO stage? LVSI? Fertility-sparing?
   • IA1, no LVSI → IA1 no LVSI → conization/hysterectomy
   • IA1+LVSI / IA2 → IA1+LVSI/IA2 → modified radical + nodes
   • IB1-IB2 / IIA1 (early, operable) → IB1-2/IIA1 → radical hysterectomy
   • Early, small tumor (generally ≤2 cm), young wanting fertility preservation → Early small-volume → radical trachelectomy
   • Locally advanced IB3 / II-IVA → Locally advanced → concurrent chemoradiation
2. [End] IA1 no LVSI → conization/hysterectomy
   IA1 no LVSI → cervical conization (negative margins, wants fertility) or extrafascial total hysterectomy (completed childbearing); follow-up.
3. [End] IA1+LVSI/IA2 → modified radical + nodes
   IA1+LVSI / IA2 → modified radical hysterectomy + pelvic nodes/sentinel; radical trachelectomy for those wanting fertility.
4. [End] IB1-2/IIA1 → radical hysterectomy
   IB1-IB2 / IIA1 → radical hysterectomy + pelvic lymph node dissection (± sentinel); open abdominal is superior to minimally invasive (LACC trial: minimally invasive had worse disease-free/overall survival); high-risk factors (margin/parametrial/node positive) → adjuvant chemoradiation.
5. [End] Early small-volume → radical trachelectomy
   Early, small tumor (generally ≤2 cm), young wanting fertility preservation → radical trachelectomy + pelvic node assessment.
6. [End] Locally advanced → concurrent chemoradiation
   Locally advanced IB3 / II-IVA → definitive concurrent chemoradiation (platinum-based) + brachytherapy; surgery is not first-line.

Source guidelines & references

• Cervical cancer management (NCCN/ESGO; LACC trial open superior to minimally invasive radical surgery)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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