Radical trachelectomy

Overview

A radical trachelectomy is commonly used to treat women with early-stage cervical cancer who wish to remain fertile. During the procedure, your doctor removes the cervix, pelvic lymph nodes, upper part of the vagina and surrounding tissue. Your surgeon will also check surrounding tissue for cancer and a pathologist will examine the lymph nodes for signs of cancer.

If cancer is discovered in the surrounding tissue or at the lower uterus at the site where the cervix was removed, a hysterectomy is needed to completely remove all the cancer.

If no cancer is found, a cervical cerclage is placed at the opening of the uterus. The cerclage takes the place of the removed cervix, though future pregnancies are still considered high-risk.

Radical trachelectomies can be performed through either open or minimally invasive surgery. They are a complicated procedure and should only be performed by a gynecologic oncologist who has experience with this technique. 

Reasons for treatment

Radical trachelectomies are used only for women with early-stage cervical cancer who wish to retain the ability to get pregnant. This is a less common treatment than hysterectomies and can only be used in women deemed eligible based on presurgical tests.

Risks and side effects

There are both short- and long-term risks associated with radical trachelectomies. Before your surgery, your gynecologic oncologist will walk you through an extensive list of potential risks, but some of the more common side effects include:

  • Bleeding
  • Infection
  • Pain in the abdomen
  • Painful intercourse
  • Issues with fertility
  • Future high-risk pregnancies
  • The need for a cesarean section (C-section)

Preparing for treatment

Before you can be considered a candidate for a radical trachelectomy, you will need to have a number of tests to make sure the procedure is a safe option. Your specialist will likely order imaging tests, such as MRI and PET/CT scans, to make sure the cancer is still at an early stage. 

You will also be counseled on the possibility of needing a hysterectomy, which may be necessary if your surgeon finds the cancer has spread outside of the cervix. If this is the case, you will no longer be able to get pregnant.

Additional preparation includes no eating or drinking after midnight the night before surgery and not taking certain medications (which will be addressed by your physician). If you need to take any additional preparation steps, your physician will explain why and what they are.

What to expect after treatment

After a successful radical trachelectomy, you will need to remain hospitalized. The length of your stay depends mostly on whether or not you received open or minimally invasive surgery.

Once you are released from the hospital, you will need two to five years of cancer surveillance. This surveillance includes counseling on symptoms to watch out for, physical examinations and tissue samples every few months.

Because all pregnancies achieved by women who underwent a successful radical trachelectomy are considered high-risk, you will be referred to Northwell Health’s Center for High Risk Pregnancy in the event you get pregnant. Vaginal delivery is no longer possible, so you will also need to have a  C-section. 

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