A 32-year-old woman at 38 weeks gestation is found to have a 2 cm exophytic squamous cell carcinoma of the cervix on biopsy, confirmed as Stage IB1 with no nodal disease on MRI. The fetus is mature. What is the most appropriate plan for delivery and definitive treatment?

• A Induction of labour and vaginal delivery, followed by radical hysterectomy 6 weeks later
• B Caesarean section followed by concurrent chemoradiation after 6 weeks
• C Neoadjuvant chemotherapy until vaginal delivery is feasible
• D Classical caesarean section with radical hysterectomy performed at the same sitting ✓

Explanation

For operable early-stage cervical cancer discovered at term, the accepted approach is caesarean delivery through a classical (vertical) incision followed immediately by radical hysterectomy with lymphadenectomy in the same operation. Vaginal delivery risks tumour laceration, catastrophic haemorrhage and possible dissemination of malignant cells into the peritoneal cavity and episiotomy site. Chemoradiation sacrifices ovarian function and is unnecessary when surgical cure is available, and delaying surgery offers no benefit at term.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.