Factsheet Cervical Cancer (PDF) by MikeJenny


									Factsheet: Trachelectomy
The conventional treatment for early stage cervical cancer is complete
removal of the uterus (hysterectomy) and the tissues surrounding the
cervix (parametrium), or pelvic chemo-radiotherapy (a treatment which
has been shown to be superior to radiotherapy alone) and
chemotherapy, both of which make a woman unable to carry a child.

Radical trachelectomy, a fertility preserving treatment, was developed
in France at the end of the 1980s by a skilled gynaecological oncologist,
Daniel Dargent.

The aim of radical trachelectomy is to treat early    • Lymphoedema and lymphocysts – swelling of the
cervical cancer by removing the part of the cervix    legs and genital area. In trachelectomy patients the
with the cancer and a sufficient margin of normal     risk of lymphoedema is higher possibly up to 15-20%.
tissue but leave behind the uterus so the woman       • Nerve damage leading to changed sensations in
could become pregnant and carry a child in the        the thighs and genital areas.
future.                                               • Cervical stenosis (narrowing of the cervix) –
                                                      leading to painful periods.
Trachelectomy is only performed in a few specialist   • Fertility problems, pregnancy problems, recurrence
centres worldwide and this means that the number of   of cancer.
women who have undergone radical trachelectomy is     • Need for further therapy in the event of close
still relatively small.                               margins or involved lymph nodes.
                                                      • Thrombosis, infection, excessive bleeding and
What are the benefits of having a                     damage to other organs are rare side effects which
trachelectomy?                                        may happen in any operation.
• You will have the option to get pregnant in the
future.                                               What happens prior to surgery?
• You should recover quickly after the operation.     Before proceeding with the surgery, you will have an
The recovery normally takes about one month and is    MRI scan (magnetic resonance imaging). This will
usually quicker than having a full hysterectomy       enable the doctor to assess:
                                                      • The size of tumour.
What are the risks associated                         • Whether there has spread to surrounding tissues
with having a trachelectomy?                          or lymph nodes.

The following are risks may occur post a
                                                      Some patients will also need to have an examination
trachelectomy, less than 5% of patients have
                                                      under anaesthetic (EUA). If your doctors need more
immediate problems.
                                                      information about your tumour they will ask you to

Information / Support / Friends
have a EUA. You will be given general anaesthetic           will be the need for further treatment. This maybe
and the doctors will examine your tumour while you          further surgery (allowing preservation of the ovaries)
are under anaesthetic. If you need a EUA it will be         or radiotherapy (if the lymph nodes contain cancer)
explained to you by your doctor.
                                                            After the operation
It is not possible to consider radical trachelectomy        There are usually four little wounds on the tummy
when your tumour is bigger than two centimetres             each less than one centimetre (1cm). A catheter
(2cm) or there are areas where there is suspicious          (tube into the bladder) is often left in after the
shadowing on the imaging. You should discuss your           procedure until you have fully woken up.
options with your doctor.
                                                            You should not experience much pain and any
The operation                                               discomfort you do experience can be controlled with
You will be admitted to the ward early on the morning       simple pain medication such as paracetamol or
of the operation. The procedure is performed with           ibuprofen. You may stay in hospital for one to two
you asleep having had a general anaesthetic.                days after the operation.

The initial surgery is done using laparoscopic              Usually, you will have a blood stained discharge
(keyhole) techniques and lymph nodes (this is similar       following the operation, this should not be a heavy
to lymph node removal in a standard hysterectomy            bleed and will settle in a week or two.
operation) from selected areas in the pelvis are
removed. This involves a long thin instrument               Your first period after the operation may be heavier
(laparoscope) being passed through small cuts (one          than expected or cause you more pain than usual.
centimetre/1cm) in the abdomen. Carbon dioxide gas          Please contact your team if there are problems and
is used to inflate the abdomen so that more room is         they can help if there are problems.
created for the doctor to work. At the end of the
operation the gas is allowed to escape and the cuts         Results are available about two weeks after the
are usually closed with dissolvable stitches.               surgery and the clinic contact you with these results.
                                                            You can choose to come to the clinic to hear the
The next part of the operation is performed through         results or speak to someone on the phone in the
the vagina and will not involve any further cuts in the     comfort of your home.
tummy area. Part of the cervix, the top portion of the
vagina and the tissue around the cervix (the                What happens after my surgery?
parametrium) are removed.                                   Usually you will be discharged from hospital
                                                            approximately one to two days after surgery. You
It is important to remove all tissue that may be            should attend your GP surgery five to seven days
cancerous including a margin of normal tissue. This         after the operation to have your abdominal wounds
means that some normal tissue near the cancer is            checked and stitches removed.
removed as well. The vagina is then reconnected to
the remains of the cervix in which a support stitch         Two weeks after surgery – you will receive the results
(cerclage) will have been inserted to hold the cervix       either by phone or at a clinic appointment. It is your
closed.                                                     decision as to how you would like the results.

A pathologist will carefully examine the tissue and         You will be reviewed every three months in clinic.
lymph glands removed during the operation to                This involves discussion, enquiry into your general
confirm complete removal of the cancerous cells.            health, and pelvic examination with a cervical
This examination may take 1-2 weeks before results          screening. This close follow up occurs for two years
are available.                                              and then you will move to six monthly visits.

You will be recovering at home whilst this is being         It is usual to continue to feel tired when you are at
processed. If cancer cells are found in the margins         home. It can take up to six weeks to fully recover
around the tumour, or in the lymph glands, then there

Jo’s Cervical Cancer Trust         T 020 7936 7498                                    Registered in England and Wales
                                                                                      Company Limited by Guarantee: 7111375
16 Lincoln’s Inn Fields            E info@jostrust.org.uk                             Registered Charity Number: 1133542
London WC2A 3ED                    www.jostrust.org.uk                                Registered Scottish Charity Number: SC041236
from this operation and what you feel able to do will      Sexual health
increase with time. Rest as much as possible and           You may have a small amount of brown discharge
gradually increase your level of activity. You may         from your vagina which is quite normal; if this
want to ask a family member or friend to help you          becomes smelly you should contact your GP as you
with household tasks for a few weeks after the             might need antibiotics for an infection. Avoid full,
operation.                                                 penetrative sex for about four weeks to enable the
                                                           top of the vagina to heal.
In the first few weeks you will need to avoid all
strenuous exercise such as jogging and swimming,           There may be certain sexual positions that are more
and lifting or carrying anything heavy, but it is          comfortable when you first resume intercourse, but
important that you continue doing the exercises            having a shorter vagina does not usually affect
shown to you by the physiotherapist.                       sexual enjoyment in the long run.

During this initial recovery period, if you are            You should discuss any concerns with your
considering becoming pregnant, you will need to            consultant/CNS. We advise that you use
make arrangements to see one of the specialist             contraception and avoid pregnancy until six months
obstetricians to discuss what will be required for         after the surgery to allow everything to heal and to
monitoring during pregnancy. Delivery of your              see any early problems which may occur (this is
subsequent children will need to be by caesarean           unlikely).
                                                           Results of the trachelectomy
You should be able to return to your normal pattern
of living within six to eight weeks; returning to work     The results over the last 20 years are very
may take longer. If you have any problems please           encouraging. Trachelectomy has a good surgical
discuss them at your first follow-up appointment.          outcome:
Remember - returning to normal life takes time.            • Recurrence 4.2%
                                                           • Death 2.3%
                                                           These results are similar to the outcomes seen in
Skin care                                                  small tumours treated by conventional radical
Most women find they suffer no ill effects after their
pelvic lymph nodes have been removed but there is a
small risk of swelling or lymphoedema. You may find        What are the chances of
you have slightly swollen ankles towards the end of        becoming pregnant?
the day and this swelling goes down as you lie flat in     There is a 70% pregnancy rate with a trachelectomy.
bed overnight.                                             You will have an increased rate of premature delivery
                                                           and require a caesarean section.
Please be extra careful with your legs and feet from
now on. Apply a moisturising cream every day to
keep your skin supple and less likely to split or crack.
An infected cut can trigger lymphoedema so use
depilatory creams or an electric razor to remove leg
hair rather than a razor. If you should receive an
injury, such as an insect bite or cut to your legs or
feet, treat it with antiseptic and cover with a dressing
or plaster. If a cut or bite becomes inflamed you
should contact your GP immediately because you
may need antibiotics.

Information / Support / Friends
Alternatives to trachelectomy
Conventional treatments for cervical cancer may be considered as an alternative to radical trachelectomy. These
are outlined below:

• Radical surgery – hysterectomy (Wertheim’s type – removal of the womb) and either leaving the ovaries behind
or removing them
• Radical radiotherapy – this is given as both external beam (from outside) and brachytherapy (a radiation
source inserted into the vagina) usually given with chemotherapy.

Benefits of having conventional treatment
• There are good outcomes in the early stage of the disease. (Early disease treated with hysterectomy has high
cure rates).
• These treatments have been available for many years and there is evidence that they are effective.

Drawbacks of conventional treatment
• Loss of fertility (being unable to get pregnant/have a baby) – for all patients.
• If ovaries are removed then this will cause the menopause (your periods will stop). You may suffer from hot
flushes, sweats, upset sleep, dry skin and vagina as a result of the menopause.
• Lymphoedema (swelling of legs and genital area), or lymphocyst (collection of fluid).
• Thrombosis, infection, excessive blood loss and damage to other organs are rare side effects but may happen in
any operation.
• Fistula (abnormal connection between ureter, bladder or bowel and vagina). This is rare.
• Late side effects of radiotherapy may be damage to the bowel and bladder leading to frequency of bowel motion
and urination or blood loss.

   This factsheet has been produced by Jo’s Cervical
   Cancer Trust. We’re the UK’s only charity dedicated
   to women, their families and friends affected by
   cervical abnormalities and cervical cancer.

   If you would like more information about cervical
   cancer, HPV and cervical screening please go to:

Information from this factsheet has been taken from “Radical vaginal trachelectomy and laparoscopic bilateral pelvic lymph node dissection”
Addenbrooke’s Hopsital, Cambridge. Our thanks are extended to Robin Crawford for his guidance in producing this factsheet.

For further information

Jo’s Cervical Cancer Trust                T 020 7936 7498                                                  Registered in England and Wales
                                                                                                           Company Limited by Guarantee: 7111375
16 Lincoln’s Inn Fields                   E info@jostrust.org.uk                                           Registered Charity Number: 1133542
London WC2A 3ED                           www.jostrust.org.uk                                              Registered Scottish Charity Number: SC041236

To top