Objective.The aim of the study was to evaluate the prog-nostic significance of tumor geogra phy,defined as exo-phytic or barrel -shaped growth,in b ulky(>4cm)cer-vical cancer.Methods.Four hundred women with cervical cancer,treated by primary radical h ysterectomy between January 1984and November 2000,were followed in a prospective cohort study.Clinical and pathology data were stored in a databank and the clinical protocolwas un-changed during the study except for t he amendment of ad-ditional indications of postoperative radiation in 1997.The assessment of tumor geography was based on pelvic exam-ination at the time of tumor staging o r radical hysterectomy or from the pathology report.Surviv al probabilities were calculated by the Kaplan -Meier meth od and compared with the log -rank test.Results.The mean age of the patients was 45years and the mean follow -up duration 48months.Tumors were of squamous cell type in 291patients(73%).Lymph node metastases were present in 91pa-tients(24%)and postoperative radiation was giv en in 179patients(45%).In 291patients,tumor diameter was<4cm;in 58patients,the tumor was defi ned as bulky exo-phytic and in 51patients as bulky barrel shaped.There were no differences among these thre e groups in terms of operating time,blood loss during su rgery or complications at3or 6months postoperatively.Bulky exophytic tumors had an identical overall survival as com pared to small -diam-eter(<4cm)tumors.The overall survival(OS)of bulky barrelshaped tumors was significan tly worse(P<10 -4 ).The same was found for disease -free s urvival(DFS).Conclusion.Bulky exophytic cervic al cancer has an iden-tical surgical morbidity,overall a nd disease -free survival as compared to nonbulky(<4cm)cervical cancer.In view of these identical characteris tics,primary surgical treatment should be considered for p atients with bulky ex-ophytic cervical cancer. Objective. Objective of the study was to evaluate the prog-nostic significance of tumor geogra phy, defined as exo-phytic or barrel -shaped growth, in b ulky (> 4cm) cer-vical cancer. Methods of women with cervical cancer, treated by primary radical h ysterectomy between January 1984 and November 2000, were followed in a prospective cohort study. Clinical and pathology data were stored in a databank and the clinical protocol was un-changed during the study except for t he amendment of ad-ditional indications of postoperative radiation in 1997. the assessment of tumor geography was based on pelvic exam-ination at the time of tumor staging or radical hysterectomy or from the pathology report. Surviv al probabilities were calculated by the Kaplan-Meier meth od and compared with the log-rank test. Results. The mean age of the patients was 45years and the mean follow-up duration 48months.Tumors were of squamous cell type in 291patients (73%). Lymph node metastases were present in 91pa-tients (24%) and postoperative radiation was giv en in 179 patients (45%). In 291patients, tumor diameter was <4 cm; in 58patients, the tumor was defi ned as bulky exo-phytic and in 51patients as bulky barrel shaped.There were no differences among these threels e groups in terms of operating time, blood loss during sugery or complications at 3or 6months postoperatively. Bleomyxoid tumors had an identical overall survival as com pared to small-diam-eter (<4cm) tumors. Overall survival (OS) of bulky Barrelshaped tumors were significantly worse (P <10 -4). The same was found for disease-free s urvival (DFS). Confound.Bulky exophytic cervic al cancer with an iden-tical surgical morbidity, overall a nd disease-free survival as compared to nonbulky (<4cm) cervical cancer. In view of these identical characteris tics, primary surgical treatment should be considered for p atients with bulky ex-ophytic cervical cancer.