A 38-year-old with stage IB2 cervical squamous cell carcinoma (4.2 cm tumour, no lymph node involvement, negative parametria on MRI) requests fertility preservation. Which fertility-sparing surgical option and its oncological eligibility criterion apply here?
- A Radical trachelectomy can be considered up to 4 cm after neoadjuvant chemotherapy in selected cases ✓
- B Simple trachelectomy is appropriate for tumours up to 4 cm
- C Radical trachelectomy (abdominal or laparoscopic) for tumours up to 2 cm with negative nodes
- D Conization with pelvic lymph node dissection for tumours up to 4 cm if histology is favourable
Correct answer: A. Radical trachelectomy can be considered up to 4 cm after neoadjuvant chemotherapy in selected cases
Explanation
Standard radical trachelectomy eligibility requires tumour ≤2 cm (IB1), squamous or adenocarcinoma histology, negative lymph nodes, and ≥5 mm free margin from internal cervical os. For IB2 (>4 cm under old FIGO or 2–4 cm under FIGO 2018), neoadjuvant chemotherapy (3 cycles cisplatin-based) followed by radical trachelectomy has been explored in fertility preservation trials, and selected centres offer this approach after tumour downstaging is confirmed. This is not yet standard practice but represents the frontier of fertility preservation in larger tumours.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.