A 29-year-old woman undergoing loop excision for an abnormal smear is found on histology to have Stage IA1 squamous cell carcinoma with 2 mm stromal invasion, 5 mm horizontal spread, negative excision margins, and no lymphovascular space invasion. She desires future fertility. What is the appropriate management?
- A Radical hysterectomy with pelvic lymphadenectomy
- B Simple hysterectomy with ovarian conservation
- C No further treatment; conisation with negative margins is sufficient ✓
- D Radical trachelectomy with sentinel node mapping
Correct answer: C. No further treatment; conisation with negative margins is sufficient
Explanation
For Stage IA1 disease without lymphovascular space invasion, the risk of parametrial and nodal spread is negligible, so cold-knife or LEEP conisation with clear margins is adequate definitive treatment and preserves fertility. Radical hysterectomy and trachelectomy are reserved for IA2 and higher, where invasion exceeds 3 mm. Simple hysterectomy is an option for women who have completed childbearing, not for those desiring fertility.
Reference: Williams Gynecology, 4th ed.
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