Postmenopausal women tend to have the most diagnosed cervical cancer. Nonetheless, premenopausal women who want to conceive can also be diagnosed. Many women these days delay conception. Unfortunately, this can lead to cervical cancer before getting pregnant. Many treatments result in permanent infertility. However, options exist for cervical cancer and pregnancy. Some women who wish to preserve their fertility can still get pregnant.
Cervical cancer and pregnancy
The standard treatments for cervical cancer, a hysterectomy (simple or radical) and pelvic radiation, result in permanent sterility. Select patients with early-stage cancer could qualify for fertility-sparing options. These include radical fertility-sparing trachelectomy. Furthermore, the cervix is removed but the uterus is spared.
Approximately one-third of patients with cervical cancer may meet the criteria for this procedure. Due to the rarity of this procedure, many referring physicians do not know this procedure can be an option.
Radical trachelectomy candidates
Those who desire future fertility possibilities qualify. Otherwise, doctors prefer more conventional methods. Surgery can be more complicated when compared to a standard hysterectomy. Furthermore, a patient might have to meet with another gynecological oncologist. Not all of these specialists can perform fertility-sparing trachelectomies.
At a patient’s initial consultation, providers would obtain important information. This is to assess if it is an appropriate option. Some of these criteria include:
- Tumor size
- Any spread of disease on imaging
- The type of cancer
- Others depending on the patient
How is the procedure performed?
Several surgical options exist with a trachelectomy. These include vaginal or abdominal, and robotic or minimally invasive. In addition, most surgeons use either an incision on the belly or multiple smaller incisions. They also perform the surgery in a minimally invasive fashion. The surgery requires very careful dissection due to the steps involved. Furthermore, this keeps the uterus viable while eliminating cervical cancer. The general steps include:
- The surgeon dissects the uterus while the blood supply remains intact.
- They separate the cervix from the uterus.
- A stitch known as the cerclage is placed around the uterus base to secure it for fertility.
- The surgeon reconstructs the uterus to the top of the vagina.
Can you get pregnant after cervical cancer?
Yes. Pregnancy rates are very encouraging after a trachelectomy with close to 70 percent of women achieving pregnancy afterward. Some patients may require some reproductive assistance. For instance, they might need intrauterine insemination or in vitro. It is important to involve a reproductive specialty physician in these cases to offer guidance along the way. Also, patients will need to deliver via cesarean section because of the permanent cerclage placed at the base of the uterus to prevent premature delivery.
Dr. Jessica Stine is a gynecologic oncologist who is trained to perform trachelectomies on young women. Schedule a consultation with Dr. Stine by calling her office at 813-530-4950.
Surgeons use robotic surgery to assist with precision during the surgery. Many consider these types of surgeries less invasive with smaller incisions. Read our FAQ below to learn everything you need to know about robotic-assisted surgeries.
What are the differences between robotic surgery and laparoscopic surgery?
In traditional laparoscopic surgery, the surgeon places small incisions on the patient’s belly. Using a camera and small instruments, they go inside those incisions to perform the procedure while the surgeon manipulates the instruments at the bedside. In addition, these straight-stick instruments only move in the up or down directions.
Robotic surgery starts in a similar same way. The surgeon creates small incisions. However, a robotic platform holds the instruments instead of the surgeon at the bedside. Furthermore, the surgeon stands near a console and manipulates the instruments with hand controls. The instruments move in all directions, unlike laparoscopic surgery. This gives the surgeon better access to operate. Therefore, surgeons have the advantage of performing more complex procedures with better precision. Lastly, the camera has a three-dimensional visualization. In other words, this allows the surgeon to see more clearly.
Does the robot or the surgeon perform the surgery?
Patients often imagine that the robot acts independently from AI or artificial intelligence. This could not be further from the truth. The surgeon controls every single movement from the console. Think of the robotic platform as a stationary assistant. It holds the instruments and directly communicates the movements of the surgeon’s hands.
What types of procedures can you perform robotically?
Many different types of robotic surgeries exist. They range from simple hysterectomies to more complex pelvic surgeries with severe endometriosis. Furthermore, robotic surgeries can perform procedures for endometrial, cervical and ovarian cancers. Robotic surgery can assist with very complex ovarian or endometrial cancer operations that involve the removal of metastatic tumors. In the past, these surgeries were commonly performed using an “open approach” or a very large incision in the belly.
What are the benefits of having a robotic procedure versus a traditional open procedure?
Many proven benefits exist with robotic surgery as opposed to open surgery. Patients who have minimally invasive surgery will experience much less pain, less blood loss, less hospitalization time, and lower infection rates. Around 90 percent of patients go home the same day as their procedures, including complex cancer procedures. The movement toward same-day discharge has been increasing steadily and has been studied extensively at major surgical and cancer centers. It has been found to be safe and very satisfying for patients who can spend more recovery time with their families in the comfort of their homes versus the hospital.
Recovery time from robotic procedures is typically cut in half when compared to open approaches, which allows patients to get back to their normal routines much sooner and relieves the financial burden for patients who need to get back to work. In the long-term, we see much less formation of adhesions and scar tissue after minimally invasive surgeries when compared to open procedures.
Who are candidates for robotic surgery and what are some important questions to ask your doctor?
Any patient who is considering a gynecological surgery should have a consultation with their trusted surgeon to discuss the possible options for performing the surgery. It is important for patients to have a detailed conversation with their provider about the appropriateness of a robotic procedure in their condition. As an example, there are many women who may be told they are not candidates for robotic surgery due to the history of multiple previous surgeries, when they actually may be able to very safely have minimally invasive surgery. It is important to ask about your doctor’s experience with minimally invasive approaches and ask what to expect after surgery, specifically regarding restrictions and timing of returning to work. These questions will help prepare patients for the recovery period.