A 27-year-old woman at 22 weeks gestation is found to have a 1.5 cm squamous cell carcinoma of the cervix confined to the cervix (FIGO Stage IB1) on cone biopsy with negative margins. She strongly desires to continue the pregnancy. The most appropriate management is:
- A Surveillance with repeat assessment near term, delivery by caesarean at about 34 to 36 weeks followed by radical hysterectomy ✓
- B Definitive concurrent chemoradiotherapy now
- C Immediate radical hysterectomy with the fetus in situ
- D Termination of pregnancy followed by fertility-sparing trachelectomy
Correct answer: A. Surveillance with repeat assessment near term, delivery by caesarean at about 34 to 36 weeks followed by radical hysterectomy
Explanation
Small volume Stage IB1 lesions diagnosed in the second trimester may be managed expectantly until fetal viability, provided there is no nodal disease and the mother accepts close surveillance; delaying therapy to about 34 to 36 weeks does not measurably worsen maternal outcome for tumours under 2 cm. Delivery is by caesarean (classical incision if the lower segment is involved) with radical hysterectomy performed at the same sitting. Immediate surgery sacrifices the pregnancy needlessly, and radiotherapy terminates the pregnancy and sterilises the pelvis.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.