Pregnancy After Cervical Cancer Surgery
New Technique Preserves Womb, Allows Delivery by C-Section
April 29, 2003 (New Orleans) -- For decades, the only recognized treatments for advanced cervical cancer were radical hysterectomy and radiation, so the "cure" deprived women of the ability to have children. Now, however, gynecologists have perfected a new surgical technique that removes only the cancerous cervix while preserving the womb.
Guiseppe Del Priore, MD, MPH, associate professor in the department of obstetrics and gynecology and women's health at Albert Einstein College of Medicine in New York, says he has treated 32 women with this new surgery and two of those women already have delivered healthy babies by cesarean section. He says 97% of women who have the surgery resume "normal periods within three months of surgery." Women are advised, however, to wait for about two years before attempting conception.
He reported on the surgery, which is called abdominal radical trachelectomy or ART, at the 51st Annual Clinical Meeting of the American College of Obstetricians and Gynecologists.
Cervical cancer is associated with human papilloma virus, or HPV. In fact, HPV is considered the most important contributing factor to the development of cervical cancer. Cervical cancer represents approximately 16% of all cancers of the female reproductive system. Most cases of cervical cancer occur in developing countries, where it is the second most frequent cause of cancer-related deaths. But in the U.S., where Pap smears are used to detect cervical cancer, the risk is much lower.
Joel Sorosky, MD, of the University of Iowa Hospitals in Iowa City and a member of the ACOG scientific program committee, estimates that "about 70% to 75% of the 15,000 cervical cancers diagnosed in the United States each year are stage I lesions and could potentially benefit from this approach. Of course, not all of these women would be good candidates since many of them older and are not interested in fertility." Sorosky led the scientific papers session at which Del Priore presented his results.
Moreover, he said that none of the women, who have been followed on average almost two years after surgery, have had a recurrence of the cancer. One woman did have an abnormal Pap smear and decided to undergo hysterectomy, but Del Priore says that no cancer was discovered in the uterine tissue.
Del Priore tells WebMD that there are two ways to surgically remove the cervix. "It can be done vaginally, which was the method originally proposed, or it can be done by abdominal surgery, as we did in this study," he says.
Trachelectomy, which is the medical term for surgical removal of the cervix, was re-introduced to the world of gynecologic surgery in the mid-1990s by Daniel Dargent, MD, of Lyon, France. At the time, the procedure was roundly criticized by U.S. surgeons. "It was embarrassing. They made fun of his accent. But I heard that first report and thought he had something," recalls Del Priore.