Q&A: Cervical Cancer and Radical Trachelectomy
CancerWise - January 2008
Until recently, a diagnosis of cervical cancer almost always meant having to undergo a radical hysterectomy (removal of all the female reproductive organs). Now, a surgical procedure called radical trachelectomy offers women hope that they might be able to have children after treatment.
Radical trachelectomy is similar to a radical hysterectomy, but it leaves a woman's uterus (womb) intact. After the procedure, many women can conceive and deliver full-term babies.
Answering questions about radical trachelectomy is Pedro Ramirez, M.D., an associate professor in M. D. Anderson's Department of Gynecologic Oncology and one of the few physicians in the United States who performs this new procedure.
What happens in radical trachelectomy?
The surgeon removes the cervix, parametrium (tissue immediately next to the cervix) and the upper two centimeters of the vagina, but does not remove the uterus. The uterus then is connected to the remaining portion of the upper vagina.
A cerclage (permanent suture) is placed where the cervix used to be to help maintain the pregnancy.
Why are some women interested in this procedure?
About 40% of cervical cancers are diagnosed in women of childbearing age. Since many women now choose to delay pregnancy until their middle to late 30s, a large percentage who are diagnosed with cervical cancer have not had children but would like to keep the option open.
Who might be a candidate for radical trachelectomy?
Women who would be considered candidates have:
- Either of the following types of cervical cancers:
- Squamous carcinoma
- A tumor less than two centimeters in diameter
- No tumor in the upper cervical canal
- No evidence the cancer has spread
- Interest in future fertility
- No extensive history of infertility
Is age a requirement for this procedure?
All patients interested in future fertility are candidates for this procedure. There is no specific age restriction.
Is trachelectomy as effective as radical hysterectomy?
Cancer recurrence statistics and death rates for both procedures are similar.
For trachelectomy patients, the cancer returns in about 4% of patients, and the death rate is 2.5%, which is similar to statistics for radical hysterectomy.
The median time we have followed patients who have received trachelectomy is about four years.
How many of these procedures have been completed?
About 500 of these surgeries have been performed so far, most of them in countries other than the United States, particularly France, England and Canada.
What are some complications of the surgery?
Complications happen during trachelectomy in 6% to 19% of cases, which is similar to that seen in radical hysterectomy or other abdominal surgeries.
Complications from trachelectomy may include injuries to the bladder, nerves, blood vessels, urethra or rectum.
The most frequent complications have been:
- Bladder problems
- Vulvar swelling
- Formation of lymphocyst (mass of lymph fluid)
As a result of the surgery, some women also may:
- Experience irregular menstrual bleeding
- Stop menstruating
- Become infertile
How likely are women to get pregnant?
The largest study so far reported that 43% of women who tried to conceive after trachelectomy were successful.
What is the birth rate after trachelectomy?
Of the women studied, 68% reached the third trimester (last three months) of their pregnancies. About 72% of those women went on to deliver full-term babies.
The rate of miscarriage after the procedure was:
- 16% in the first trimester (first three months)
- 4% in the second trimester (second three months)
These figures are similar to statistics in the general population of pregnant women.
Are special precautions needed if a woman gets pregnant?
A high-risk obstetrical specialist should follow a pregnant woman who has had this procedure. To reduce the risk of infection, patients should not have a cervical biopsy during the first three months of their pregnancy. They should consider not having sexual intercourse between 20 and 36 weeks of pregnancy to avoid infection and reduce the risk of rupturing membranes.
Some physicians suggest:
- Steroid medication to help the fetus's lungs develop faster
- Antibiotics between 14 and 16 weeks of pregnancy
What happens at birth?
If a woman has had a trachelectomy, her baby will be delivered by Caesarian section.
Is trachelectomy for everyone?
We are very selective about who undergoes this procedure. It has been shown there's a higher risk of cancer recurrence or need for postoperative radiation therapy if women don't meet the specified criteria.
What is the future of this procedure?
There is increasing evidence that radical trachelectomy is a reasonable option for young women diagnosed with early stage cervical cancer who desire future fertility. There is no compromise in oncologic outcome, and the complication rate is similar to that seen with a radical hysterectomy. Patients are becoming more aware of this option, and we anticipate the procedure will continue gaining in popularity.
M. D. Anderson resources:
- Overview: cervical cancer (American Cancer Society)
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