Cervical Cancer and Fertility-Sparing Treatment

Radical hysterectomy with pelvic node dissection is the standard treatment for early-stage cervical cancer. However, the latter can be diagnosed at a young age when patients have not yet achieved their pregnancy plans. Dargent first described the vaginal radical trachelectomy for patients with tumors < 2 cm. It has since been described a population of low risk of recurrence: patients with tumors < 2 cm, without deep stromal infiltration, without lymphovascular invasion (LVSI), and with negative lymph nodes. These patients can benefit from a less radical surgery such as conization or simple trachelectomy with the evaluation of the pelvic node status. Tumors larger than 2 cm have a higher risk of recurrence and their treatment is a challenge. There are currently two options for these patients: abdominal radical trachelectomy or neoadjuvant chemotherapy (NACT), followed by fertility-sparing surgery. All patients who wish to preserve their fertility must be referred to expert centers.

Automated summary

For early-stage cervical cancer patients, less radical surgeries such as conization or simple trachelectomy can be considered under specific conditions. However, for patients with larger tumors, treatment becomes more challenging and may require abdominal radical trachelectomy or neoadjuvant chemotherapy, which should be carried out in expert centers to preserve fertility.