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Fertility-sparing surgery for cervical cancer

Author
Marie Plante, MD
Section Editors
Barbara Goff, MD
Susan M Ramin, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Discussion of fertility issues is an important part of pretreatment counseling for reproductive-age cancer patients [1]. Most young cancer survivors desire to eventually become parents; thus, the psychosocial impact of cancer-related infertility is significant, with a high proportion of these patients experiencing feelings of depression, grief, stress, and sexual dysfunction [2,3].

Concerns about fertility preservation are particularly common among women with gynecologic malignancies. Cervical cancer, in particular, is likely to impact young women; 46 percent of cases of cervical cancer are diagnosed in women <45 years old [4]. These young women may be candidates for fertility preservation options, such as radical trachelectomy, since most of their cancers are diagnosed at an early stage (table 1) when survival is over 90 percent [5]. Observational studies published in the past decade have reported good oncologic and obstetric outcomes after this procedure.

Fertility-sparing surgery for cervical cancer will be discussed here. Additional issues related to fertility and cancer are discussed separately. (See "Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection" and "Ovarian failure due to anticancer drugs and radiation" and "Overview of infertility and pregnancy outcome in cancer survivors".)

OVERVIEW

Radical hysterectomy is the standard surgical treatment for women with cervical cancer. In general, women with stage IA1 (table 1) disease may be treated with conization (or extrafascial hysterectomy). However, some other women are candidates for fertility-sparing surgery. These include women of reproductive age with early-stage disease (stage IA2 or IB1) who have no features of disease that are high risk for recurrence (ie, lesion size >2 cm, lymph node metastases). Lymphovascular space invasion (LVSI) within the tumor is a risk factor for lymph node recurrence, but as a sole finding, it is not a contraindication for fertility-sparing surgery. Options for fertility-preserving surgery include conization and radical trachelectomy (removal of the cervix and surrounding tissues with conservation of the uterus).

STAGE IA1 WITHOUT VASCULAR INVASION

Conization — Women with stage IA1 disease (table 1) without lymphovascular space invasion (LVSI) are candidates for treatment with cervical cold knife conization alone [6]. A United States study of data from a national cancer database study (n = 1409) of women age ≤40 years with stage IA1 cervical cancer found no significant difference in five-year survival between those who underwent conization versus hysterectomy (98 versus 99 percent); data regarding LVSI were not available [7]. (See "Management of early-stage cervical cancer", section on 'Surgical treatment'.)

                                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 20 00:00:00 GMT 2016.
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