A 32-year-old woman with FIGO 2018 Stage IA1 cervical squamous cell carcinoma (stromal invasion 2 mm, horizontal spread 4 mm) with no lymphovascular space invasion desires fertility preservation. What is the recommended management?
- A Radical trachelectomy with pelvic lymphadenectomy
- B Conization with clear margins and close follow-up ✓
- C Simple extrafascial hysterectomy
- D Concurrent chemoradiation
Correct answer: B. Conization with clear margins and close follow-up
Explanation
Stage IA1 cervical cancer without LVSI can be managed with conization alone if margins are negative and the patient desires fertility preservation. The risk of lymph node metastasis is <1% in this group, making lymphadenectomy unnecessary. Radical trachelectomy is reserved for Stage IA2-IB1 (tumor ≤2 cm). Simple hysterectomy is acceptable if fertility is not desired. Chemoradiation is not indicated for Stage IA1.
Reference: NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer, 2024 ed.
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