A 38-year-old woman has FIGO Stage IB2 squamous cell carcinoma of the cervix (tumor >4 cm confined to cervix). She desires future fertility. Which statement is MOST accurate regarding her management options?

• A Radical trachelectomy is the standard fertility-sparing option for Stage IB2
• B Simple hysterectomy with pelvic lymph node dissection is adequate for IB2
• C Radical hysterectomy (Wertheim's) with pelvic LN dissection is the preferred surgical option
• D Concurrent chemoradiation is preferred over radical hysterectomy for IB2 disease ✓

Explanation

For Stage IB2 cervical carcinoma (>4 cm), concurrent chemoradiation (cisplatin-based) is the preferred primary treatment and has equivalent or superior outcomes compared to radical hysterectomy, with lower surgical morbidity for bulky disease. Radical trachelectomy is feasible for fertility preservation only in Stage IB1 (≤4 cm) tumors. Radical hysterectomy (Wertheim's) is appropriate for IB1 and select IB2 cases but the 2018 FIGO reclassification and current evidence favor chemoradiation for IB2. Simple hysterectomy is inadequate for invasive carcinoma.

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

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