A 33-year-old woman presents with rapid enlargement of the cervix and a bulky friable tumour. Biopsy shows sheets of small round blue cells with scant cytoplasm, nuclear moulding and brisk mitoses. Immunohistochemistry is positive for chromogranin A and synaptophysin. The most appropriate first-line treatment strategy is:
- A Neoadjuvant etoposide and cisplatin chemotherapy followed by locoregional therapy ✓
- B Radical hysterectomy alone
- C Simple hysterectomy alone
- D Vaginal vault brachytherapy alone
Correct answer: A. Neoadjuvant etoposide and cisplatin chemotherapy followed by locoregional therapy
Explanation
The morphology and neuroendocrine markers identify small cell neuroendocrine carcinoma of the cervix, an aggressive tumour associated with HPV 16 and 18 that behaves like its pulmonary counterpart. Because it disseminates early even when apparently localized, multimodal therapy with platinum-etoposide chemotherapy combined with radiation or surgery is standard. Surgery alone, whether simple or radical, fails to address occult systemic micrometastases and yields poor survival.
Reference: Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.