A 54-year-old woman treated with definitive chemoradiation for Stage IIB cervical carcinoma two years ago now has biopsy-proven squamous cell carcinoma recurring centrally in the cervix with a vesicovaginal fistula. PET-CT shows no nodal or distant disease, the pelvic sidewalls are free, and she is medically fit. The most appropriate surgical management is:

• A Repeat external beam radiotherapy with brachytherapy boost
• B Total pelvic exenteration with urinary diversion ✓
• C Anterior pelvic exenteration only, preserving the rectum
• D Palliative chemotherapy with carboplatin and paclitaxel

Explanation

Central recurrence after prior pelvic radiation, with disease confined to the pelvis, free sidewalls and no metastases, is the classic indication for total pelvic exenteration, the only potentially curative salvage option. Because the vesicovaginal fistula implies bladder involvement, both bladder and rectum are removed, making anterior exenteration alone inadequate. Re-irradiation risks severe bowel injury, and chemotherapy offers palliation rather than cure in this fit patient with curable disease.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.