Fertility after cervical cancer

Gynecologic malignancies are most often diagnosed in postmenopausal women, and can also arise in premenopausal women who have fertility as top of mind. The increasing number of women delaying childbearing has led to a significant increase in the number of women diagnosed with a gynecologic malignancy before desired completion of childbearing. Many of the standard treatments for these malignancies result in permanent sterility; however, there are now options for select young women who wish to preserve their fertility.

Cervical cancer

The standard treatments for cervical cancer—hysterectomy (simple or radical) and pelvic radiation—result in permanent sterility. Select patients with early stage cancer could qualify for fertility sparing options, which include radical fertility sparing trachelectomy, where the cervix is removed but the uterus is spared.

Radical trachelectomy

It is estimated that 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 are not aware that this is an option for their patients.

Who is a candidate for radical trachelectomy?

It is first and foremost important to have a patient that desires future fertility. Otherwise, more conventional methods for treating cervical cancer are typically preferred, primarily due to the fact that the surgery itself can be more complicated when compared to a standard hysterectomy. The patient would need to meet with a gynecologic oncologist who performs the procedure, because not all gynecologic oncologists are adequately trained to perform fertility sparing trachelectomies.

At a patient’s initial consultation, important information would be obtained to assess if it is an appropriate option. Some of these criteria include tumor size, lack of any spread of disease on imaging and the specific pathologic type of cancer, among others.

How is the procedure performed?

There are many surgical approaches to performing a trachelectomy, including vaginal or abdominal, and robotic or minimally invasive. Most surgeons utilize either an incision on the belly or multiple smaller incisions, and perform the surgery in a minimally invasive fashion. The surgery requires very careful dissection due to the steps involved to keep the uterus viable while eliminating the cervical cancer. Here are the general steps:

  • The uterus is carefully dissected and the blood supply to the uterus is spared.
  • The uterus is separated from the cervix, and a stitch, also known as a cerclage, is placed around the base of the uterus to secure it in the event that the patient becomes pregnant in the future.
  • The uterus is reconstructed to the top of the vagina.

Can women still become pregnant naturally after a trachelectomy?

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, intrauterine insemination or in vitro. It is important to involve a reproductive specialty physician in these cases to offer guidance along the way. 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.