How should I approach the management of a patient diagnosed with early-stage cervical cancer in terms of referral and treatment options?

Referral: For a patient diagnosed with early-stage cervical cancer, an urgent referral to colposcopy or gynaecology oncology for specialist assessment should be arranged using a 2-week cancer pathway. This referral should not be delayed regardless of previous normal cervical screening results or pregnancy status.

Initial Assessment: Specialist assessment may include punch or excisional biopsy procedures such as loop electrosurgical excision and conization of suspicious lesions to confirm diagnosis and assess margins.

Staging and Investigations: Further investigations to determine the extent of disease include clinical, radiological, and pathological staging using the 2018 FIGO system. MRI is used to determine tumour size and local extension, while chest X-ray and renal imaging assess for metastases and hydronephrosis. Examination under anaesthesia and sentinel node biopsy or PET/CT may be required to evaluate lymph node involvement and distant spread.

Treatment Options for Early-Stage Disease: For stage IA1 (microinvasive disease), treatment typically involves loop electrosurgical excision or conization aiming for negative margins of both cancer and dysplasia. Treatment decisions consider the patient’s age, wishes, comorbidities, and fertility preservation desires.

Multidisciplinary Management: Management is undertaken by a multidisciplinary team including gynaecology oncologists, clinical oncologists, radiologists, and clinical nurse specialists to plan specialist treatment and provide counselling about prognosis.

Supportive Care: Patients should be offered smoking cessation advice, HIV testing if appropriate, emotional and psychological support, management of treatment side effects, sexual dysfunction, early menopause, bladder and bowel symptoms, and lymphoedema. Follow-up includes assessment for symptoms suggestive of recurrence.