08-2013 Case of the Month

What would you do in this this case?

A 38-year-old, recently-married female who strongly desires childbearing has been diagnosed with a malignant gynecologic cancer and asks about her options for surgery and future fertility. 

For which one of the following malignant diagnoses would you consider a fertility-sparing surgical approach? 

A. Stage IA2 small cell cervical cancer
B. Stage IIB cervical squamous cancer
C. Grade 3 endometrial cancer
D. Stage IB1 cervical adenocarcinoma

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Answer A is incorrect: Stage IA2 small cell cervical cancer
 Small cell cervical cancer at any stage is highly lethal and commonly treated with a combination modality including chemotherapy and often pelvic radiation and surgery. Recurrence rates are high and only 30% of stage I cases have long-term remission. Thus, uterine preservation with procedures such as radical trachelectomy is not offered to these patients; however, oocyte retrieval prior to treatment is possible in select cases. 

Answer B is incorrect: Stage IIB cervical squamous cancer
Stage IIB cervical cancer is treated with definitive chemoradiation, thus fertility-sparing surgery (radical trachelectomy) is not possible. The patient may have ovarian transposition or oocyte retrieval prior to definitive pelvic radiation. 

Answer C is incorrect: Grade 3 endometrial cancer
Grade 3 endometrial cancer is treated with total hysterectomy and bilateral salpingo-oophorectomy and staging. Many patients will require radiation or chemotherapy. Uterine preservation and ovarian preservation is not offered to women with high-grade endometrial cancer. Select cases may undergo pre-hysterectomy oocyte retrieval. 

Answer D is CORRECT: Stage IB1 cervical adenocarcinoma
Stage IB1 cervical adenocarcinoma or squamous carcinoma is highly curable with radical trachelectomy, a fertility-sparing surgery. The majority of cases will not need radiation or chemotherapy and can go on to conceive and deliver.
 

Learn more about this topic while earning CME at ASRM eLearn®.  

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