A 35-year-old woman with Stage IB2 cervical cancer (4.5 cm tumour) wishes to preserve fertility. Which of the following procedures may be considered for fertility preservation in this scenario, and what is the tumour size upper limit accepted by most centres for this procedure?

• A Radical trachelectomy (vaginal or abdominal); tumour size up to 2 cm
• B Neoadjuvant chemotherapy followed by radical trachelectomy; tumour size up to 4 cm after response ✓
• C Simple trachelectomy with sentinel lymph node biopsy; tumour size up to 4 cm
• D LEEP conisation with pelvic lymphadenectomy; tumour size up to 3 cm

Explanation

Radical trachelectomy (removal of the cervix, parametria, and upper vagina with preservation of the uterine corpus) is the fertility-preserving procedure for cervical cancer. The traditional cut-off for suitability is tumours ≤2 cm (Stage IA2–IB1). For Stage IB2 (tumours 2–4 cm), neoadjuvant chemotherapy (NACT) followed by radical trachelectomy has been investigated as a fertility-sparing approach — if the tumour responds adequately to NACT and achieves a residual of ≤2 cm, trachelectomy may be attempted at specialised centres. Simple trachelectomy and LEEP are inadequate for invasive cervical cancer ≥IB.

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

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Written and medically reviewed by the StethoPrep medical team.