# Cervical Cancer Management

> Cervical cancer management notes for NEET-PG Obstetrics and Gynaecology: FIGO 2018 staging, radical hysterectomy, chemoradiation, VIA screening, HPV vaccine.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/cervical-cancer-management
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Cervical Cancer Management", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/cervical-cancer-management

## Direct answer

Cervical cancer — virtually always human papillomavirus-driven (types 16 and 18 causing about 70 per cent) — is managed by FIGO 2018 staging (now incorporating imaging and nodes: IIIC1 pelvic, IIIC2 para-aortic): microinvasive IA1 by cone biopsy or extrafascial hysterectomy, tumours below 4 cm (IB1-IIA1) by type C radical hysterectomy (Wertheim's) with pelvic lymphadenectomy, and locally advanced disease (IB3-IVA) by concurrent chemoradiation — external beam plus weekly cisplatin 40 mg per square metre followed by brachytherapy. India carries roughly a fifth of the world's cases, which makes the national response — acetic-acid screening for women over 30 with screen-and-treat ablation, and HPV vaccination for 9-14-year-old girls — as examinable as the surgery.

## What you must remember

- **Staging skeleton (FIGO 2018):** IA1 under 3 mm, IA2 3-5 mm, IB1 under 2 cm, IB2 2-4 cm, IB3 over 4 cm; IIA upper vagina, IIB parametrium; III pelvic wall, lower vagina, or hydronephrosis (IIIC1 pelvic, IIIC2 para-aortic nodes); IV mucosa or distant spread.
- **Early-stage surgery:** IA1 without lymphovascular invasion — cone biopsy (fertility preserved) or extrafascial hysterectomy; IB1-IIA1 — type C1 nerve-sparing radical hysterectomy (Wertheim's) with pelvic lymphadenectomy; radical trachelectomy (Dargent's) plus node dissection for tumours under 2 cm in selected young women.
- **The chemoradiation standard:** IB3, IIA2 and IIB-IVA receive external beam radiotherapy (45-50 Gy) with weekly cisplatin 40 mg/m² for five to six weeks, then intracavitary brachytherapy (point A about 28-30 Gy); chemoradiation beat radiotherapy alone by about 12 per cent absolute survival in the landmark meta-analysis.
- **Adjuvant treatment after surgery:** chemoradiation for high-risk factors (nodes, margins, parametrium); radiotherapy alone for intermediate-risk combinations (deep invasion, lymphovascular space invasion, large tumour — Sedlis).
- **Recurrent disease:** central recurrence after radiation — pelvic exenteration; after surgery — chemoradiation; metastatic — platinum doublets, bevacizumab adding survival.
- **Screening in India:** visual inspection with acetic acid for women 30-65 every five years, with immediate cryotherapy or thermal ablation of precancer (screen-and-treat); Pap every three years and HPV DNA every 5-10 years as alternatives.
- **Precursor management:** CIN2/3 by LEEP or cold-knife conisation; adenocarcinoma in situ demands conisation with clear margins, usually hysterectomy once fertility is complete.
- **Vaccines:** quadrivalent (6, 11, 16, 18) and nonavalent products globally, and Cervavac, India's indigenous quadrivalent vaccine; the national immunisation for 9-14-year-old girls is rolling out — two doses below 15 years (0 and 6 months), three at 15 or older.

## One algorithm, three women

Woman one, 34, screen-positive on visual inspection with acetic acid: colposcopy shows a high-grade lesion, LEEP returns CIN3 with clear margins — cured, annual follow-up. Woman two, 46, a 3 cm carcinoma under the 4 cm threshold: surgical after imaging excludes nodes — type C radical hysterectomy with pelvic nodes; a positive node converts her to IIIC1 and adjuvant chemoradiation follows. Woman three, 52, fungating growth with left hydronephrosis — IIIB, nodes unknown: a radiotherapy patient, full stop; the surgeon biopsies and stages, the oncologist delivers external beam with weekly cisplatin and image-guided brachytherapy. The teaching spine is the fork at 4 cm and the parametrium: below it surgery, beyond it chemoradiation — trials showed only added morbidity when surgery entered bulky, parametrial disease.

## India's burden and its programme math

India registers about 1.2 lakh new cases and 77,000 deaths yearly (GLOBOCAN-era figures) — roughly one in five of the world's cases, most diagnosed at stage III-IV because screening coverage is low. The national response has three prongs: screening women 30-65 with visual inspection with acetic acid at Ayushman Arogya Mandirs, with immediate thermal ablation or cryotherapy — a single-visit screen-and-treat policy from WHO's elimination strategy; colposcopy referral at district hospitals; and HPV vaccination — Cervavac, the indigenous quadrivalent vaccine, rolling out nationally for 9-14-year-old girls, the highest-leverage prevention decision in the country's history. The remaining realities: brachytherapy access rate-limits cure in government oncology, palliative care reaches a minority, and the viva asks for point A (2 cm above the external os on the uterine axis), the weekly cisplatin dose (40 mg/m²), and the IIIC1/IIIC2 distinction.

## Frequently asked questions

### What defines stage IA1 and how is it treated?

Under 3 mm depth and 7 mm width — cone biopsy with clear margins (fertility preserved) or extrafascial hysterectomy; lymphovascular invasion upgrades management.

### Which stages receive radical hysterectomy rather than radiotherapy?

IB1-IIA1 — tumours up to 4 cm without parametrial or lower-vaginal extension — type C radical hysterectomy with pelvic nodes, chemoradiation reserved for adjuvant or bulky situations.

### What is the chemoradiation regimen for locally advanced disease?

External beam 45-50 Gy with weekly cisplatin 40 mg per square metre for five to six cycles, then intracavitary brachytherapy delivering roughly 28-30 Gy to point A.

### What are the Sedlis intermediate-risk criteria?

Combinations of deep (outer-third) invasion, lymphovascular space invasion, and tumour size — any two warrant adjuvant radiotherapy.

### What is India's indigenous HPV vaccine and who receives it?

Cervavac, the Serum Institute of India's quadrivalent HPV vaccine (6, 11, 16, 18), rolling out nationally for 9-14-year-old girls — two doses if under 15.