A 35-year-old nulliparous woman is diagnosed with FIGO Stage IA1 squamous cell carcinoma of the cervix (stromal invasion 1.2 mm, horizontal spread 4 mm, no LVSI). She desires future fertility. Which management is most appropriate?
- A Radical trachelectomy with pelvic lymphadenectomy
- B Simple hysterectomy with ovarian preservation
- C Cone biopsy with clear margins ✓
- D Radical hysterectomy with ovarian transposition
Correct answer: C. Cone biopsy with clear margins
Explanation
Stage IA1 cervical cancer with no LVSI can be treated with a cone biopsy (LEEP or cold knife conization) provided margins are negative. This approach preserves fertility with excellent oncologic outcomes. Radical trachelectomy is reserved for Stage IA2 to IB1 tumors <2 cm where more extensive removal of the cervix and parametrium is needed. Simple or radical hysterectomy is not fertility-preserving. The absence of LVSI in Stage IA1 carries negligible risk of nodal metastasis, making lymphadenectomy unnecessary.
Reference: Williams Gynecology, 4th ed.
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Written and medically reviewed by the StethoPrep medical team.