Tracing the Natural History of Cervical Cancer Progression: Lymph Node Metastasis and Opportunities for Prevention

Background: Cervical cancer lymph node metastasis involves lymphovascular space invasion (LVSI), isolated tumor cells (ITC), and micro- and macro-metastases (MIC and MAC), all potential targets for prevention and treatment. Purpose: This study aimed to track cancer spread, identify risk factors for lymph node metastasis, and explore avenues for prevention. Methods: We conducted a retrospective analysis on 27 early cervical cancer patients (tumor size ≤ 4 cm) who underwent sentinel (SLN) and non-sentinel (nSLN) lymph node dissection and histopathological ultrastaging. Patient and tumor characteristics associated with lymph node events (LNE) and prevention efforts were analyzed, following STROBE guidelines. Results: Primary prevention steps were absent, secondary prevention was limited to opportunistic measures, and follow-up served as tertiary prevention. LNE occurred in 11 of 27 cases: 4 with ITC alone, 1 with MIC alone, 1 with both ITC and MIC, 1 with MAC alone, and 4 with both MIC and MAC. Obturator and external iliac lymph nodes were most commonly affected, and only LVSI was a significant predictor of LNE (p < 0.05). Among LNE cases, 9 patients were at FIGO stage 1b1 and 2 at stage 1b2. The smallest tumor with lymph node burden (ITC in both SLN and nSLN) was 2.0 cm, while MAC alone occurred in a single nSLN case. Conclusions: Limited prevention at all levels contributes to lymph node metastasis in about half of early-stage cervical cancer cases. FIGO stages do not adequately predict the extent, type, or distribution of lymph node invasion.