Cervical & Ovarian Cancer Treatment | Dr. Hua Ke-qin (Gynecologic Oncology) | CMCS Shanghai

About Dr. Hua Ke-qin

Dr. Hua Ke-qin is Chief of Gynecologic Oncology at Obstetrics & Gynecology Hospital of Fudan University, with deep expertise in cervical, ovarian, and endometrial cancers. He is a national leader in fertility-sparing surgical techniques for gynecologic malignancies. Dr. Hua combines surgical precision with a compassionate approach to women's cancer care, and his team's outcomes in radical trachelectomy are among the best documented in China.

Case Overview

A 29-year-old newlywed presented with three months of post-coital bleeding. Colposcopy-directed biopsy confirmed invasive squamous cell carcinoma of the cervix; pelvic MRI staged the disease as FIGO IB1 (1.8 cm tumor confined to the lower cervical canal, parametria clear, internal os margin 1.5 cm). The patient and her family strongly wished to preserve the uterus and future fertility, and declined radiotherapy. Following MDT discussion chaired by Dr. Hua Ke-qin, she underwent laparoscopic radical trachelectomy (LRT) with bilateral pelvic lymph node dissection using sentinel lymph node (SLN) mapping, and intraoperative McDonald cerclage placement. Intraoperative blood loss was less than 50 mL; operative time was 120 minutes. All resection margins were negative (R0). The patient conceived naturally 18 months post-surgery and delivered a healthy 3,100 g baby boy by caesarean section at 37 weeks and 2 days.

Patient Background

• Age / Sex: 29-year-old female
• Marital Status: Married 1 year; actively trying to conceive
• Chief Complaint: Post-coital bleeding for 3 months
• Gynaecological History: LEEP conisation for CIN II two years prior; lost to follow-up post-procedure
• Gynaecological Examination: Normal vulva and vagina; moderate cervical ectropion; contact bleeding positive; uterus anteverted, normal size, mobile; no adnexal masses

Diagnosis & Staging

Laboratory & Pathology

• HPV Testing: HPV 16 positive (high viral load)
• Colposcopy-Directed Biopsy (3 o'clock and 9 o'clock): Invasive squamous cell carcinoma

Pelvic MRI (Enhanced)

• 1.8 cm × 1.5 cm mass in the lower cervical canal, confined to the cervical stroma
• Key findings: No parametrial invasion; tumor-to-internal-os distance approximately 1.5 cm; no bladder or rectal involvement; no enlarged iliac lymph nodes

Clinical Stage

FIGO IB1 — tumor diameter <2 cm, confined to the cervix.

Patient's expressed priority: Uterine and fertility preservation; refusal of radiotherapy.

MDT Discussion

Chaired by Dr. Hua Ke-qin (Chief, Gynecologic Oncology, Obstetrics & Gynecology Hospital of Fudan University)
Participating departments: Gynecologic Oncology, Pathology, Radiology, Reproductive Medicine, Psychology.

Dr. Hua Ke-qin's analysis: "This patient is 29 years old with FIGO IB1 cervical squamous cell carcinoma — tumor diameter under 2 cm, located in the lower cervical canal, with no uterine body or parametrial involvement. This is a textbook indication for fertility-sparing surgery. Radical hysterectomy would cure the cancer but permanently end her chance of motherhood. Radical radiotherapy would also cure the tumor but cause ovarian failure and uterine atrophy — the same outcome. Our approach is laparoscopic radical trachelectomy with pelvic lymph node dissection. This demands the highest surgical precision: sufficient parametrial and upper vaginal resection to ensure oncological clearance, while meticulously preserving the uterine artery ascending branch and pelvic autonomic nerves to maintain the uterine environment for future pregnancy."

Surgical Procedure

Technical Challenges

• Deep parametrial dissection in the confined laparoscopic field while protecting the ureter and bladder
• Maintaining internal os integrity as the future site of uterine-vaginal anastomosis
• Achieving oncologically adequate margins without compromising uterine blood supply

Step-by-Step Procedure

1. Sentinel Lymph Node (SLN) Mapping & Pelvic Lymph Node Dissection: Bilateral pelvic lymph node dissection performed first using SLN tracer technique. Intraoperative frozen section: all nodes negative. Extended para-aortic dissection was therefore avoided, reducing operative trauma and lymphedema risk.
2. Ureteral Dissection: Dr. Hua precisely dissected the ureteral tunnel under laparoscopic visualization, suspending the ureter with a vessel loop to protect against thermal injury during subsequent parametrial dissection.
3. Parametrial & Vascular Management:
   • Cardinal and uterosacral ligaments divided at the level of the internal os (approximately 1.5 cm above the superior tumor margin) — intraoperative frozen section of parametrial margins confirmed negative
   • Core technique — uterine artery ascending branch preservation: Rather than ligating the uterine artery in its entirety as in standard radical hysterectomy, Dr. Hua performed meticulous vessel dissection, dividing only the descending (cervical) branch while preserving the ascending (uterine body) branch — maintaining perfusion to the uterine corpus and ensuring a viable implantation environment for future pregnancy
4. Cervical Resection & Anastomosis:
   • Cervix and upper vaginal cuff (approximately 2 cm) excised en bloc with the tumor
   • Remaining internal os anastomosed to the vaginal stump with interrupted sutures
   • McDonald cerclage placed intraoperatively at the level of the neo-cervix

Dr. Hua's operative note: "The cerclage is placed at the time of surgery — not as an afterthought during pregnancy. This is the step most commonly overlooked in fertility-sparing surgery, and it is the step that determines whether the uterus can carry a pregnancy to term. Cervical incompetence after trachelectomy is not a complication — it is an expected anatomical consequence that must be anticipated and addressed at the time of the index procedure."

Operative Data

• Operative Time: 120 minutes
• Estimated Blood Loss: <50 mL
• Intraoperative Frozen Section: All parametrial and vaginal margins negative; all lymph nodes negative

Pathology & Post-operative Management

Final Pathology Report

• Histology: Invasive squamous cell carcinoma, moderately differentiated; tumor size 1.6 cm
• Lymphovascular Space Invasion: Absent
• Perineural Invasion: Absent
• Resection Margins: Parametrial, vaginal, and internal os margins all negative — R0 resection confirmed
• Lymph Nodes: 0/18 positive

Post-operative Course

• Urinary catheter retained for 14 days (to prevent bladder dysfunction and vaginal stenosis during healing)
• One-month follow-up: vaginal stump healed without stenosis; menstruation resumed with slightly reduced volume (expected, due to partial cervical canal resection) — no intrauterine adhesions

Long-term Follow-up & Pregnancy Outcome

Oncological Surveillance

• TCT + HPV testing every 3 months for 2 years post-surgery: all results negative
• No evidence of recurrence at 2-year follow-up

Fertility Management

• Dr. Hua's team coordinated with the Reproductive Medicine department for ovulation monitoring and conception planning

Pregnancy & Delivery (18 Months Post-surgery)

• Conception: Natural conception; singleton pregnancy
• Antenatal Management: High-risk obstetric pathway given trachelectomy history and cerclage; serial cervical length monitoring throughout pregnancy; full-course tocolytic support
• Delivery: Caesarean section at 37 weeks and 2 days (indication: premature rupture of membranes; vaginal delivery not recommended post-trachelectomy due to risk of cervical laceration)
• Neonatal Outcome: Healthy male infant, birth weight 3,100 g; Apgar score 10 at 1 and 5 minutes
• Intraoperative Finding at Caesarean: Lower uterine segment scar well-healed; no rupture risk identified

Expert Commentary — Dr. Hua Ke-qin

1. Strict Patient Selection Is the Foundation of Safety

Fertility-sparing surgery is not "preserving the uterus at any cost." The indications are precise and non-negotiable: FIGO IB1 stage, tumor diameter under 2 cm, squamous or adenocarcinoma histology, no lymph node metastasis, no parametrial invasion. If any single criterion is not met, oncological cure must take absolute priority. The surgeon's role is not to fulfill the patient's wish — it is to determine whether that wish is oncologically safe to fulfill, and to be honest when it is not.

2. The Three Preservations: Blood Supply, Nerves, and Vaginal Length

Laparoscopic radical trachelectomy has been called the crown jewel of gynecologic oncology surgery. Its difficulty lies in three simultaneous preservation objectives: preserving the uterine artery ascending branch to maintain uterine perfusion; preserving the pelvic autonomic nerve plexus to prevent bladder and rectal dysfunction; and preserving sufficient vaginal length for anatomical function and future obstetric delivery. Our institutional data show that with experienced hands, the recurrence rate of radical trachelectomy is equivalent to radical hysterectomy — below 5%. Oncological safety and fertility preservation are not competing goals. They are achievable together, in the right patient, by the right team.

3. Full-Cycle Fertility Management

The surgery is the beginning, not the end. Post-operative cerclage, antenatal cervical length surveillance, coordination with reproductive medicine for conception planning, and the decision to deliver by caesarean section — each of these steps requires a multidisciplinary team that remains engaged from the day of surgery through the day of delivery. A trachelectomy performed without this infrastructure is an incomplete service to the patient. We do not discharge patients after surgery — we accompany them through to motherhood.

4. The Human Dimension of Oncological Surgery

For a young woman, hysterectomy is not only a physiological loss — it is a profound psychological wound. As surgeons, our obligation is not only to remove the cancer. It is to restore the possibility of the life the patient had planned. When she came back to clinic carrying her son, that was not a clinical outcome. That was the reason we do this work.

How CMCS Shanghai Coordinated This Case

China Medical Concierge Shanghai (CMCS) supported this patient's care pathway from initial overseas inquiry through delivery and two-year oncological surveillance. Our coordination included:

• Pre-arrival HPV results, biopsy pathology, and MRI review; specialist referral to Dr. Hua Ke-qin's gynecologic oncology team at Obstetrics & Gynecology Hospital of Fudan University
• Arrangement of enhanced pelvic MRI, colposcopy-directed biopsy, and multidisciplinary staging workup
• Bilingual interpretation during MDT discussion, including detailed explanation of fertility-sparing eligibility criteria, surgical technique, cerclage rationale, and recurrence risk
• Psychological support coordination — liaison with the hospital's psychology department for pre-operative counseling on cancer diagnosis and fertility implications
• Surgical admission logistics, including hospital registration and accommodation support for accompanying family
• On-site medical interpretation throughout the hospitalization and post-operative recovery period
• Post-discharge coordination of 3-monthly TCT + HPV surveillance scheduling, results translation, and communication with the patient's home gynaecologist
• Antenatal coordination: referral to high-risk obstetric team, cervical length monitoring scheduling, and tocolytic management liaison during pregnancy
• Delivery planning coordination: caesarean section scheduling, neonatal team briefing, and post-partum oncological surveillance resumption

For international patients facing a cancer diagnosis that threatens both their life and their dream of motherhood, the existence of fertility-sparing surgical expertise at Shanghai's leading women's hospitals represents a genuine alternative to the binary choice of "cure or children." CMCS exists to connect patients with that expertise — ensuring every option is evaluated, every risk is explained in their language, and every step from diagnosis to delivery is coordinated with precision and care.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.