A 30-year-old woman is diagnosed with adenocarcinoma in situ (AIS) of the cervix on cone biopsy. Margins are positive for AIS. She has completed her family. Which is the most appropriate management?

• A Repeat cone biopsy to achieve clear margins
• B Observation with annual Pap smear and HPV testing
• C Radical hysterectomy with pelvic lymphadenectomy
• D Simple hysterectomy ✓

Explanation

For AIS with positive margins after cone biopsy in a woman who has completed childbearing, simple hysterectomy is recommended. AIS can coexist with invasive adenocarcinoma, and negative margins on cone biopsy do not reliably exclude invasion. Repeat cone may be offered for fertility preservation, but with completed family and positive margins, hysterectomy is definitive. Observation is inappropriate given positive margins.

Reference: NCCN Guidelines: Cervical Cancer

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.