Cervical cancer surgeries

What are your best treatment options after you hear you have cervical cancer? The answer depends on your individual circumstances; here’s what you need to know about available interventions as you begin your trek toward better health.

 These options are for early stage cervical cancer, which is less than 4 cm. Larger and more advanced cervical cancers are treated with chemotherapy and radiation, and not surgery.

 

Radical hysterectomy with robotic surgery (Da Vinci technology)

Several small incisions are made to remove the uterus, cervix, and additional tissue near the uterus and cervix (parametrium). The surgeon does this by controlling robotic arms in the body for precise movements, and also inserts a tiny camera in the body to view the area in 3D images.  This procedure may be an option to the conventional laparoscopic technique for early cervical cancer or some uterine cancers that have spread to the cervix. It is usually done with a laparoscopic lymph node dissection to hopefully rule out cancer spread, or determine best treatment if cancer is in the nodes.

“Some surgeons feel robotic is always better than the conventional way. I think it depends on the case. It’s easier to do robotic surgery for obese women because you get better camera angles and better movement of your instruments into the deep pelvis. Also the robotic platform keeps the camera and instruments in position, thereby improving flexibility,” says Dr. Nita Karnik Lee, a gynecological oncologist at The University of Chicago Medicine.

Dr. Lee does the robotic procedure when more detailed dissection is required as in radical hysterectomy and lymph node dissection.

“With a simple hysterectomy, a laparoscopic approach may be just as good as a robotic approach. The decision for me is based on the patients’ weight and size, prior surgeries, and the exact indication for the procedure.”

 

Pelvic lymph node dissection

At the time the tumor is removed, the surgeon takes nearby lymph nodes to determine the best treatment if by chance cancer has entered the nodes. This is usually done in conjunction with a radical hysterectomy. Lymph node dissection can be done via a traditional open incision, laparscopically, or robotically.

 

Laparoscopic extraperitoneal lymph node dissection

A benefit of this approach is that surgeons do not enter the entire abdominal cavity, so they can prevent additional scarring, which is ideal if radiation is required after surgery.

“Think of the bones and muscles as a hollow shell that contains the uterus, cervix, and intestines. Now think of a saran wrap coating inside the shell. The saran wrap is the peritoneal lining.

“The lymph nodes are between the shell containing the organs and saran wrap.   So these organs are separated from the lymph nodes,” says Dr. Lee.

“There are different ways to get to the lymph nodes. The most common, direct way is through the ‘shell’ and ‘saran wrap.’ We make a separate incision into the peritoneum (saran wrap) to remove the lymph nodes. This approach is used when we need to remove uterus, cervix, and parametrium,” says Dr. Lee.

But with extraperitoneal lymph node dissection, we make an incision where we are able to avoid entering the cavity that holds the organs. The space between the shell and saran wrap is expanded. The lymph nodes are then removed.

“This second approach is technically more challenging and done less often. It may be an option in select patients with locally advanced cervical cancer (Stage II-III) who need lymph nodes removed and also require radiation. It may avoid adhesions and preserve tissue that will be exposed to radiation,” says Dr. Lee.

Generally, extraperitoneal lymph node dissection is not done in early stage cervical cancer, but rather a PET scan, CT scan, and or MRI to determine if lymph nodes are involved.

 

Radical trachelectomy

This is a fertility-sparing option for select early stage cervical cancer patients whose tumors are less than 2 cm. The cervix and parimetrium (tissue near  the cervix) are removed. But the uterus and ovaries are left in place.

Studies show the survival and recurrence rates to be as promising as with radical hysterectomy and lymph node dissection when the malignancy is found early.

Radical trachelectomy is done at the time of lymph node dissection. It involves placing a permanent stitch where the cervix was removed to lessen risk of preterm deliveries.

“Each case is unique—some centers perform this procedure only in women who are 40 or younger. And it is done only in small tumors when we believe we can remove all the cancer,” says Dr. Lee.

“We want to make sure we achieve the same outcomes and hopefully our goal of curing the cancer. Patients must be carefully and fully counseled about risks, benefits and future potential pregnancy complications before having radical trachelectomy.”

 

More on cervical cancer treatments:

http://www.webmd.com/cancer/cervical-cancer/cervical-cancer-treatment-overview

 

 

Uterine and cervical cancer:  I’m through treatment: what now?

Once you’re done with treatment, you may feel like shouting, “It’s over!”  But you’ll probably also feel comforted that your doctor isn’t going anywhere. He or she will follow you— to increase your chances for ongoing health that is now yours again.

 

Follow-up care after treatment

Follow up depends on your personal situation, factors like how aggressive the cancer was, its stage, and if you continue to appear cancer-free. But whatever your individual case, you will be seen anywhere from three months to six months for a specified period. 

If you are at high risk for cancer recurrence, know you will be treated with kid gloves. You may have a pap smear and pelvic exam every three months for several years. You may drop back to every six months in time. If you are high risk you’ll probably have a yearly chest x-ray. You may have periodic CT scans and a tumor marker test called a CA-125; it’s a blood test that detects indication of a possible recurrence. A lot of doctors won’t do the later two screenings routinely, but may do so to stay on top of your situation if you happen to be at very high risk for recurrence, if you report symptoms, or if something shows up during the exam that requires a closer look.

Many patients continue to see their radiation oncologist for check ups. Your doctor may order a baseline bone density test if you are menopausal.

You may have periodic colonoscopies until your risk of recurrence lessens, which it does drop dramatically, typically after three years. So once you reach your three-year landmark, visits will probably be only twice yearly.

 

What you can do yourself:

• Do regular self-examinations of your genital area. 
• Don’t be shy! Ask your doctor any and all questions you have related to symptoms that may be tied to treatments you’ve endured. They are common but may be nothing serious, and your doctor may be able to offer some relief. Know that once your chance for recurrence drops, and you’re back to the old routine of annual Pap smears, you can request more frequent ones if it brings you peace of mind. 
• Also, should you see a new doctor, come prepared. Bring the following to your first visit:
  • Pathology reports
  • Hospital discharge summaries
  • Treatment summary
  • A list of drugs you are on, including doses

 

You can also learn plenty and find comfort in talking to other women who’ve been and or are where you are. For on-line support from other gynecological cancer survivors:

 

http://eyesontheprize.org/community/index.html

 

More resources:

http://www.cancer.org/cancer/endometrialcancer/detailedguide/endometrial-uterine-cancer-additional

http://www.drugs.com/cg/endometrial-cancer-discharge-care.html

 

 

 

Early-stage ovarian and uterine cancer patients preserve fertility

A recent study finds that young women with early-stage gynecological cancers can preserve their fertility by keeping at least one ovary or their uterus and have as good a prognosis.

Researchers at Columbia University College of Physicians and Surgeons in New York City studied the safety of fertility-conserving surgery in premenopausal women with ovarian cancer.

They looked at women who had both ovaries removed, comparing them to those who only had one ovary taken. The women who had just one ovary removed had similar survival for up to at least five years.

A second analysis examined uterine conservation vs. hysterectomy in early stage cancers. Uterine  conservation also was not found to effect survival.

Depending on the situation, more options are becoming available as technology moves forward. Ovarian transposition in cervical cancer to reposition ovaries during radiation. Hormone therapy rather than surgery.  Hysteroscopic resection in endometrial cancer to remove only the tumor and some surrounding tissue. And conservative surgery in ovarian cancer.

More on fertility-preserving surgeries:

www.cancernetwork.com/display/article/10165/61433

There’s good news for women who chose, or who require, more aggressive surgery. 

Here are links to information on fertility options that may be available to you:

www.mskcc.org/mskcc/html/98454.cfm

www.fertilehope.org

 

 

Cervical cancer: Ousting the myths

A woman hears she has cervical cancer and the devastating thoughts start to come; it’s natural. But there are a lot of myths floating around. Bad, scary ones. Here are some of them, and let’s set the record straight …

Myth. I am probably going to die.

Truth: Survival after cervical cancer caught in its earliest stage is 92 percent. Survival is lower in developing countries because of inadequate screening. Regular screening will help ensure cervical cancer is caught early, when it’s curable.

Myth. After I finish treatment, I will have to live the rest of my life worried about cancer returning.

Truth: If cervical cancer is going to recur, it is most likely to happen in the first two years after treatment. Most patients are followed for five years, after which the risk of recurrence is extremely low.

Myth. I must have a hysterectomy to treat cervical cancer.

Truth: Hysterectomy to remove the cervix and uterus is an option, but it’s not necessarily the only one. Radiation and chemotherapy only are used to treat more advanced cancer, and are sometimes options for early stage disease. Some women with early cervical cancer can opt for procedures like cone biopsy to remove only the cancerous tissue and a small amount of surrounding tissue. Or they may be able to have a radical trachelectomy, to remove their cervix but preserve their uterus.

Myth. A hysterectomy to treat cervical cancer will put me in menopause.

Truth: Hysterectomy does not remove the ovaries, which are what determines whether you are menopausal. Cervical cancer very rarely spreads to the ovaries. Women whose cervical cancer is treated by pelvic radiation will likely experience menopause because the radiation will affect the ovaries. But there still may be a way to reposition the ovaries during radiation.

Myth. Hormone replacement therapy will increase my risk of cervical cancer.

Truth: Cervical cancer does not respond to hormone therapy in the same way as breast or ovarian cancers. Low doses of hormone replacement therapy can treat menopausal symptoms without increasing risk of cervical cancer.

For more information about cervical cancer and the HPV vaccine, visit the following resources: www.mcancer.org

*Adapted from Medical News Today, 15 Common Myths About Cervical Cancer

 

Robotics for uterine cancer

If you’ve just heard you have uterine cancer, you may be a candidate for a fairly new robotic-type surgery that could make a trying experience a little easier on you.

Your doctor is still in control, but with help from a computer and robotic arm that translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. Surgeons can operate with better visualization—they actually see 3-D images of the surgical area. You also end up with only tiny incisions, less blood loss, and a shorter hospital stay. Studies have shown these benefits to be especially apparent in heavy uterine cancer patients.

 

Profile of a study

There have been a number of studies looking specifically at women with uterine cancer. Here’s a summary of one of them; it compared patients who underwent one of three types of hysterectomy for uterine cancer: robotic surgery, laparotomy, or laparoscopic surgery.

The results: The women who had robotic surgery had less complications and returned to their regular routines the quickest. Their surgeries took longer than the laparotomies, but was comparable to laparascopy. The patients who had the robotic procedure lost less blood than the laparotomy group, comparable to the patients who had laparoscopy. Additionally, the average cost was highest for laparotomy, followed by robotic, and least for standard laparoscopy. (Gynecological Oncology Nov 2008).

Studies on robotic surgery for gynecological cancer:

www.ncbi.nlm.nih.gov/pubmed/20375811

www.ncbi.nlm.nih.gov/pubmed/20812220

FAQ on da Vinci procedure:

www.davincihysterectomy.com/davinci_hysterectomy/davinci_faqs.aspx