A 34-year-old woman with Stage IB2 cervical cancer (4.5 cm squamous cell carcinoma, confined to cervix) wishes to preserve fertility. She is referred for radical trachelectomy. What is the standard upper limit of tumor size for fertility-sparing radical trachelectomy to be considered appropriate?
- A ≤2 cm with no lymph node involvement ✓
- B ≤4 cm with no parametrial involvement
- C Any size if the margins are clear on frozen section
- D ≤3 cm if squamous histology only
Explanation
Radical vaginal or abdominal trachelectomy (removal of cervix, upper vagina, and parametria with preservation of corpus uteri) is the fertility-sparing surgical option for carefully selected patients with early cervical cancer. The standard eligibility criteria include: desire to preserve fertility, tumor size ≤2 cm (some centers accept up to 2 cm with caution for stage IB1), no lymphovascular space invasion, negative lymph nodes on sentinel node biopsy or pelvic lymphadenectomy, squamous, adenocarcinoma, or adenosquamous histology, and adequate uterine vascularity. Tumors >2 cm have significantly higher recurrence rates and are not ideal candidates; the 4 cm cutoff described in option B is too large. This patient at 4.5 cm (now FIGO IB3) is NOT a candidate.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.