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Women who receive treatment for early-stage cancer (stage I) of the cervix generally have an excellent prognosis, with a cure rate of greater than 90%. A commonly used treatment is a surgical procedure, called a radical hysterectomy, which may or may not be followed by radiation therapy. A radical hysterectomy entails the surgical removal of the cancer, uterus, cervix, and part of the vagina. However, some women of childbearing age who may wish to have children, would prefer a therapy that preserves their reproductive function. Now, Canadian researchers have reported promising results with such a therapy, a less extensive surgical procedure called a radical trachelectomy.

Cancer of the cervix is a common cancer in women that affects the cervix, the part of the body that connects the uterus (or womb) to the vagina (or birth canal). Treatment of cancer of the cervix depends on the stage of disease (extent of disease at diagnosis), which ranges from stage 0 (early stage) to stage IV (advanced stage). Treatment options might include surgery, radiation therapy, chemotherapy, conization (removal of a cone-shaped segment of tissue where the cancer is found), laser surgery, and/or cryosurgery (using cold temperature to kill cancer cells). A radical hysterectomy allows the removal of the cancer and also reduces the risk of recurrence (return) of the cancer later.

Researchers from Toronto evaluated an alternative surgical procedure, called a radical trachelectomy, in 32 patients with stage I cervical cancer with cancers measuring 2 cm or smaller. The patients first underwent a pelvic lymph node dissection, that is, surgical removal of the area lymph nodes to ensure that the cancer had not spread. The lymph nodes were removed using an endoscope, or a lighted flexible tube, through a procedure called a laparoscopy. Once stage I cancer was confirmed, patients underwent the radical trachelectomy, which is a much less extensive procedure than the radical hysterectomy, allowing the removal of the cancer and still the preservation of reproductive function.

Results showed a 2-year survival rate of 95%, without any relapse of the cancer. The rate of conception after 12 months was 37%; however, some patients had reasons other than the cancer and/or surgical procedure for not conceiving. One patient did experience a recurrence of cancer (in the uterus) after 13 months; she later died of metastatic cancer (cancer that spread to other parts of the body).

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The researchers concluded that these findings hold promise for radical trachelectomy as an alternative to radical hysterectomy for women with stage I cervical cancer who wish to preserve the option to have children. However, they also indicated that larger studies with longer followup times are needed to confirm these results. (Cancer, Vol 86, No 11, 1999)