Ans-D i.e., Intracavity brachytherapy followed by external beam radiotherapy Stage 1IA * Invasion limited to the measured stromal invasion with the maximum depth of 5mm and not wider than 7 mm IA1 * Invasion of stroma not greater than 3 mm in depth and no wider than 7mmIA2 * Measured invasion of stroma greater than 3mm but not greater than 5mm and not wider than 7 mm At this stage, the cancer is micro-invasiveMicroinvasive cervical cancer carries a minor risk of lymph node involvement and excellent prognosis following t/t.Therefore conservative t/t i.e., "conization" may also be considered many in these patients.Management of Stage IA1These are associated with the lowest risk of lymph node involvementThe risk increases only when there is lymphovascular space invasionThe t/t also varies according to the lymphovascular space invasion Lymphovascular space - Fertilities to be preserved invasion absent - Cervical Conization Do not wish to retain fertilities - Total infra fascial hysterectomy Lymphovascular - Modified radical hysterectomy and space invasion present pelvic lymphadenectomyManagement of State IA2These patients have 7% risk of lymph node metastasis and a greater than 4% risk of disease recurrence.Conservative management cannot be done for this degree of micro-invasion.These patients require "modified radical hysterectomy and pelvic lymphadenectomyIf fertility is to be preserved - Radical trachelectomy and lymphadenectomyPatients with micro-invasive cancers (Stages IA1and IA2) can also be treated with intracavitary brachytherapy aloneThis is usually done in older women who do not wish to preserve ovarian or sexual function stage IB* Clinical lesions confined to the cervix or preclinical lesions greater than IAIB,* Clinical lesions <=4 cm in sizeib2* Clinical lesions >=4 cm in sizeSTAGE II* Carcinoma extends beyond the cervix but has not extended to the pelvic wall, involves vagina, but not lower thirdHa* No obvious parametrial involvement but do extend vaginally at far as proximal thirdHb* Invades vagina to a similar extent as well as invade the parametriumManagement of stage IB to IIa TumoursBoth Radiotherapy and surgery are viable options in these patientsThe current practice is: IB1 ib2Radical hysterectomyManaged primarily with chemoradiation similar to advanced staged cancers* In general radical hysterectomy for stage IB through IIA tumors is usually selected for younger women with low BMI's who wish to preserve ovarian function and have concerns about sexual function following radiotherapy. STAGE IIICarcinoma has extended to the pelvic wall on pelvic examination there is no cancer-free space between the tumor and the pelvic wallTumor involves a lower third of the vaginaAll cases with hydronephrosis or nonfunctioning kidney should be includedIIIAIIIbInvolvement of lower third of vagina but no extension to the pelvic wallExtension to the pelvic wall, or hydronephrosis or nonfunctioning kidney due to the tumor.STAGE IV* Carcinoma has extended beyond the true pelvis or has clinically involved mucosa of bladder or rectumIVa* Spread of growth the adjacent organsIVB* Spread to distant organsManagement of stage IIB through IVa These are advanced stage cervical cancers, they extend past the confines of the cervix and often involve adjacent organs and retroperitoneal lymph nodesMost of the advanced stage tumors have a poor prognosis and their survival rate is less than 50%Two treatment modalities are available for these patientsRadiation therapyChemoradiation"Radiation therapy" was the cornerstone of advanced stage cervical cancer managementBut current evidence indicates that concurrent chemotherapy significantly improved overall and disease-free survival of women with advanced cervical cancerThus most patients with stage IIB through IVA cervical cancer are best treated with "chemoradiation" - Cisplatin containing regimens are associated with best survival rates since chemoradiation is not given in the option, radiotherapy is the answer.Management of stage IVBThey have poor prognosis and are treated with a goal of palliationThey are administeredPelvic radiation - To control vaginal bleeding and painSystemic chemotherapy - To palliate symptoms