Treatment & Management of Cervical Cancer

Treatment for cervical cancer may require surgery, radiation, chemotherapy or a combination.

Treatment & Management of Cervical Cancer

Medically reviewed by Dr. C.H. Weaver M.D. 8/2018

The specific treatment for cervical cancer depends on the stage of the cancer and its genomic profile and may include surgery, radiation, chemotherapy or precision cancer medicines. Surgery is the mainstay of treatment for early stage disease.

Surgery

Early-stage cervical cancer is typically treated with surgery to remove the uterus (hysterectomy). A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant.

  • Simple hysterectomy. The cervix and uterus are removed along with the cancer. Simple hysterectomy is usually an option for very early-stage cervical cancer.
  • Radical hysterectomy. The cervix, uterus, part of the vagina and lymph nodes in the area are removed with the cancer.

Radiation

Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.

Precision Cancer Medicines

The purpose of precision cancer medicine is not to categorize or classify cancers solely by site of origin, but to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are being developed for the treatment of advanced stages of cervical cancer and patients should ask their doctor about whether testing is appropriate.

Chemotherapy

Chemotherapy uses medications, usually injected into a vein, to kill cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control more advanced cervical cancer.

Treatment of Cervical Cancer by Stage

Precancerous lesion involves only the cells on the surface of the cervix.

Cancer is confined to the cervix, and may be evident only under microscopic evaluation (stage IA) or apparent by visible or physical examination (stage IB).

Cancer has spread beyond the cervix to involve the tissues surrounding the cervix (parametria) or the upper portion of the vagina.

Cancer spreads beyond the cervix to the lower vagina or to the sides of the pelvis, or causes a blockage of drainage from the kidney, a condition called hydronephrosis.

Cancer invades structures adjacent to the cervix such as the bladder or rectum or has spread to other parts of the body such as the liver or lungs.

Cervical cancer is still detected or has returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy, and/or chemotherapy.

The Role of Surgery in Managing Cervical Cancer

Surgery is a local therapy used to remove precancerous tissue or cancer in or near the cervix. A surgeon who specializes in treatment of disorders of the female reproductive tract is known as a gynecologist. Some gynecologists have special training in treatment of cancers of the female reproductive tract, and are known as gynecologic oncologists. Gynecologic oncologists have developed expertise in performing surgical treatment of cancer of the cervix.

Cervical Biopsy

If a pelvic examination or Pap smear result suggests that cervical cancer may be present, the patient will need to have a biopsy. A biopsy is the only way to know for sure whether a patient has cancer. During a biopsy, an instrument is used to remove small pieces of cervical tissue. The pieces of cervical tissue are then examined under the microscope to determine whether cancer cells are present. A cervical biopsy can be performed in the office using a special microscope called a colposcope, or occasionally in the operating room during a more thorough examination while the patient is asleep.

Conservative Surgery for Precancerous Cervical Disease

Surgery is a standard treatment of precancerous cervical disease. The type of operation used to remove the precancerous disease depends on how abnormal the cells appear to be under the microscope, the patient’s general medical condition and whether the patient wishes to have children in the future. A number of surgical procedures are effective in treating precancerous cervical disease. Most procedures do not involve removal of the uterus and can permit future childbearing if desired by the patient.

Surgical procedures that preserve the uterus and may permit future childbearing include cryosurgery (freezing), laser surgery, loop electrosurgical excision procedure (LEEP) or cold-knife conization. Cryosurgery, laser surgery and LEEP can be performed in the doctor’s office or outpatient short procedure center, often with local anesthesia. A cold-knife conization is a more extensive operation that involves removal of part of the cervix under general anesthesia. Not all patients can be adequately treated with cryosurgery, laser surgery or LEEP. This decision depends on the extent and appearance of the disease on examination.

Women who undergo one of these surgical procedures may experience cramping or pain in the pelvis, infection, bleeding or watery discharge. Watery discharge can persist for several weeks following cryosurgery. Women who undergo a cold-knife conization may have difficulty with cervical function during a future pregnancy.

Even with surgical treatment of precancerous cervical disease, some patients may experience recurrence of precancerous disease or invasive cancer. Treatment of stage 0 cervical cancer with cryosurgery, laser surgery or LEEP cures 85-90% of women. Approximately 10-15% may experience a recurrence of precancerous cervical disease and approximately 2% will develop invasive cancer following treatment with these procedures. Women treated with conservative surgery require lifelong visits to their doctor to ensure that recurrence of cervical disease can be detected in the precancerous state or early while the cancer is still curable.

Simple Hysterectomy

A hysterectomy is a common treatment of stage I cancer and precancerous disease of the cervix. The type of hysterectomy used to remove the cervical cancer depends upon the extent of the cancer.

If the precancerous disease is more extensive and the patient desires no further children, a simple hysterectomy can be performed. During a simple hysterectomy, the entire uterus, including the cervix with the precancerous disease and an area of normal tissue around it, is removed through a low abdominal incision or the vagina. A simple hysterectomy is very effective therapy if the cancer has not invaded beyond the surface cell layer of the cervix. In addition, doctors can perform a bilateral salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes. The decision to perform a bilateral salpingo-oophorectomy depends on the woman’s age and whether the ovaries are still functioning.

A simple hysterectomy and/or a bilateral salpingo-oophorectomy are the most extensive surgical options used for precancerous disease and require general anesthesia and a hospital stay. Women undergoing a hysterectomy may experience lower abdominal pain and difficulty with urination after the operation. After a hysterectomy, women no longer menstruate and can no longer have children.

Radical Hysterectomy

A radical hysterectomy is more extensive surgery that involves the removal of the entire uterus, including the cervix, with the cancer and an area of normal tissue through a low abdominal incision. This area of normal tissue also includes a portion of the upper vagina and may result in vaginal shortening after the operation, but rarely causes sexual problems. As with a simple hysterectomy, doctors might opt to perform a bilateral salpingo-oophorectomy, which is the removal of the ovaries and fallopian tubes. The decision to perform a bilateral salpingo-oophorectomy depends on the woman’s age and whether the ovaries are still functioning.

Women undergoing a radical hysterectomy may experience lower abdominal incisional pain, bleeding or infection after the operation. In addition, some women may experience difficulty with urination or problems with bladder control. Less commonly, some women may have injury to the rectum, ureters (tubes that drain the kidneys) or bladder. One type of injury may be in the form of a “fistula” or abnormal connection to the vagina. After a hysterectomy, women no longer menstruate and can no longer have children. With radical hysterectomy and pelvic lymph node dissection alone or, more commonly, when it is combined with radiation therapy, women are at higher risk for bowel complications and chronic swelling in the legs, known as lymphedema. In-hospital death occurs after radical hysterectomy in less than 1% of cases.

Hysterectomy and Pelvic Lymph Node Dissection

A radical hysterectomy is most effective if the exploration during surgery shows that the cancer has not spread beyond the cervix. Some patients will have cancer that has spread outside the cervix into the lymph nodes in the pelvis. Before performing a hysterectomy, the doctor will sometimes perform a pelvic lymph node dissection, which is surgery to remove lymph nodes to see if they contain cancer. If the lymph nodes contain cancer, usually the surgeon will not proceed with a radical hysterectomy. Another form of treatment, usually radiation therapy and chemotherapy, is generally recommended.

Even after surgical removal of cervical cancer, some patients may experience recurrence of their cancer. Cancer recurrence occurs more commonly with bulky stage IB or stage II cervical cancer. It is important to realize that some patients with cervical cancer already have small amounts of cancer that have spread outside the cervix and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the cervix are referred to as micrometastases. The presence of these micrometastases causes recurrence following the initial treatment. External beam radiation therapy with or without implant radiation and chemotherapy are often recommended to cleanse the body of micrometastases in order to improve the cure rate achieved with surgical removal of the cancer.

Robotically - Assisted Hysterectomy Appears Effective for Cervical Cancer

Robotically-assisted hysterectomy (RAH) in patients with early-stage cervical cancer is at least as effective as traditional open radical hysterectomy (ORH) and produces fewer complications.[1]

Robotically-assisted radical hysterectomy (RAH) is a technique during which a surgeon sits at a remote console viewing a magnified 3D image of the surgical site. From here, the surgeon can manipulate four tiny robotic arms inside the patient. These arms mimic the intricate movements of a surgeon’s hands and wrists in real time, which allows for complex and precise techniques. Furthermore, through special hardware and software components, the system even filters out natural hand tremors, which adds to its accuracy. Finally, the robotic arms make dime-sized incisions, whereas a major incision is required with traditional hysterectomy.

In a recent study, researchers at the University of North Carolina compared the outcomes of 51 patients who underwent RAH with those of 49 patients who underwent traditional open radical hysterectomy (ORH). They found that patients who underwent RAH experienced less blood loss and shorter hospital stays than patients who underwent ORH. All RAH patients were discharged the day following surgery compared with an average hospitalization of approximately three days for the ORH group. Furthermore, the incidence of postoperative complications was almost 8% for the RAH group compared with approximately 16% for the ORH group.2

Retroperitoneal Lymph Node Dissection and Scalene Lymph Node Biopsy

Patients who cannot undergo surgery to remove the cancer or who have advanced stage cervical cancers will often receive radiation therapy usually combined with chemotherapy. Before radiation therapy is delivered, it is helpful to know if the lymph nodes in the abdomen and pelvis have small deposits of cancer in them. This is determined by an operation called a retroperitoneal lymph node dissection. During this operation, a small incision is made in the middle abdomen and the surgeon removes the lymph nodes, which lie behind the abdominal contents. Most patients are able to leave the hospital after a day or two and begin treatment with radiation therapy shortly afterwards. If the sampled lymph nodes contain cancer, the radiation oncologist may modify treatment to include these areas of microscopic disease.

Some patients have advanced cervical cancer when they are diagnosed. In these patients, it is important to know whether disease has spread outside the pelvis to distant parts of the body. One method is to perform a small operation to dissect the lymph nodes at the base of the left neck. This operation is called a scalene lymph node biopsy, and can be performed on an outpatient basis. Subsequent treatment may depend on the results of this biopsy.

Radiation Therapy for Cervical Cancer

Radiation therapy, or radiotherapy, is a common way to treat cervical cancer. Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be administered by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. In stage I cervical cancer, radiation therapy may be used instead of surgery, or it may be used after surgery to destroy remaining cancer cells. In stage IB-IVA cervical cancer, radiation therapy is administered concurrently with chemotherapy.

External Beam Radiation Therapy

External beam radiation therapy (EBRT) for cervical cancer is administered on an outpatient basis, 5 days a week for several weeks. EBRT begins with a planning session, or simulation, where marks are placed on the body and measurements are taken in order to line up the radiation beam in the correct position for each treatment. A program of daily treatments is then begun where the patient lies on a couch and is treated with radiation from multiple directions to the pelvis. External beam radiation therapy for cervical cancer is administered on an outpatient basis for approximately 4 to 6 weeks.A combination of external beam radiation therapy and implant radiation is used to increase the dose of radiation administered to the cancer. Implant or internal radiation is further described in the section below. When these two methods are combined, the external beam radiation therapy is given for 4-6 weeks, and the final “boost” of radiation to the cervix is given with the implant radiation.Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. It is also common for patients to experience loose stools or diarrhea. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. This can make sexual relations painful and make future pelvic examinations difficult. Patients are often taught how to use a dilator to maintain the pliability of the vagina. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early.

Implant Radiation Therapy

Implant radiation, sometimes referred to as brachytherapy, refers to treatment where radioactive material is placed directly into the cervix. Placing the radiation in this manner allows a high radiation dose to be delivered directly to the cancer, while reducing radiation to surrounding normal organs, such as the rectum and bladder.

During a procedure in the operating room, a small device is placed into the cervix and vagina. This device is later “loaded” with the radiation capsules while the patient is in a lead-shielded hospital room. The radioactive material is left in place for 1-3 days. This procedure may be performed once or twice during the course of treatment. The patient is discharged from the hospital once the device is removed from the cervix.Many centers are administering the implant radiation on an outpatient basis using a slightly different technique called “high-dose rate (HDR) brachytherapy.” With this procedure, a device is inserted into the cervix and vagina in the radiation therapy department and the patient remains with the radiation for only 30 minutes to one hour. This procedure is generally repeated weekly, approximately 3 to 5 times during the course of treatment. HDR brachytherapy is a newer technique and is not yet widely available. The results from early experience demonstrate that HDR brachytherapy appears to be just as effective as traditional implant radiation, but avoids a hospital stay.A less commonly used method of brachytherapy is interstitial (into the tissue) implant. With this method, the patient is placed under general anesthesia and fine tube like needles are placed into the cancer and immediate tissue around it in a manner to fit the shape of the cancer. The tube-like needles are later “loaded” with the radioactive seeds and the remaining steps are similar to what is done with implants.In implant radiation therapy, the positioning of the device is critical to the effectiveness and safety of the treatment. Although the cervical cancer receives the highest radiation dose, the surrounding organs, such as the rectum and bladder, are also exposed to some radiation. Radiation injury to the rectum, bladder or bowel can occur and may cause pain or bleeding with urination or passage of stools. Less commonly, some patients will develop a fistula, which is an abnormal connection between the rectum or bladder and the vagina. At times, additional surgery may be necessary for repair of fistulas or other radiation injury.

Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be given by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. For stage I cervical cancer, radiation therapy may be used instead of surgery or it may be used after surgery to destroy remaining cancer cells. For stages IB-IVA cervical cancer, radiation therapy is usually administered concurrently with chemotherapy.

Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. Loose stools and diarrhea are also common. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early and subsequently be infertile.

With any treatment of cancer, you must first understand your responsibility, your medical team’s role, explore treatment options and get a second opinion(s) before you begin treatment. Since the side effects of radiation can be significant, talk to your doctor before treatment begins so that you understand the specific kind of radiation you will receive and the expected side effects. The following list of questions is meant as a guide to issues you should discuss with your radiation oncologist and medical team before undergoing radiation therapy for cervical cancer.

Questions to Ask When Exploring Your Options

  • What is the stage of my cancer?
  • Why do you recommend radiation?
  • What are my options besides radiation?
  • Is radiation the standard therapy for my stage of disease?
  • Are there clinical trials for my stage of disease?
  • Will I have chemotherapy concurrently with radiation?
  • Are there any protocols for neoadjuvant therapy for my stage of disease?
  • Are there any pre-radiation procedures I might benefit from to protect my fertility?

Questions to Ask about Radiation

  • What is your experience with complications from radiation?
  • What should I expect as far as complications and side effects?
  • Considering my age and general health, am I at higher or lower risk for complications and side effects?
  • Will my radiation treatments be external, internal or both?
  • How many treatments will I have?
  • How will the treatments be administered?
  • If I have both external and internal radiation, what type of internal radiation is used and when?
  • During external radiation treatments, do you use shields to protect the small bowel and other organs?
  • Will the beam be directed at all four sides (front, back, and laterals) to help diminish side effects?
  • If, for modesty reasons, I am uncomfortable having male technicians, is it possible to have only female technicians attend me during my treatments?
  • Have my radiation treatments been approved by my insurance?

Questions to Ask about Side Effects

  • What are the expected side effects and how do I deal with them?
  • Are the treatments painful?
  • How will treatment affect my sexuality, both long and short term?
  • Do you recommend use of a vaginal dilator? If so, how and when should I use it?
  • Do you prescribe medications to help me with emotional issues?
  • Will I get advice on my diet and supplemental nutrition from a registered nutritionist?
  • Will I get advice on caring for the radiated area from an oncology nurse?

Questions to Ask about Recovery

  • How long will my recovery take when I have completed my radiation treatment?
  • Who can I call with questions or concerns?
  • If my radiation therapy induces menopause, would I benefit from estrogen replacement therapy?
  • Who will be my follow-up doctor?

Determining that radiation therapy is the right treatment for you, as well as asking your radiation oncologist about treatment procedures and side effects are critical to making informed decisions about your disease. Exploring emotional and physical side effects of radiation therapy will give you some insight into potential problems before they occur. Although managing and living with these side effects may still be difficult, at least you will be aware and informed if they occur. Before undergoing any treatment for you disease you should understand your responsibility, your medical team’s role, explore treatment options, ask questions and get a second opinion(s).

Questions to Ask Before Radiation Therapy for the Treatment of Cervical Cancer

Radiation therapy, or radiotherapy, is a common way to treat cervical cancer. Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be given by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. For stage I cervical cancer, radiation therapy may be used instead of surgery or it may be used after surgery to destroy remaining cancer cells. For stages IB-IVA cervical cancer, radiation therapy is usually administered concurrently with chemotherapy.

Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. Loose stools and diarrhea are also common. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early and subsequently be infertile.

Determining that radiation therapy is the right treatment for you, as well as asking your radiation oncologist about treatment procedures and side effects are critical to making informed decisions about your disease. Exploring emotional and physical side effects of radiation therapy will give you some insight into potential problems before they occur. Although managing and living with these side effects may still be difficult, at least you will be aware and informed if they occur. Before undergoing any treatment for you disease you should understand your responsibility, your medical team’s role, explore treatment options, ask questions and get a second opinion(s).

With any treatment of cancer you must first understand your responsibility and your medical team’s role as well as explore treatment options and get a second opinion(s) before you begin treatment. Since the side effects of radiation can be significant, talk to your doctor prior to treatment so that you understand the specific kind of radiation you will receive and the expected side effects. Doctors who specialize in treating cancers with radiation are known as radiation oncologists. During radiation therapy, high-energy x-rays are used to kill cancer cells. Radiation therapy can be given by a machine that aims x-rays at the body (external beam radiation) or by placing small capsules of radioactive material directly into the cervix (internal or implant radiation or brachytherapy). Many patients receive both kinds of radiation therapy. For stage I cervical cancer, radiation therapy may be used instead of surgery or it may be used after surgery to destroy remaining cancer cells. For stages IB-IVA cervical cancer, radiation therapy is usually administered concurrently with chemotherapy.

Fatigue from radiation therapy can be a cumulative result of the stress from your disease, daily trips for radiation treatment and radiation effects on normal cells in the body. Patients vary in their degree of fatigue and their toleration of a normal work schedule and activities. Some patients suggest that a flexible work schedule is important since fatigue is more noticeable after the first couple of weeks of radiation therapy. Patients who were in a very stressful, high demand job suggested taking time off from work. On the other hand, patients who enjoyed their job suggested maintaining a regular work schedule or adjusted schedule to benefit from some degree of normalcy. In addition, patients suggest taking naps, getting adequate sleep, light exercise and some limitation of normal activities to help with fatigue. Check with your doctor to see what his or her recommendations are for exercise, activities and work load.

Diarrhea and loose stools may be a common temporary side effect or uncommon longer lasting side effect due to the radiation of the pelvis. Managing diarrhea may require anti-diarrhea medication and following nutritional recommendations by your doctor. Avoiding foods high in fiber like raw vegetables, fruit, grains and cereals may decrease the occurrence of diarrhea. A liquid diet at the onset of diarrhea may also help to reduce the occurrence. Check with your doctor for specific medication and nutritional recommendations.

Frequent and uncomfortable urination may be alleviated by drinking a lot of fluids, but avoiding caffeine and carbonated beverages. Your doctor may also prescribe medication to help relieve urination difficulty side effects.

Irritation of the skin is another common side effect associated with radiation therapy. Your doctor may be able to prescribe anti-itch medication for severe itching and irritation. Avoiding unnecessary irritation of the radiated area will also prevent further discomfort. Avoid lotion application within 2 hours of treatment, very hot or very cold water, sun exposure, tight clothing and scratching or scrubbing the affected area. Also, ask your doctor to recommend skin care products that will not irritate the tender skin. Most skin reactions will go away when treatment is over.

Shrinking and scarring (stenosis) of vaginal tissue associated with radiation therapy of the pelvis can be a difficult long-term side effect. This can make sexual relations painful and make future pelvic examinations difficult. In order to manage this side effect, it is important to maintain the pliability of the vagina with frequent sexual intercourse or the use of a dilator. Lubricants and creams may also help with vaginal dryness and sexual function.

Pelvic radiation for the treatment of cervical cancer can cause the ovaries to stop working either temporarily or permanently. In women of child-bearing age, early menopause inducement results from ovarian function cessation. There are many side effects of early menopause ranging from irregular periods, hot flashes and vaginal dryness to infertility and emotional issues. Hormone replacement therapy and other alternative methods may be recommended by your gynecologist to help manage the side effects of early menopause.

The potential loss of fertility associated with ovarian dysfunction resulting from radiation therapy should be discussed with your doctor before treatment begins. Some patients may want to have their eggs harvested for surrogacy before radiation treatment. Also, a highly experimental approach is currently being explored that involves removing an ovary and implanting it in an area of the body that will not be affected by the radiation treatment. This experimental approach may one day be offered to help avoid infertility and early menopause associated with radiation therapy of the pelvis.

Preservation of Reproductive Function

Generally, women who receive treatment for stage I cervical cancer have an excellent prognosis, with a cure rate of greater than 90% following a hysterectomy. However, some women of childbearing age would prefer a therapy that preserves their reproductive function. One such procedure for preserving reproduction function is a radical trachelectomy, which only removes a portion of the uterus. In a recent clinical study, 32 patients with stage I cervical cancer measuring 2cm or less who were treated with radical trachelectomy experienced a 2-year survival rate of 95%, without any relapse of the cancer. Approximately 40% of women were able to conceive after treatment.

Ovarian Transplantation Into Forearm: A new procedure that involves the permanent placement of a section (cortical strip) from a patient’s ovaries into her forearm may preserve fertility and normal ovarian function in pre-menopausal women who are treated with radiation to the pelvic area or undergo the removal of their ovaries.

Researchers evaluated the surgical procedure in two women, a 35-year-old with advanced cervical cancer who was to undergo pelvic radiation and a 37-year-old with benign cysts on her ovaries who was to undergo an oophorectomy. Both patients had cortical strips removed from their ovaries and permanently transplanted to the forearm. The first patient received her transplant prior to radiation and the second patient received her transplant during the oophorectomy. Ten weeks following surgery, the transplant tissue in both patient forearms had resumed the production of ovarian hormones and the development of follicles (eggs). One patient has actually ovulated and the other patient is producing cyclical hormone levels indicative of ovulation. Besides normal hormonal function, the other end goal of this procedure is to be able to harvest eggs from the transplanted ovarian strips so that pre-menopausal patients having to undergo treatment that normally causes sterility can bear children.

Preservation of Ovarian Function: A new procedure that involves the permanent placement of a section (cortical strip) from a patient’s ovaries into her forearm may preserve fertility and normal ovarian function in pre-menopausal women who are treated with radiation to the pelvic area or undergo the removal of their ovaries.

Researchers evaluated the surgical procedure in two women, a 35-year-old with advanced cervical cancer who was to undergo pelvic radiation and a 37-year-old with benign cysts on her ovaries who was to undergo an oophorectomy. Both patients had cortical strips removed from their ovaries and permanently transplanted to the forearm. The first patient received her transplant prior to radiation and the second patient received her transplant during the oophorectomy. Ten weeks following surgery, the transplant tissue in both patient forearms had resumed the production of ovarian hormones and the development of follicles (eggs). One patient has actually ovulated and the other patient is producing cyclical hormone levels indicative of ovulation. Besides normal hormonal function, the other end goal of this procedure is to be able to harvest eggs from the transplanted ovarian strips so that pre-menopausal patients having to undergo treatment that normally causes sterility can bear children.

Preservation of Reproductive Function: Generally, women who receive treatment for stage I cervical cancer have an excellent prognosis, with a cure rate of greater than 90% following a hysterectomy. However, some women of childbearing age would prefer a therapy that preserves their reproductive function. One such procedure for preserving reproduction function is a radical trachelectomy, which only removes a portion of the uterus. In a recent clinical study, 32 patients with stage I cervical cancer measuring 2cm or less who were treated with radical trachelectomy experienced a 2-year survival rate of 95%, without any relapse of the cancer. Approximately 40% of women were able to conceive after treatment.

Ovarian Transplantation Into Forearm: A new procedure that involves the permanent placement of a section (cortical strip) from a patient’s ovaries into her forearm may preserve fertility and normal ovarian function in pre-menopausal women who are treated with radiation to the pelvic area or undergo the removal of their ovaries.

Researchers evaluated the surgical procedure in two women, a 35-year-old with advanced cervical cancer who was to undergo pelvic radiation and a 37-year-old with benign cysts on her ovaries who was to undergo an oophorectomy. Both patients had cortical strips removed from their ovaries and permanently transplanted to the forearm. The first patient received her transplant prior to radiation and the second patient received her transplant during the oophorectomy. Ten weeks following surgery, the transplant tissue in both patient forearms had resumed the production of ovarian hormones and the development of follicles (eggs). One patient has actually ovulated and the other patient is producing cyclical hormone levels indicative of ovulation. Besides normal hormonal function, the other end goal of this procedure is to be able to harvest eggs from the transplanted ovarian strips so that pre-menopausal patients having to undergo treatment that normally causes sterility can bear children.

Preservation of Ovarian Function: A new procedure that involves the permanent placement of a section (cortical strip) from a patient’s ovaries into her forearm may preserve fertility and normal ovarian function in pre-menopausal women who are treated with radiation to the pelvic area or undergo the removal of their ovaries.

Researchers evaluated the surgical procedure in two women, a 35-year-old with advanced cervical cancer who was to undergo pelvic radiation and a 37-year-old with benign cysts on her ovaries who was to undergo an oophorectomy. Both patients had cortical strips removed from their ovaries and permanently transplanted to the forearm. The first patient received her transplant prior to radiation and the second patient received her transplant during the oophorectomy. Ten weeks following surgery, the transplant tissue in both patient forearms had resumed the production of ovarian hormones and the development of follicles (eggs). One patient has actually ovulated and the other patient is producing cyclical hormone levels indicative of ovulation. Besides normal hormonal function, the other end goal of this procedure is to be able to harvest eggs from the transplanted ovarian strips so that pre-menopausal patients having to undergo treatment that normally causes sterility can bear children.

References

  1. nccn.org/professionals/physician_gls/f_guidelines.asp#site
  2. Boggess JF, Gehrig PA, Cantrell L, et al. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. American Journal of Obstetrics and Gynecology. 2008; 199: 357.e1-357.e7.
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