Conservative Surgery for Women With Cervical Cancer

Stage IA2 or IB1 cervical cancer is currently treated by a radical hysterectomy (removal of
the uterus, cervix, and the parametrium) or radical trachelectomy (removal of the cervix and
the parametrium). The parametrium is the tissue next to the uterus and cervix that holds
these organs in place. Pelvic lymph nodes and possibly para-aortic lymph nodes (near the
aorta in the abdomen) are also removed. This procedure is called a pelvic and para-aortic
lymphadenectomy. While these surgeries are very effective, significant side effects can
occur, such as bladder, bowel, and/or sexual dysfunction.

Conservative surgery involves the removal of the pelvic lymph nodes (pelvic lymphadenectomy)
and/or lymphatic mapping with sentinel lymph node biopsy. The cervix and parametrium are left
intact. During surgery, for women no longer wanting children, a simple hysterectomy (removal
of the uterus with or without removal of the fallopian tubes and ovaries) can also be
performed. In this study, participants will have conservative surgery.

Screening Tests:

Signing this consent form does not mean that you will be able to take part in this study. You
will have "screening tests" to help the doctor decide if you are eligible to take part in
this study. The following tests and procedures will be performed:

You will have a cervical cone biopsy and endocervical curettage (ECC) performed. A cone
biopsy is surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal.
It is used to diagnose cervical cancer and also to learn how extensive the disease is. An ECC
is a procedure using a curette, a spoon-shaped instrument, that is used to scrape the mucus
membrane of the endocervical canal (passageway between cervix and uterus) in order to get a
tissue sample.

The tissue taken from both of these procedures will be reviewed by a pathologist from
MDAnderson.

If your tissue samples are negative for invasive cancer or adenocarcinoma-in-situ (AIS), you
will be eligible for conservative surgery.

If your tissue samples are positive for invasive cancer and/or AIS, you may have the cervical
cone biopsy and ECC repeated. If the tissue samples are negative after the second procedure,
you will be eligible for conservative surgery. If your tissue samples from the second
procedure are positive, you will be removed from study and other treatment options will be
offered.

Conservative Surgery:

If you are found to be eligible to take part in this study, you will have conservative
surgery. You will be taken to the operating room where you will be put to sleep using general
anesthesia. You will have your pelvic lymph nodes removed by pelvic lymph node dissection
and/or lymphatic mapping with sentinel lymph node biopsy, however, the parametrium is left
intact. If you no longer want to have children, you can have a simple hysterectomy. Removal
of the pelvic lymph nodes takes about 1-2 hours. If you also decide to have a simple
hysterectomy, this procedure will take about 2 hours.

You will sign a separate consent for this surgery/procedure, which will discuss the risks in
more detail.

Study Procedures:

If you agree to take part in this study, the following information will be collected from
your medical record and/or you will be asked for this information when you enroll in the
study:

- Age at the time of the cancer diagnosis

- Race

- Height and weight to determine body mass index (BMI)

- Menopausal status

- Symptoms

- History of sexually transmitted diseases

- Smoking history

- Child bearing history

The following information will be collected from your medical record and/or you will be asked
for this information after surgery:

- How long the surgery took to complete

- What procedures were performed during the surgery

- How long you were in the hospital

- If there was any blood loss before or after surgery

- If blood transfusions were performed before or after surgery

- What complications, if any, happened that were related to the surgery

Starting 3 months after your first visit after surgery, you will have study visits every 3
months for 2 years. At these visits, the following tests and procedures will be performed:

- You will have a physical exam.

- You will have a pelvic exam.

- You will have a pap smear.

You will be contacted by telephone or by mail every year for 3 years. You will be asked if
the cancer has returned, when you last saw your doctor, and any complications or problems you
may be having. If you are called, the call will take less than 10 minutes.

Length of Study:

You may remain on study for 5 years after surgery. You will be taken off study early if
either the lymph nodes or cervix (if a simple hysterectomy was performed) removed during
surgery contain cancer.

This is an investigational study. Up to 195 patients will take part in this multicenter
study. Up to 40 participants will be enrolled at MD Anderson and the Harris Health System.

Inclusion Criteria:

1. Histologically confirmed squamous cell carcinoma of the cervix (any grade) or
Histologically confirmed grade 1 or 2 adenocarcinoma of the cervix

2. FIGO stage IA2 or IB1 disease

3. Tumor diameter
4. No lymphovascular space invasion (LVSI) present on biopsy or previous cone

5. Less than 10mm of cervical stromal invasion

6. Cone margins and endocervical curettage (ECC) specimen negative for invasive cancer,
cervical intraepithelial neoplasia (CIN) CIN II, CIN III or adenocarcinoma-in-situ. (A
negative margin is defined as no invasive cancer within 1.0mm of both the endocervical
and ectocervical margins and no AIS or CIN II or CIN III at the inked or cauterized
margin; one repeat cone and ECC permitted)

7. Patients are eligible for the study when a cone and ECC are performed prior to
pre-enrollment in the study, and pathologic eligibility criteria are met. The cone and
ECC must be performed within 12 weeks prior to pre-enrollment in the study. If the
cone and ECC performed prior to pre-enrollment do not meet the pathologic criteria,
patients may be pre-enrolled and are allowed 1 repeat cone & ECC after pre-enrollment
in order to meet pathologic eligibility criteria.

8. Patients must sign an approved informed consent document

9. If patient is of childbearing potential, she must have a negative blood or urine
pregnancy test within 14 days of surgical treatment on study.

10. Imaging with Positron emission tomography (PET) scan, computed tomography (CT) scan of
the abdomen and pelvis, and/or magnetic resonance imaging (MRI) of the abdomen and
pelvis must be performed and negative for metastatic disease within 12 weeks of
enrollment.

Exclusion Criteria:

1. Clear cell, neuroendocrine, adenosquamous, serous carcinoma or other high-risk
histologies

2. Grade 3 adenocarcinoma

3. FIGO stage IA1, IB2, II, III or IV disease

4. Tumors >2 cm in diameter on physical exam or imaging studies

5. Presence of LVSI

6. Greater than or equal to 10mm of cervical stromal invasion

7. Cone margins or ECC specimen positive for invasive cancer, CIN II, CIN III or
adenocarcinoma-in-situ (one repeat cone permitted)

8. Neoadjuvant radiation therapy or chemotherapy for cervical cancer

9. Patients unwilling or unable to provide informed consent for the study

10. Evidence of metastatic disease on PET, CT, and/or MRI performed within 12 weeks of
enrollment

11. Patients who have had a simple hysterectomy (cut through hysterectomy)