Expanded Indications for Fertility-preserving Surgery for Early Cervical Cancer

Expanded Indications for Fertility-preserving Surgery for Early Cervical Cancer

The National Comprehensive Cancer Network (NCCN) has recommended fertility-preserving surgery to include more women with cervical cancer.

The cervix is located at the bottom part of the uterus. It is typically in a closed position, but opens during labor to allow the baby to pass through the uterus into the vaginal canal.

Rates of cervical cancer, particularly advanced cervical cancer, are low in industrialized nations; these low rates are attributed to Pap smear screening and early intervention when pre-cancerous cells are found. However, cervical cancer is one of the most common causes of cancer-related deaths for women in underdeveloped countries-a statistic explained by a lack of accessible screening in such regions.

Standard treatment for cervical cancer is determined by the extent of spread of the cancer, but most approaches include the surgical removal of the cancer. If too much of the cervix is removed during such a procedure, a woman cannot have a normal pregnancy because a closed cervix would keep the fetus inside the uterus.

The NCCN consists of a panel from the nation’s most reputable cancer treatment facilities. The panel sets clinical guidelines for diagnostic procedures and treatment of cancer; these guidelines are continually refined. Just recently, the NCCN expanded the role of surgery that preserves the ability of women to carry a baby (fertility-sparing surgery) to include patients whose disease has spread through some tissue layers of the cervix (Stage Ib1). However, these patients must have cancers that are 2 centimeters or less in diameter.

The surgery would include the removal of most of the cervix, but the internal opening would be stitched closed with a stitch strong enough to support a pregnancy. The small opening would allow menstrual flow to pass. In addition, lymph nodes near the cervix are also removed and tested for cancer.

Patients diagnosed with early cervical cancer may wish to discuss their eligibility, as well as individual risks and benefits, of fertility-sparing surgery.

Reference: National Comprehensive Cancer Network. Practice Guidelines in Oncology – Cervical Cancer. Available at : http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf. Accessed August 2007.

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