Stage I cervical cancer encompasses a wide range of clinical disease from microscopic microinvasive tumors to bulky lesions measuring as much as 10 cm in diameter. Tumor volume and lymph node status are the most important predictors of recurrence and survival. Assessment of tumor volume using the parameters of clinical substage, depth of stromal invasion, and cervical diameter are currently used to determine primary therapy. Patients with positive lymph nodes are at high risk for recurrence and should be treated aggressively. Features that may be predictive of treatment failure in node-negative patients include nonsquamous histology, poor histologic differentiation, lymphatic space invasion, and altered host immune responses. Further investigation of stage I patients should focus on the determination of an optimal management approach for high-risk patients with lymph node involvement of bulky tumors, and identification of secondary prognostic features that can target low-risk patients who might benefit from adjuvant therapy.