Patient Question: My mother is 58 years old and is menopausal. She was found to be positive for HPV16 during a physical examination. After colposcopy at China-Japan Friendship Hospital, she was examined for CIN3 with glandular involvement and underwent cervical Leep knife conization. The pathology report of the conization showed multiple points of CIN3/CIS with glandular involvement and a little early infiltration. On the other hand, preoperative ultrasound showed atrophy of the uterus and atrophy of the cervix. The pathology report of cervical conization showed multiple points of CIN3/CIS with involvement of glands, one of which was early infiltration. Vaginitis is on medication. There is no other treatment. Based on the conization report, can we determine that it is early invasive cancer? What is the severity, Ia1, Ia2, Ib? Has the CIS part been excised? How likely is it that the blood or lymph nodes are infected? Do you need further tests to confirm the extent of the infection by other means? For example, imaging studies? If hysterectomy is required, should it be an extra-fascia total hysterectomy? Subextensive total hysterectomy? Total extensive? Or which one? Reply from Peng Yong Pai, Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University: In this case, it is treated as cervical cancer stage Ib1. Extensive total hysterectomy with or without pelvic lymphatic dissection. Patient’s question: Why is it treated as stage 1b1? Is the extent of the lesion really at stage 1b1? Or is it due to the non-clear cone cut margin? Response from Peng Yong Pai, Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University: The medical treatment principle: safe, effective and as little trauma as possible. Safety should be given priority when it cannot be fully satisfied. Take a look at your current condition: carcinoma in situ, positive cut margin, and the presence of early infiltrative lesions. If you are sure that the infiltrating lesion is only stage Ia1, you can have a total hysterectomy. If it is not completely sure that it is only stage 1al, the scope should be slightly expanded to be safe. Otherwise, the lesions will be left behind and will cause a lot of harm. Choosing a larger scope may cause a little more damage to the patient, but it is easy for a very experienced gynecologic oncologist. The side effects are also within the tolerable range. One of the benefits is safety. Patient question: I had a total hysterectomy two weeks ago. The pathology report is shown in the picture, is radiotherapy or chemotherapy recommended? If so, how soon do I need to start? What is the duration of treatment? Thanks a lot! Reply from Peng Yong Pai, Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University: Very well, your doctor is quite experienced and was able to perform surgery according to stage 1b of cervical cancer. From the surgical pathology, it was eventually stage Ib. It should be said that the surgery solved the problem and no other adjuvant treatment should be needed. NCCN 2015 clinical practice guideline on cervical cancer regarding whether adjuvant radiotherapy is indicated after extensive hysterectomy plus pelvic lymph node dissection looks at three aspects: whether choroidal invasion, depth of tumor invasion into the cervical mesenchyme and tumor size.