Dear Colleagues,

Cervical cancer (CC) is one of the most common malignancies to occur in women. In 2022, there were approximately 660,000 new cases and 350,000 deaths worldwide.

The treatment of early-stage cervical cancer depends primarily on tumor extent along with the patient's medical condition and preferences regarding fertility. In patients with FIGO stage IA1 cervical cancer, fertility can be preserved by a conservative approach. In stage IA2, trachelectomy is indicated for women who wish to maintain fertility. Conization may be an option in cases of absence of vascular/lymphatic invasion, negative cone margins, squamous carcinoma of any grade,  usual type adenocarcinoma of grade 1 or 2, tumor size ≤ 2 cm, depth of invasion ≤ 10 mm, and negative imaging for metastatic disease.

When there is no need or possibility to preserve fertility, hysterectomy with bilateral salpingo-oophorectomy is the preferred surgical procedure. The decision to perform radical surgery depends on many factors, including tumor size. In early-stage cervical cancer, the pelvic recurrence rate is similar when comparing radical and simple hysterectomies and radical hysterectomy is indicated for tumors larger than 2 cm.

Survival decreases markedly as the number of positive lymph nodes increase. Lymph node positivity is the main prognostic factor in early-stage cervical cancer. The highest lymph node positivity is detected below the iliac bifurcation. Recent studies have demonstrated that undergoing a hysterectomy in patients with lymph node involvement found intraoperatively does not improve survival. Therefore, the surgical procedure should be abandoned and the patient should be referred for medical therapy.

This special issue focuses on new treatment methods for early-stage cervical cancer and emphasizes how these can be tailored to patients considering new implications and future prospectives.

Dr. Violante Di Donato and Dr. Andrea Giannini
Guest Editors