To summarize the available evidence on the management of cervical cancer in older women across early and advanced disease stages, with particular attention to treatment selection, feasibility, tolerance, and specific clinical situations, including cervical cancer associated with pelvic organ prolapse.

A narrative review was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library. Studies addressing surgery, radiotherapy, concurrent chemoradiotherapy, brachytherapy, para-aortic lymphadenectomy, cervical cancer associated with pelvic organ prolapse, and pre-treatment geriatric assessment were considered. The evidence was synthesized qualitatively according to six predefined clinical questions.

In early-stage disease, radical hysterectomy is feasible in selected fit elderly patients but is associated with increased perioperative morbidity, with advancing age. The available evidence does not establish whether surgery or definitive radiotherapy provides superior oncological outcomes in this population. In locally advanced cervical cancer, concurrent chemoradiotherapy appears to improve survival compared with radiotherapy alone in selected older patients, but with increased toxicity. Brachytherapy is associated with improved local control and survival, yet its use decreased with advancing age. No age-specific evidence demonstrated a survival benefit form pretreatment para-aortic lymphadenectomy. Data on cervical cancer associated with pelvic organ prolapse are limited to heterogeneous case reports and small retrospective studies. Pretreatment geriatric assessment influences treatment decisions in mixed cancer populations, but cervical cancer–specific outcome data are lacking.

Age-specific evidence remains limited and largely retrospective, and chronological age alone should not determine access to standard treatment. Treatment selection requires integration of tumor characteristics, frailty, comorbidities, functional status, expected treatment tolerance, quality of life, and patient preferences.