A 25-year-old nulliparous woman is diagnosed with Stage IA2 squamous cell carcinoma of the cervix (depth of invasion 4 mm, horizontal spread 6 mm) on cone biopsy with clear margins. She strongly desires fertility. The most appropriate fertility-sparing surgical option is:

• A Repeat cone biopsy alone (since margins are clear)
• B Radical vaginal or abdominal trachelectomy with pelvic lymph node dissection ✓
• C Simple trachelectomy (cervicectomy) without lymph node dissection
• D Neoadjuvant chemotherapy followed by simple hysterectomy preserving ovaries

Explanation

For Stage IA2 cervical cancer (FIGO 2018: invasion 3–< 5 mm, any horizontal spread) in a woman desiring fertility preservation, radical trachelectomy (vaginal — Dargent procedure, or abdominal) combined with pelvic lymph node dissection (sentinel node biopsy or full dissection) is the standard of care. This provides adequate surgical margins with radical parametrial resection while preserving the uterine body for future pregnancy. Simple trachelectomy without lymphadenectomy is insufficient for IA2 disease. Repeat cone biopsy alone is inadequate for IA2 with lymphovascular space invasion risk.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.