Cervical cancer was the 9th most common cancer in the world in 2020, accounting for approximately 6.4% of new cancer cases. It was estimated that approximately 604,000 women were diagnosed with cervical cancer and of those, 342,000 died during 2020 (Sung et al., 2021). In most cases, patients with cervical cancer die from multiple organ failure, the key stage of which is lymph node metastasis (LNM) (van Trappen and Pepper, 2002).

Lymph node metastases are arbitrarily classified into two groups that were first designed for breast cancer patients: macrometastases (MAC), metastases greater than 2 mm, and micrometastases (MIC), or LNM larger than 0.2 mm and up to 2 mm. Isolated tumour cells (ITC) are not proper LNM, but are classified as an aggregate of tumour cells not exceeding 0.2 mm (Fig. 1) (Green et al., 2002).

Both MIC and ITC consist of low volume lymph node disease (LVLND). There is growing evidence supporting the notion that MIC have the same prognostic value as macrometastases (MAC) in cervical cancer (Cibula et al., 2012, Guani et al., 2022, Kocian et al., 2020) although some authors challenge this consideration (Buda et al., 2021, Dostálek et al., 2023, Guani et al., 2020). The need to include the status of LNs in the staging, has been considered in the latest cervical cancer classification by the International Federation of Gynaecology and Obstetrics (FIGO) (Bhatla et al., 2019). This latest modification highlighted that positive pelvic LNs, regardless of cervical tumour size, are a major prognostic factor in cervical cancer (Matsuo et al., 2019). This notion forms a premise for expanding knowledge of the biological nature of cervical cancer as well as the mechanisms of its spread and recurrence.

Cervical cancer is potentially preventable using a prophylaxis consisting of primary, secondary, and tertiary stages. Further, an important role of healthcare systems is limiting the incidence of cervical cancer at every stage that it is preventable.

Cervical cancer is an HPV-driven malignancy, (Zur Hausen, 2002) and primary prevention consists in increasing the body’s immunity against high-risk human papillomavirus (hrHPV) by vaccination and increasing awareness of cervical cancer risk factors by educating parents and children. The most effective primary prophylaxis is population-based vaccination against hrHPV when included in the vaccination schedules performed by general practitioners, paediatricians or gynaecologists (Walling et al., 2016 Jul, Lei et al., 2020, Immunization, Vaccines and Biologicals/World Health Organization, 2022).

Secondary prevention can be achieved through screening programmes. Three tests may be available, depending on the setting resources: cervical cytology (Pap smear, or Pap test, which may be either glass-based or liquid-based), molecular diagnostics for hrHPV, and visual inspection (naked-eye examination) of the uterine cervix after applying acetic acid (VIA) (Jeronimo et al., 2016). These preventative measures can be undertaken in gynaecological and obstetrics surgeries, midwifery consulting rooms when such authority has been delegated, and by the patient at home, using a self-testing kit (Hansen, 2023).

The tertiary prevention stage is aimed at reducing the occurrence of sequelae of cancer treatments and limiting the number and extent of necessary interventions. At this stage, the screeners are put on the highest alert and, despite the disease burden borne by the patient, they start treatment, continue diagnostics, and make subsequent follow-up visits (Śniadecki et al., 2022). This prophylactic stage also includes an hrHPV vaccination in cases of women who already have cervical cancer (Jentschke et al., 2020). Preventive measures at this level are carried out in the gynaecological oncology facility at the reference centre.

A summary of all types of prophylaxis is provided in Table 1.

Relatively little is known about tertiary prophylaxis in cervical cancer, especially when it comes to the newly adapted sentinel lymph node (SLN) technique, lymph node ultrastaging, and MICs detection. In our opinion, improving the tertiary stage of prophylaxis is crucial in providing the best care for cervical cancer survivors. Therefore, we determined that this article ought to focus on exploring this topic.

The primary aim of this study was to conduct an overview of current follow-up practices with patients with LVLND. Two secondary objectives were to analyse whether there is a rationale for a ‘LVLND – less extended tertiary prevention’ paradigm, and to propose a model for tertiary prevention in the absence of a ready-made proposal for pN0 patients.