Fertility-Sparing Treatment of Cervical Cancer ≤ 2 cm in Young Patients (Squamous Cell Carcinoma or HPV-Related Adenocarcinoma)
For young patients diagnosed with cervical cancer measuring 2 cm or less — specifically squamous cell carcinoma or HPV-related adenocarcinoma — who wish to preserve fertility, an oncologically valid surgical approach exists as an alternative to radical hysterectomy, provided pelvic lymph node status is confirmed negative.
Clinical scenario
- Young patient with cervical cancer ≤ 2 cm
- Histology: squamous cell carcinoma or HPV-related adenocarcinoma of the cervix
- Desire to preserve fertility
- Negative pelvic lymph node status (mandatory precondition)
Fertility-sparing therapy is an oncologically valid alternative to radical hysterectomy in this population. Negative pelvic lymph node status is the non-negotiable precondition for any fertility-sparing approach.
Treatment approach (overview)
Pelvic lymph node staging is the required first step before any fertility-sparing surgical procedure. Depending on tumour stage and specific pathological features, the approach involves fertility-sparing surgical options of varying extent — with the choice guided by staging findings determined at the outset of the procedure.
The full algorithm — including which surgical option applies to which stage, and the pathway when intraoperative findings change the picture — is in the complete protocol.
References
DOI: 10.1016/j.ijgc.2025.102747
- Fertility-sparing therapy is an oncologically valid alternative to radical hysterectomy for young patients with cervical cancer ≤ 2 cm (squamous cell carcinoma and HPV-related adenocarcinoma) who want to preserve the option to have children.
- Negative pelvic lymph node status is the precondition for any fertility-sparing therapy.
- Therefore, pelvic lymph node staging (sentinel lymph node dissection) should always be the first step in each fertility-sparing treatment procedure.
- Conization and simple trachelectomy are adequate fertility-sparing procedures in patients with T1a1 and T1a2 tumors, regardless of lymphovascular space involvement status.
- In case of intra-operatively proven pelvic lymph node involvement, fertility-sparing surgery should be abandoned, and patients should be referred for chemoradiotherapy and brachytherapy.
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