Cervical Cancer Fertility Sparing Treatment
Cervical cancer remains the second commonest cancer in women under the age of 35 in Britain, and so frequently affects young women just at the time that they are considering having a family. We have even seen young women who were going through sub-fertility investigations at the time of the diagnosis and a few women who were even pregnant at the time of diagnosis. The effects may be devastating.
With women having their children much later than in previous generations, this is an increasingly common problem and so consideration of a woman’s fertility and offering treatments that keep someone’s fertility options open to them, are extremely valuable.
When cervical cancers are very small it is possible to conserve much of the cervix and this improves the chances of a normal pregnancy, and we have performed many such procedures. But for slightly larger tumours it is necessary to remove all or almost the entire cervix in a procedure called Trachelectomy. We have performed 23 of these operations for young women with cervical cancer since 2008. I initially learned the technique in France from a pioneering surgeon called Daniel Dargent, who sadly is no longer with us, and over the years we have modified and adapted the technique. In 2009 we introduced the da Vinci surgical robot for our patients and we have built this into our practice. Removal of most of the cervix leaves the mother at risk of preterm labour or premature delivery and so such pregnancies are high risk and require a lot of medical supervision and delivery by caesarean section.
We were actually the first department in the country to perform a radical trachelectomy using the da Vinci robot and have considerable experience of this now. Furthermore we have taught the technique to gynae cancer surgeons from other centres around the country and at International meetings. The photograph of young Finn, given to us by kind permission of his Mum and Dad, Victoria and Alistair Awcock, really says it all. It is enormously rewarding to us all to be able to offer such treatments, but sadly some young people with cancer do relapse despite their treatment and initial results all seeming to be perfect. This is true for all cancer treatments, and fertility-sparing treatments for early-stage cervical cancer do not appear to significantly increase the chance of cancer recurrence.
One of the biggest problems we face is that many young women still fail to attend for their smear tests and put themselves of greater risk of developing cervical cancer. The worst uptake of the screening test is among young women under 30, and almost half of women presenting to us with cervical cancer have not had a smear test within the last 5 years. This is a very sad fact when this is a largely preventable disease. Furthermore, the HPV vaccination programme has been going for almost 10 years now but about a quarter of those teenagers eligible also fail to attend, putting themselves and their potential to have children at increased risk.
GRACE has done a lot of work around health promotion, together with other charities, and has also provided much of the state of the art equipment at the Royal Surrey in Guildford, enabling our team to offer the very best surgical and radiotherapy-based treatments for women with cervical cancer.
Young people feel invincible, but many still suffer with embarrassment and hang-ups about their sexuality and body image. If you can, help or encourage any young person you know to have the HPV vaccine and to attend for their smear test. It could save their life and those of their children.
Simon Butler-Manuel, MD, FRCOG, FRCS
Consultant Surgeon in Gynaecological Oncology
Chair of GRACE