iCliniq logo

Ask a Doctor Online Now

HomeHealth articlescervical cancerWhat Are the Criteria for Fertility Sparing Surgery in Cervical Cancer?

Fertility-Sparing Surgery for Cervical Cancer

Verified dataVerified data
0

4 min read

Share

Vaginal radical trachelectomies and abdominal radical trachelectomies are safe surgical procedures performed in women with cervical cancer to save fertility.

Medically reviewed by

Dr. Arjun Chaudhari

Published At April 21, 2023
Reviewed AtMarch 22, 2024

Introduction

Cervical cancer is the second most common gynecological tumor worldwide. Cervical cancer is the leading cause of death from gynecological cancer. There were more than 13,800 new cases of cervical cancer reported in the United States in 2020. The incidence of cervical cancer decreases in developed countries but is most frequently seen in developing nations. Cervical cancer is caused due to infection with the human papillomavirus (HPV). The management of cervical cancer depends on the stage of the disease. A combination of therapy (radical surgery, chemotherapy, and radiotherapy) can treat cervical cancer. However, few surgical procedures preserve fertility in women with cervical cancer. Vaginal radical trachelectomies (VRT) and abdominal radical trachelectomies (ART) are safe surgical procedures that can be done to save fertility in women with cervical cancer. The oncology outcomes are similar in VRT and ART, but pregnancy outcomes favor VRT.

What Is Cervical Cancer?

Cervical cancer is a disease in which a group of abnormally growing cells in the cervix (lower part of the uterus in women) divides rapidly, having the potential to invade other body parts. The group of cell mass (tumor) can invade and spread (metastases) outside the uterine. Cervical cancer is caused due to human papillomavirus infection. It is most commonly seen in people with multiple sex partners. Patients with cervical cancer suffer from vaginal bleeding or vaginal discharge. Severe cases of cervical cancer show metastases to bone and lung.

What Is Fertility Sparing Surgery?

Vaginal radical trachelectomies (VRT) and abdominal radical trachelectomies (ART) are safe surgical procedures that spare fertility in women with cervical cancer along with good oncological outcomes (reducing the chance of recurrence of cervical cancer). In addition, these procedures allow women with cervical cancer to conceive. Fertility-sparing surgery preserves the uterus, allowing women to be pregnant. The two fertility-sparing procedures are as follows:

  • Vaginal Radical Trachelectomies (VRT) - VRT is an invasive laparoscopic (invasive surgical technique done by the use of a laparoscope) procedure that incises the vagina or uterine and removes the affected cells. VRT aims to preserve uterine arteries, and ligation of uterine vessels gives improved pregnancy outcomes.

  • Abdominal Radical Trachelectomies (ART) - ART is the second most common type of fertility-sparing surgery in cervical cancer. This procedure involves incisions in the lower abdomen with or without preserving the uterine artery. ART is the modification of radical abdominal hysterectomy (removal of the uterus). This surgery can be performed in a low-resource setting. ART is more favored in stage 1 tumors (tumors size less than 2 cm). The disadvantage of ART over VRT is blood loss and complications of the wounds.

What Are the Criteria for Fertility Sparing Surgery in Cervical Cancer?

The selection criteria for fertility-sparing surgery in cervical cancer depends upon the patient's complete history. Doctors must inform the patients about examinations before surgery, surgical procedures, and the late complication of fertility-sparing surgery.

The following are the criteria for fertility-sparing surgery in cervical cancer:

  • Size of Tumor - The most important criterion for fertility-sparing surgery is that tumor size should be less than two centimeters.

  • The Extent of Tumor - The appropriate patients for fertility-sparing surgery should have healthy cells (approx 50 percent) in the cervix. The extent of the tumor should not be outside the uterine.

  • Nature of Tumor - The histopathological findings of the tumor through biopsy are considered to define the type and depth of invasion.

  • Informed Consent - Detailed information before the surgery is given to the patients, such as examinations before surgery, surgical procedures, and the late complication of fertility-sparing surgery. Doctors should inform patients about the reduced quality of normal lifestyles accompanied by risky future pregnancies. If the patient wants to preserve the uterus despite knowing all consequences, then only fertility-sparing surgery can be performed. Hence, informed consent is essential for all centers to proceed.

What Is the Complication for Fertility Sparing Surgery in Cervical Cancer?

Fertility-sparing surgery preserves the uterus and helps women to retain their childbearing potential. But, there are a few complications of fertility-sparing surgery

  • Patients who have undergone fertility-sparing surgery for cervical cancer have risky future pregnancies, such as the risk of premature delivery.

  • The patients have to plan pregnancy with the help of a doctor in the future.

  • Cervical incompetence is a late complication in fertility-sparing surgery. Cervical incompetence is a condition in which the cervix (part of the uterus) tissue becomes weak, causing pregnancy loss or premature delivery.

  • There is a 4.5 percent chance of reoccurrence of cervical cancer in women who have undergone fertility-sparing surgery.

  • Cervical stenosis is a late complication in women who have undergone fertility-sparing surgery. Cervical stenosis is a condition in which the narrowing of the cervix occurs.

What Are the Outcomes of Fertility Sparing Surgery?

Radical surgery or radiotherapy is only the treatment of choice for women with more than 3 mm tumor invasion in cervical cancer. Radical surgery does not spare fertility and result in decreased quality of life due to psychosexual dysfunction. In addition, it is observed that infertile women, after radiotherapy, have decreased quality of life as infertility leads to an inability to be pregnant, and cause depression, and stress. These emphasize the need for fertility-sparing surgery in women with cervical cancer, especially for those affected women under the age of 40.

The following are the outcomes of fertility-sparing surgery:

  • Oncological Outcome - The recurrence rate of cervical cancer in patients who have undergone vaginal radical trachelectomies is four percent. The patients who have undergone vaginal radical trachelectomies have an excellent prognosis with rare death (one percent). The recurrence rate of cervical cancer in patients who have undergone abdominal radical trachelectomies is 3.9 percent. The recurrence rate of abdominal radical trachelectomies is higher in patients with a tumor size of more than 2 cm.

  • Pregnancy Outcome - The pregnancy rate is 49 percent in women who have undergone vaginal radical trachelectomies. The late complication of vaginal radical trachelectomies may result in the inability to conceive.

The pregnancy rate is 44 percent in women who have undergone abdominal radical trachelectomies.

Conclusion

Fertility-sparing surgery is becoming a priority as 25 percent of the affected women are at their reproductive age (under age 40). Good public health and screening of cervical cancer can lower the incidence of cervical cancer in developing countries. The early diagnosis of cervical cancer can completely cure patients. The prognosis of early-stage cervical cancer is excellent. Proper counseling before surgery and prompt investigation after surgery helps the patients to reach their reproductive goals.

Source Article IclonSourcesSource Article Arrow
Dr. Arjun Chaudhari
Dr. Arjun Chaudhari

Obstetrics and Gynecology

Tags:

fertilitycervical cancer
Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Ask your health query to a doctor online

Obstetrics and Gynecology

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy