During counselling before radical hysterectomy for a 2.5 cm cervical tumour, a 34-year-old woman asks whether her ovaries can be preserved. On which histological feature does this decision chiefly depend?

• A Adenocarcinoma histology permits ovarian preservation because it spreads only lymphatically
• B Squamous histology carries a very low rate of ovarian metastasis, permitting preservation ✓
• C Ovarian metastasis rates are identical across all cervical cancer histologies
• D Ovarian preservation is contraindicated in all premenopausal cervical cancers

Explanation

Ovarian metastasis occurs in fewer than 1 percent of squamous cell carcinomas of the cervix, so ovaries can be preserved or transposed out of the radiation field in young women with squamous tumours. In contrast, cervical adenocarcinoma carries a substantially higher rate of ovarian involvement, around several percent, which is why option A reverses the correct rule. This histology-based distinction is the deciding factor in practice.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.