A 28-year-old woman with dysgerminoma of the right ovary, FIGO Stage IA, desires future fertility. What is the most appropriate management?

• A Bilateral salpingo-oophorectomy with total hysterectomy to prevent recurrence
• B Right salpingo-oophorectomy with full staging; observe without adjuvant chemotherapy ✓
• C Right salpingo-oophorectomy followed by three cycles of BEP chemotherapy
• D Fertility-sparing surgery followed by whole-abdominal radiotherapy

Explanation

Stage IA dysgerminoma has an excellent prognosis (>95% 5-year survival) with unilateral salpingo-oophorectomy alone. Adjuvant chemotherapy (BEP) is NOT required for Stage IA disease because even relapse can be salvaged with chemotherapy with >90% cure rates. Bilateral surgery would compromise fertility unnecessarily. Radiotherapy is now largely abandoned for dysgerminoma due to chemosensitivity and fertility-preservation concerns. Comprehensive surgical staging (peritoneal washings, omentectomy, lymph nodes) should accompany the procedure.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.