A 38-year-old woman with Stage IB1 squamous cell carcinoma of the cervix (tumor 2.8 cm, confined to cervix) wishes to preserve fertility. She has no lymphovascular space invasion on biopsy. The most appropriate fertility-sparing surgical option is:
- A Simple hysterectomy preserving both ovaries
- B Conisation alone with follow-up
- C Chemoradiation preserving the uterus
- D Radical trachelectomy with pelvic lymph node dissection ✓
Explanation
Radical trachelectomy (radical removal of the cervix with parametria and a vaginal cuff, preserving the uterine corpus and isthmus) combined with pelvic lymph node dissection is the standard fertility-sparing procedure for Stage IA2–IB1 cervical cancer with tumor ≤2 cm by most criteria (some extend to ≤4 cm). This patient at 2.8 cm with no LVSI is a suitable candidate. Simple hysterectomy does not remove parametria and is inadequate for invasive cervical cancer. Conisation is appropriate only for Stage IA1 without LVSI. Chemoradiation ablates ovarian function and does not preserve fertility.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.