Conservative treatment in young patients with cervical cancer: a review

For cervical cancer cases with a low risk of relapse who wish to maintain their fertility, radical trachelectomy is an alternative to radical hysterectomy. Pelvic magnetic resonance imaging is recommended before surgery, with laparoscopic assisted lymphatic dissection required for assessment of lymphatic metastasis. If there is a visible lesion in the cervix, the specimen taken during trachelectomy should be sent for frozen section. The complications of radical trachelectomy are chronic vaginal discharge, irregular vaginal bleeding, dysmenorrhea, ulceration, amenorrhea and cervical stenosis. The probability of cervical cancer recurrence with a lesion of similar size is comparable with radical trechelectomy and radical hysterectomy. Two thirds of pregnancies after trachelectomy lead to live births of which approximately 40% of them are healthy. However, the probability of second trimester abortion and pre-term labor is greater than in the general population. Because of the possibility of uterine arterial injury in short cervix, vaginal delivery should be avoided and a cesarean operation in 37-38th week is recommended. Adjuvant treatment with chemotherapy followed by radical trachelectomy is a suitable option for larger lesions. On the other hand, conization or simple trachelectomy are more proper approaches for very small lesions.