A 35-year-old nulliparous woman is diagnosed with cervical cancer Stage IB2 (3.5 cm tumor, squamous cell carcinoma). She strongly desires future fertility. Which fertility-sparing option, if feasible, has the best oncologic evidence for tumors up to 2 cm but limited data for 2–4 cm tumors?

• A Simple trachelectomy (Dargent procedure without radical parametrectomy)
• B Cone biopsy with pelvic lymph node dissection
• C Neoadjuvant chemotherapy followed by radical trachelectomy
• D Radical trachelectomy (vaginal or abdominal) with pelvic lymphadenectomy ✓

Explanation

Radical trachelectomy (vaginal — Dargent procedure, or abdominal) with pelvic lymphadenectomy is the established fertility-sparing procedure for early cervical cancer. It is best supported for tumors ≤2 cm (recurrence rates <5%), while evidence for 2–4 cm tumors is limited and outcomes less certain. Neoadjuvant chemotherapy followed by trachelectomy is investigational. Simple trachelectomy lacks radical parametrectomy and is not standard for invasive cancer. Cone biopsy alone is appropriate only for Stage IA1 without LVSI.

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

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Written and medically reviewed by the StethoPrep medical team.