A 28-year-old woman with Stage IB1 cervical cancer (2.5 cm squamous cell carcinoma) desires fertility preservation. She has no lymphovascular space invasion. The MOST appropriate fertility-sparing surgical option is:

• A Cold knife conization alone
• B Simple trachelectomy without lymph node dissection
• C Neoadjuvant chemotherapy followed by conization
• D Radical trachelectomy with pelvic lymph node dissection ✓

Explanation

Radical trachelectomy (vaginal or abdominal) with pelvic lymph node dissection is the established fertility-sparing procedure for Stage IB1 cervical cancer with tumor ≤2 cm (some centers extend to ≤4 cm). It removes the cervix with parametrial tissue while preserving the uterine corpus. Simple trachelectomy without lymphadenectomy is insufficient for a 2.5 cm tumor. Conization alone is appropriate only for Stage IA1 without LVSI. The tumor here is 2.5 cm — radical trachelectomy is the standard per NCCN guidelines for tumor ≤2 cm; for tumors 2–4 cm, this remains investigational but radical trachelectomy with PLND is still the best option listed.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.