Cervical cancer surgery: Difference between revisions
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== | ==Overview== | ||
==Hysterectomy== | |||
Microinvasive cancer (stage IA) is usually treated by [[hysterectomy]] (removal of the whole uterus including part of the [[vagina]]). For stage IA2, the [[lymph node]]s are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a [[loop electrical excision procedure]] (LEEP) or [[Cervical conization|cone biopsy]]. | Microinvasive cancer (stage IA) is usually treated by [[hysterectomy]] (removal of the whole uterus including part of the [[vagina]]). For stage IA2, the [[lymph node]]s are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a [[loop electrical excision procedure]] (LEEP) or [[Cervical conization|cone biopsy]]. | ||
If a cone biopsy does not produce clear margins,<ref>[http://www.meb.uni-bonn.de/cgi-bin/mycite?ExtRef=MEDL/94063663]</ref> one more possible treatment option for patients who want to preserve their fertility is a [[trachelectomy]].<ref>[http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm]</ref> | ==Trachelectomy== | ||
*If a cone biopsy does not produce clear margins,<ref>[http://www.meb.uni-bonn.de/cgi-bin/mycite?ExtRef=MEDL/94063663]</ref> one more possible treatment option for patients who want to preserve their fertility is a [[trachelectomy]].<ref>[http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm]</ref> | |||
*This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. | |||
*It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16493253&query_hl=2&itool=pubmed_docsum]</ref> as few doctors are skilled in this procedure. | |||
*Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. | |||
*If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent. | |||
*Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the womb for pathologic evaluation. | |||
====Radical Trachelectomy==== | |||
A radical trachelectomy can be performed abdominally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15918265&query_hl=8&itool=pubmed_docsum]</ref> or vaginally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15936061&query_hl=5&itool=pubmed_docsuminstead]</ref> and there are conflicting opinions as to which is better.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8812529&query_hl=13&itool=pubmed_docsum]</ref> A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10760765&dopt=Abstract]</ref> It is generally recommended to wait at least one year before attempting to become pregnant after surgery.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12548192&dopt=Abstract]</ref> Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16493253&query_hl=4&itool=pubmed_docsum]</ref> Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/[[colposcopy]], with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through [[safe sex]] practices until one is actively trying to conceive. | A radical trachelectomy can be performed abdominally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15918265&query_hl=8&itool=pubmed_docsum]</ref> or vaginally<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15936061&query_hl=5&itool=pubmed_docsuminstead]</ref> and there are conflicting opinions as to which is better.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8812529&query_hl=13&itool=pubmed_docsum]</ref> A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10760765&dopt=Abstract]</ref> It is generally recommended to wait at least one year before attempting to become pregnant after surgery.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12548192&dopt=Abstract]</ref> Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16493253&query_hl=4&itool=pubmed_docsum]</ref> Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/[[colposcopy]], with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through [[safe sex]] practices until one is actively trying to conceive. | ||
==Radical Hysterectomy== | |||
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or [[radiation therapy]]. Radiation therapy is given as external beam radiotherapy to the pelvis and [[brachytherapy]] (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. | Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or [[radiation therapy]]. Radiation therapy is given as external beam radiotherapy to the pelvis and [[brachytherapy]] (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse. | ||
==Radiation & Chemotherapy== | |||
Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and [[cisplatin]]-based chemotherapy, hysterectomy (which then usually requires [[adjuvant]] radiation therapy), or cisplatin chemotherapy followed by hysterectomy. | Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and [[cisplatin]]-based chemotherapy, hysterectomy (which then usually requires [[adjuvant]] radiation therapy), or cisplatin chemotherapy followed by hysterectomy. | ||
Revision as of 20:57, 13 January 2012
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Cervical cancer Microchapters |
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Cervical cancer surgery On the Web |
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American Roentgen Ray Society Images of Cervical cancer surgery |
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Risk calculators and risk factors for Cervical cancer surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [11]
Overview
Hysterectomy
Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed as well. An alternative for patients who desire to remain fertile is a local surgical procedure such as a loop electrical excision procedure (LEEP) or cone biopsy.
Trachelectomy
- If a cone biopsy does not produce clear margins,[1] one more possible treatment option for patients who want to preserve their fertility is a trachelectomy.[2]
- This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy.
- It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,[3] as few doctors are skilled in this procedure.
- Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown.
- If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the patient is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the patient has given prior consent.
- Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the womb for pathologic evaluation.
Radical Trachelectomy
A radical trachelectomy can be performed abdominally[4] or vaginally[5] and there are conflicting opinions as to which is better.[6] A radical abdominal trachelectomy with lymphadenectomy usually only requires a two to three day hospital stay, and most women recover very quickly (approximately six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage.[7] It is generally recommended to wait at least one year before attempting to become pregnant after surgery.[8] Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy.[9] Yet, it is recommended for patients to practice vigilant prevention and follow up care including pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3-4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.
Radical Hysterectomy
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Patients treated with surgery who have high risk features found on pathologic examination are given radiation therapy with or without chemotherapy in order to reduce the risk of relapse.
Radiation & Chemotherapy
Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy.
Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy.
On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment.[10] Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects. Hycamtin is manufactured by GlaxoSmithKline.