Approximately 43 percent of all cervical cancers diagnosed are in women under the age of 45. Although the average age for women to develop cervical cancer is when they are in their 30's, unfortunately there are times when HPV (human papillomavirus) results in cervical cancer in even younger women in their 20's. In either case, with many women now putting off having children until a later age, either group can find themselves facing treatment which may put an end to their fertility.
While many physicians routinely perform a hysterectomy in cases of cervical cancer where appropriate, for many women there is another option and one which spares one’s fertility – the VRT or vaginal radical trachelectomy.
This procedure was introduced in the 1990’s by Dr. Daniel Dargent of Lyon, France. Other physicians, particularly those in the U.S., laughed at Dargent who is now seen as a hero, and despite 15 years of documentation regarding the procedure and the live births which have resulted, it is exceedingly difficult for a woman to find a doctor who is trained to perform this procedure.
According to Dr. Joel Sorosky, of the University of Iowa Hospitals and a member of the ACOG scientific program committee, of the cases of cervical cancer diagnosed each year, 70 to 75 percent are stage one lesions. Aside from the women in this group who are older and not concerned with fertility, a large percentage of these patients are good candidates and could benefit from the trachelectomy procedure.
The patient must meet certain criteria, part of which includes that there be no lymph node involvement and the likelihood of recurrence is small. In addition, delivery must be performed via a Caesarean section and there is an increased risk of miscarriage. However, for those desperate to have a family, it is worth the risk.
The procedure itself involves entrance through the vagina as opposed to the abdomen. Although it can be performed through abdominal incision the vaginal procedure reduces another potential site of infection post surgery. The cervix is totally removed along with a portion of the lower uterus and upper vagina. The ovaries are preserved and the remaining uterus is then sutured to the vaginal vault.
The procedure has been shown to have a shorter recovery time than a hysterectomy, is less painful and is just as effective in treating cervical cancer as a hysterectomy. Hopefully more doctors will become trained in this procedure in order to provide women the option of retaining their fertility. Meanwhile, women should know about this procedure because if your doctor does not perform it, he may not mention it as an option – something I have been told by many women. For those wanting children it is a very important procedure to know about.
http://www.medscape.com/viewarticle/453234
http://www2.mdanderson.org/depts/oncolog/articles/08/6-jun/6-08-2.html
http://www.ncbi.nlm.nih.gov/pubmed/10760765
http://www.umm.edu/patiented/articles/what_specific_treatments_cervical_intraepithelial_neoplasia_cin_000046_9.htm
http://www.uwhealth.org/uw-carbone-cancer-center/trachelectomy-cervicectomy/10985
Reviewed May 25, 2011
Edited by Alison Stanton