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Yamamoto M, Motohara T, Iwagoi Y, Tayama S, Tashiro H, Kondoh E, Katabuchi H. Fertility-sparing surgery for early-stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy. J Obstet Gynaecol Res 2022; 48:1444-1450. [PMID: 35315183 DOI: 10.1111/jog.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the oncologic and obstetric outcomes of cervical conization followed by pelvic lymphadenectomy, which is used as a fertility-sparing procedure, in reproductive-aged patients with early-stage cervical cancer. METHODS We performed a retrospective study of patients with stage IA1-IB1 cervical cancer who underwent cervical conization followed by pelvic lymphadenectomy from 2011 to 2020 at Kumamoto University Hospital. RESULTS In total, eight patients underwent conization followed by pelvic lymphadenectomy. The median age of the patients was 33 (range: 28-36) years. Four (50.0%) patients were nulliparous. Seven (87.5%) patients were diagnosed with squamous cell carcinoma (87.5%) and one (12.5%) with adenocarcinoma. Five (62.5%), two (25.0%), and one (12.5%) presented with stage IA1, IA2, and IB1 disease, respectively. Five (62.5%) patients had lymphovascular space invasion (LVSI) based on the assessment of specimens obtained via conization. However, none had lymph node metastasis based on pelvic lymphadenectomy. Regarding long-term oncologic outcomes, recurrence was not observed at a median follow-up of 60 (range: 8-107) months. In addition, obstetric outcomes were consistently favorable in terms of achieving pregnancy, preterm delivery, and live birth. During the study period, two patients who actively attempted to conceive had four pregnancies, resulting in full-term deliveries, and one was on her first trimester of pregnancy. CONCLUSION Cervical conization combined with pelvic lymphadenectomy represents a feasible conservative management for histologically well-selected patients with early-stage cervical cancer. Furthermore, an optimal histopathological evaluation of conization specimens will contribute to decision-making regarding the use of this fertility-sparing procedure.
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Affiliation(s)
- Mayuko Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Takeshi Motohara
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Yutaka Iwagoi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Shingo Tayama
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Hironori Tashiro
- Department of Woman's Health Sciences and Pediatric Nursing, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Eiji Kondoh
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-city, Kumamoto, Japan
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Cottrell CM, Ohaegbulam GC, Smith JR, Del Priore G. Fertility-sparing treatment in cervical cancer: Abdominal trachelectomy. Best Pract Res Clin Obstet Gynaecol 2021; 75:72-81. [PMID: 33846052 DOI: 10.1016/j.bpobgyn.2021.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, great strides have been made to treat cancer while sparing fertility for young women. This is at least partly in response to changing demographics, including delayed childbearing and fewer historically traditional couples. The trachelectomy has become emblematic in this endeavor. With comparable outcomes to hysterectomy and successful conceptions, trachelectomy utilization has increased over time. It is now a standard of care for many situations. While there are several approaches, (vaginal, laparoscopic, and robotic), the abdominal trachelectomy allows surgeons to overcome several limitations, such as patient anatomy, surgical experience, and resources (i.e. no robot) to provide women everywhere this revolutionary operation. In this chapter, we outline surgical techniques, outcomes, and other aspects of the abdominal trachelectomy.
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Affiliation(s)
- Cyra M Cottrell
- Morehouse School of Medicine, 720 Westview Drive Atlanta, GA 30310, USA.
| | - Gail C Ohaegbulam
- Morehouse School of Medicine, 720 Westview Drive Atlanta, GA 30310, USA.
| | - J Richard Smith
- Consultant Gynaecological Surgeon, West London Gynaecological Cancer Centre, Imperial College, London, UK.
| | - Giuseppe Del Priore
- Morehouse School of Medicine, Department of Ob-Gyn, Gynecologic Oncology, 720 Westview Drive Atlanta, GA 30310, USA.
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Su Y, Zhang C, Hou W, Liou Y, Chen Y, Xie Y, Zhang D, Ji P, Chen R, Jiang G, Zhang M. Fertility-preserving local excision under a hysteroscope with combined chemotherapy in a 6-year-old child with clear cell adenocarcinoma of the cervix: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e18646. [PMID: 32000369 PMCID: PMC7004716 DOI: 10.1097/md.0000000000018646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Clear cell adenocarcinoma of the cervix (CCAC), a rare and more severe type of gynecological cancer, is especially rare in pediatric patients. Traditionally, surgery following chemotherapy (CT) and radiation therapy is the preferred treatment for CCAC; however, patients have poor 5-year survival rates than other types of cervical cancers. PATIENT CONCERNS A 6-year-old girl with a history of vaginal discharge for 18 months was diagnosed with CCAC by histological examination. Her parents refused the traditional treatment of radical hysterectomy and lymph node dissection because of her young age. DIAGNOSIS The patient's tests revealed negative human papilloma virus and negative methylated paired box 1 gene results. The tumor mass histopathology revealed stage IIA1 CCAC that originated from the cervix. INTERVENTIONS Tumor mass excision with preservation of the cervix by electrosurgical biopsy under hysteroscopy was performed. Four cycles of docetaxel and oxaliplatin CT were administered every 3 weeks. OUTCOMES No signs of recurrence were observed in the 28 months after final treatment and diagnosis on magnetic resonance imaging, color ultrasonic imaging, and gynecological examination. Serologic tumor biomarkers were also within normal ranges. CONCLUSIONS This is the first reported CCAC case in which the primary treatment included electrosurgical biopsy of the polypoid mass under hysteroscopy, followed by CT without traditional treatment: radical surgery with pelvic and/or lymphadenectomy for fertility preservation. This is a new treatment approach for young CCAC patients without the use of surgery.
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Affiliation(s)
- Yuehui Su
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Chunyan Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Wenjing Hou
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Yuligh Liou
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha
| | - Yueyue Chen
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Ya Xie
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Dongya Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Pengcheng Ji
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
| | - Renyin Chen
- Department of Pathology, First Affiliated Hospital of Zhengzhou University, Henan, P. R. China
| | - Guozhong Jiang
- Department of Pathology, First Affiliated Hospital of Zhengzhou University, Henan, P. R. China
| | - Mengzhen Zhang
- Department of Gynecology, First Affiliated Hospital of Zhengzhou University, Henan
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Zhang Q, Li W, Kanis MJ, Qi G, Li M, Yang X, Kong B. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:46580-46592. [PMID: 28418849 PMCID: PMC5542294 DOI: 10.18632/oncotarget.16233] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy. STUDY DESIGN This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity. RESULTS Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%). CONCLUSION Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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Affiliation(s)
- Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Wenhui Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Margaux J Kanis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Minghao Li
- Shandong University School of Medicine, Ji'nan, Shandong, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
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Tirlapur A, Willmott F, Lloyd P, Brockbank E, Jeyarajah A, Rao K. The management of pregnancy after trachelectomy for early cervical cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/tog.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anushka Tirlapur
- Whipps Cross University Hospital, Barts Health NHS Trust; Whipps Cross Road London E11 1NR UK
| | - Fredric Willmott
- Whipps Cross University Hospital, Barts Health NHS Trust; Whipps Cross Road London E11 1NR UK
| | - Philippa Lloyd
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Elly Brockbank
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Arjun Jeyarajah
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Kalpana Rao
- Newham University Hospital, Barts Health NHS Trust; Glen Road London E13 8SL UK
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Fertility-Sparing Options for Early Cervical Cancer: Optimism for Oncologic and Obstetric Outcomes. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0177-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yan H, Liu Z, Fu X, Li Y, Che H, Mo R, Song L. Long-term outcomes of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy after neoadjuvant chemotherapy for the IB1 cervical cancer: A series of 60 cases. Int J Surg 2016; 29:38-42. [PMID: 26975424 DOI: 10.1016/j.ijsu.2016.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/27/2016] [Accepted: 03/08/2016] [Indexed: 12/01/2022]
Abstract
OBJECTS The present study sought to analyze the long-time clinical outcomes of the stage IB1 cervical cancer patients who had received the radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy after neoadjuvant chemotherapy (NACT). METHOD This is a prospective study of 60 patients potentially selected for RVT for a clinical and radiologic cervical cancer (stages IB 1) less than 2 cm. These patients were treated with surgery combined with preoperative NACT in the Department of Obstetrics and Gynecology, PLA General Hospital. We collected the patients' general clinical information, surgical characteristics and obstetric data, and then assessed their long-term oncological outcomes. RESULTS The average operative time of the enrolled cases was 204 min and the average blood loss was 443 mL. The average postoperative hospitalization time was 10.6 days. The postoperative pathologic results indicated that the average parametrical width was 1.99 cm; the average length of removed of cervical was 2.6 cm; the average number of excised pelvic lymph node was 20. The median of the follow-up was 43 months (range between 13month and 12 years). Only one case of recurrence was found. Thus far, totally 42 women had tried to conceive, and 36 of them had live births. The live birth pregnancy rate was 86% (36/42). CONCLUSION The radical vaginal trachelectomy in combination with the laparoscopic lymphadenectomy surgical is a safe and effective therapeutic strategy for the for IB 1 cervical cancer.
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Affiliation(s)
- Hong Yan
- Department of Obstetrics and Gynecology, Hainan Branch of PLA General Hospital, Sanya, PR China
| | - Zhongyu Liu
- Department of Obstetrics, The General Hospital of Jinan Military Command, Jinan, PR China; Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China
| | - Xiaoyu Fu
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China
| | - Yan Li
- Department of Obstetrics and Gynecology, Huabei Oil Field General Hospital, Hebei, PR China
| | - Hongzhi Che
- Department of Obstetrics and Gynecology, Hainan Branch of PLA General Hospital, Sanya, PR China
| | - Rui Mo
- Department of Obstetrics and Gynecology, Hainan Branch of PLA General Hospital, Sanya, PR China
| | - Lei Song
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing, PR China.
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Isla Ortiz D, Montalvo-Esquivel G, Chanona-Vilchis JG, Herrera Gómez Á, Ñamendys Silva SA, Pareja Franco LR. [Laparoscopic radical trachelectomy for preservation of fertility in early cervical cancer. A case report]. CIR CIR 2016; 84:329-35. [PMID: 26738647 DOI: 10.1016/j.circir.2015.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 04/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Radical hysterectomy is the standard treatment for patients with early-stage cervical cancer. However, for women who wish to preserve fertility, radical trachelectomy is a safe and viable option. OBJECTIVE To present the first case of laparoscopic radical trachelectomy performed in the National Cancer Institute, and published in Mexico. CLINICAL CASE Patient, 34 years old, gravid 1, caesarean 1, stage IB1 cervical cancer, squamous, wishing to preserve fertility. She underwent a laparoscopic radical trachelectomy and bilateral dissection of the pelvic lymph nodes. Operation time was 330minutes, and the estimated blood loss was 100ml. There were no intraoperative or postoperative complications. The final pathology reported a tumour of 15mm with infiltration of 7mm, surgical margins without injury, and pelvic nodes without tumour. After a 12 month follow-up, the patient is having regular periods, but has not yet tried to get pregnant. No evidence of recurrence. CONCLUSIONS Laparoscopic radical trachelectomy and bilateral pelvic lymphadenectomy is a safe alternative in young patients who wish to preserve fertility with early stage cervical cancer.
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Affiliation(s)
- David Isla Ortiz
- Servicio de Ginecología Oncológica, Instituto Nacional de Cancerología México, México D.F., México.
| | | | | | - Ángel Herrera Gómez
- Servicio de Ginecología Oncológica, Instituto Nacional de Cancerología México, México D.F., México
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Radical Vaginal Trachelectomy with Laparoscopic Pelvic Lymphadenectomy for Fertility Preservation in Young Women with Early-Stage Cervical Cancer. Indian J Surg 2015; 78:265-70. [PMID: 27574342 DOI: 10.1007/s12262-015-1351-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022] Open
Abstract
The primary objective of this study was to describe our experience with the conservative treatment of early-stage cervical cancer (stages IA1, IA2, and IB1) with radical vaginal trachelectomy (RVT) and laparoscopic pelvic lymphadenectomy. This retrospective observational case series included 36 patients with early cervical cancer. Radical trachelectomy and laparoscopic pelvic lymphadenectomy were performed as described by D. Dargent in 32 of these cases. Oncologic, reproductive, and obstetric outcomes were observed subsequently over a median period of 42 (24-96) weeks. A total of 32 RVTs were preformed with a mean operating time of 117 ± 22.8 (77-167) minutes and an average blood loss of 486 mL (150-800 mL). All obtained resection margins were negative for cancer. Lymphovascular space invasion was noted in 11 (30.55 %) of the cases. No recurrences occurred during the study period. Seven (17.8 %) patients were able to become pregnant postoperatively, five of whom delivered healthy infants near term. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy appears to be a safe therapeutic option for fertility preservation in young women with early cervical cancer.
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10
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Faber-Swensson AP, Perrin LC, Nicklin JL. Radical trachelectomy for early stage cervical cancer: the Queensland experience. Aust N Z J Obstet Gynaecol 2015; 54:450-2. [PMID: 25287560 DOI: 10.1111/ajo.12234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 05/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radical trachelectomy and pelvic lymph node dissection are an increasingly recognised treatment for early cervical cancer in women wishing to retain their fertility. AIMS To analyse and summarise the outcomes of women having undergone radical trachelectomies at the Queensland Centre for Gynaecological Cancer (QCGC) between June 2000 and June 2012. METHODS Retrospective study of data collected on the QCGC database. RESULTS 17 women underwent radical trachelectomies, with six subsequently giving birth to a total of seven live term babies, all delivered by caesarean section. There was one-first trimester miscarriage, but no major obstetric complications. There have been no cancer recurrences, deaths or major complications. CONCLUSIONS Radical trachelectomy should be offered as an alternative treatment for women with early stage cervical cancer who wish to preserve their fertility as long as they are aware of the increased risk of infertility and preterm birth.
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Affiliation(s)
- Anders P Faber-Swensson
- Obstetrics and Gynaecology, Nambour General Hospital, Nambour, QLD, Australia; The University of Queensland, Brisbane, QLD, Australia
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Salman MC, Ozgul N, Yuce K. Widespread recurrence 7 years after radical abdominal trachelectomy for early cervical adenocarcinoma. Case Rep Obstet Gynecol 2015; 2015:517496. [PMID: 25918655 PMCID: PMC4396145 DOI: 10.1155/2015/517496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/21/2015] [Indexed: 11/28/2022] Open
Abstract
Cervical cancer is the third most common female cancer worldwide and the use of routine screening resulted in earlier stage and younger age at diagnosis. Fertility preservation via radical trachelectomy comes up as an option in such patients. Recent literature reviews confirm the safety of this operation with excellent oncologic outcomes in appropriately chosen patients. However, recurrent disease is likely and a strict follow-up is recommended to detect recurrences at an early stage following radical trachelectomy. In this report, a case who underwent radical trachelectomy and developed widespread recurrences 7 years after initial surgery possibly due to the lack of oncologic follow-up is discussed.
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Affiliation(s)
- M. Coskun Salman
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Kunter Yuce
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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Maguire R, Kotronoulas G, Simpson M, Paterson C. A systematic review of the supportive care needs of women living with and beyond cervical cancer. Gynecol Oncol 2015; 136:478-90. [DOI: 10.1016/j.ygyno.2014.10.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 01/29/2023]
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Treviño-Salinas E, Ayuzo-del Valle C, Guzmán-López A, Dávila-Escamilla I, García-Lezama R, Pérez-Morones D, Gutiérrez OV. Abdominal Trachelectomy for Cervical Pregnancy: Surgical Conservative Management. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Emilio Treviño-Salinas
- Departments of Gynecologic Oncology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
| | | | - Abel Guzmán-López
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
| | - Iván Dávila-Escamilla
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
| | - Reyna García-Lezama
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
| | - Daniela Pérez-Morones
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
| | - Oscar Vidal Gutiérrez
- Obstetrics and Gynecology, University Hospital Dr. José Eleuterio Gonzalez, Monterrey, Nuevo León, México
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Sacco JJ, Cliff J, Green JA. Chemotherapy for gynaecological malignancies and fertility preservation. World J Obstet Gynecol 2014; 3:54-60. [DOI: 10.5317/wjog.v3.i2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/31/2013] [Accepted: 08/06/2013] [Indexed: 02/05/2023] Open
Abstract
Infertility is an increasingly important issue for patients surviving cancer. Significant improvements in cancer management have led to greater numbers of patients living healthy and fulfilling lives for many years after a diagnosis of cancer, and the ability to bear children is a major component of well-being. Infertility is particularly challenging in gynaecological cancer, where multiple treatment modalities are often employed. Surgery may involve the removal of reproductive organs and subsequent chemotherapy may also lead to infertility. Mitigation of this through the use of cryopreservation of embryos, oocytes or ovarian tissue before chemotherapy may enable subsequent pregnancy in the patient or a surrogate mother. Suppression of ovarian function during chemotherapy is less well established, but promises a reduction in infertility without the risks associated with surgery. Similarly, evolving chemotherapy regimens with replacement of alkylating agents will reduce the incidence of infertility. With a combination of these techniques, an increasing proportion of patients may be able to conceive after completion of treatment, and there is no evidence of an increase in congenital abnormalities. This review discusses chemotherapy-induced infertility, interventions and success rates, and demonstrates that individualisation of management is required for optimum outcome.
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Downey K, Shepherd JH, Attygalle AD, Hazell S, Morgan VA, Giles SL, Ind TEJ, Desouza NM. Preoperative imaging in patients undergoing trachelectomy for cervical cancer: validation of a combined T2- and diffusion-weighted endovaginal MRI technique at 3.0 T. Gynecol Oncol 2014; 133:326-32. [PMID: 24582988 PMCID: PMC4012135 DOI: 10.1016/j.ygyno.2014.02.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study is to validate high-resolution endovaginal T2- and diffusion-weighted MRI measurements (tumour size, volume and length of uninvolved cervical canal) against histology in patients undergoing trachelectomy. PATIENTS/INTERVENTIONS 55 consecutive patients 25-44 years with cervical cancer being considered for trachelectomy were prospectively assessed with endovaginal T2-W and diffusion-weighted MRI. Two independent observers blinded to histology recorded maximum tumour dimension, volume and distance from the superior aspect of the tumour to the internal os. Following trachelectomy, pathologist-outlined tumour sections were photographed with a set scale and similar measurements were recorded. RESULTS Fifteen of 45 patients subsequently treated with fertility-sparing surgery had residual tumour (median histological volume: 0.28 cm(3), IQR=0.14-1.06 cm(3)). Sensitivity, specificity, positive and negative predictive values for detecting tumour: Observer 1: 86.7%, 80.0%, 68.4%, and 92.3%, respectively; Observer 2: 86.7%, 90.0%, 81.0%, and 93.1%, respectively. Size and volume correlated between observers (r=0.96, 0.84, respectively, p<0.0001). Size correlated between each observer and histology (observer 1 r=0.91, p<0.0001; observer 2 r=0.93, p<0.0001), volume did not (observer 1: r=0.08, p=0.6; observer 2: r=0.21, p=0.16); however, differences between observer measurements and histology were not significant (size p=0.09, volume p=0.15). Differences between MRI and histology estimates of endocervical canal length were not significant (p=0.1 both observers). CONCLUSION In subcentimetre cervical cancers, endovaginal MRI correlates with pathology and is invaluable in assessing patients for fertility-sparing surgery.
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Affiliation(s)
- Katherine Downey
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
| | - John H Shepherd
- Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - Ayoma D Attygalle
- Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - Steve Hazell
- Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - Veronica A Morgan
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
| | - Sharon L Giles
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK
| | - Thomas E J Ind
- Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - Nandita M Desouza
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
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16
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Lloyd PA, Briggs EV, Kane N, Jeyarajah AR, Shepherd JH. Women's experiences after a radical vaginal trachelectomy for early stage cervical cancer. A descriptive phenomenological study. Eur J Oncol Nurs 2014; 18:362-71. [PMID: 24794078 DOI: 10.1016/j.ejon.2014.03.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This paper reports on a phenomenological study of women's experiences 1-10 years following a radical vaginal trachelectomy and describes the impact on health, sexuality, fertility and perceived supportive care needs. METHOD AND SAMPLE Qualitative telephone interviews employing a descriptive phenomenological approach were conducted using a purposive sample of 12 women. KEY RESULTS Several felt their cancer experience was positive; bringing them closer to family and changed their outlook on life. A few experienced delayed psychological reactions and/or fears of recurrence. Many experienced isolation and the desire to contact others with similar experiences. Women recovered well but a few experienced fears/concerns about lymphoedema and intermenstrual bleeding. Sexual function was not a long-term issue for most. Some that could feel the cerclage (stitch) during intercourse, developed techniques to reduce this. Single women felt vulnerable in new relationships. Pregnancy was an anxious time, especially for those that experienced a miscarriage or pre-term birth. Sources of support included the clinical nurse specialist, family/friends, surgical consultant, online patient forums and a support group. Women needed more information on trachelectomy statistics, pregnancy care recommendations as well as access to counselling, peer support, being seen by the same person and increased public awareness. CONCLUSIONS This study has provided an interesting and detailed insight into women's experiences in the years following a trachelectomy, with results that have important considerations for practice such as provision of statistical information; counselling; peer support; consistent pregnancy recommendations; increased public awareness and increased identification and management or prevention of long-term physical effects.
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Affiliation(s)
- Philippa A Lloyd
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Emma V Briggs
- Florence Nightingale School of Nursing and Midwifery, Kings College London, UK.
| | - Nichola Kane
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Arjun R Jeyarajah
- Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
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Abstract
Oncofertility is an exciting new interdisciplinary field that encompasses the obstetrician gynecologist, gynecologic oncologist, reproductive endocrinologist, and primary care physician in a common goal to provide fertility preservation options for cancer patients. Maintaining their fertility is of the upmost importance for many oncology patients diagnosed during their childbearing years. This review addresses the common types of cancers in reproductive-age patients and how the treatment of these cancers may impact reproductive potential. Fertility preservation treatments will also be discussed to assist health care providers in appropriately counseling patients about options after a diagnosis of cancer. The goal of oncofertility is to provide both physicians and patients with the knowledge and resources to make fertility an ongoing opportunity for all patients who desire a future with children.
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Lanowska M, Mangler M, Grittner U, Akbar GR, Speiser D, Tucher E, Köhler C, Schneider A, Kühn W. Isthmic‐vaginal smear cytology in the follow‐up after radical vaginal trachelectomy for early stage cervical cancer: Is it safe? Cancer Cytopathol 2014; 122:349-58. [DOI: 10.1002/cncy.21402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/13/2014] [Accepted: 01/06/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Malgorzata Lanowska
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Mandy Mangler
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical EpidemiologyCharité University Hospital BerlinBerlin Germany
| | - Gerta Rose Akbar
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Dorothee Speiser
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Elisabeth Tucher
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Christhardt Köhler
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Achim Schneider
- Department of Gynecology and Gynecologic OncologyCharité University Hospital BerlinBerlin Germany
| | - Wolfgang Kühn
- Division of Cytology and Gynecologic MorphologyCharité University Hospital Berlin Germany
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Undurraga M, Loubeyre P, Dubuisson JB, Schneider D, Petignat P. Early-stage cervical cancer: is surgery better than radiotherapy? Expert Rev Anticancer Ther 2014; 10:451-60. [DOI: 10.1586/era.09.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Rob L, Pluta M, Skapa P, Robova H. Advances in fertility-sparing surgery for cervical cancer. Expert Rev Anticancer Ther 2014; 10:1101-14. [DOI: 10.1586/era.10.61] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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21
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Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy — A systematic literature review. Gynecol Oncol 2013; 131:77-82. [DOI: 10.1016/j.ygyno.2013.06.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 12/14/2022]
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22
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Li J, Wu X, Li X, Ju X. Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors ≥2cm? Gynecol Oncol 2013; 131:87-92. [DOI: 10.1016/j.ygyno.2013.07.079] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/28/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
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23
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Association Between Reproductive Cancer and Fetal Outcomes: A Systematic Review. Int J Gynecol Cancer 2013; 23:1171-7. [DOI: 10.1097/igc.0b013e31829e9fe2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThis study aimed to review studies that addressed the impact of previous reproductive cancer diagnosis on selected fetal birth outcomes.Materials and MethodsWe searched PubMed and Web of Knowledge to identify peer-reviewed articles published from January 1992 to December 2012, investigating the association between reproductive cancer and birth outcomes. After applying exclusion criteria, 49 articles were identified for full review, and 36 articles were finally selected for this systematic review. The quality of the studies was assessed by independent reviewers.ResultsWe found 13 cervical cancer studies, 16 ovarian cancer studies, and 7 corpus uteri cancers that reported subsequent pregnancies (n = 688 pregnancies in 477 women). Of these, 489 pregnancies reached third trimester. Among viable pregnancies, only 416 pregnancies had information on maturity status based on gestational age and/or birth weight. For those with cervical cancer, the preterm birth (PTB) rate was 48.5%. For those with ovarian cancer, there were no cases of PTB. For those with corpus uteri cancers, the PTB was 7.7%. All studies had small sample sizes, and there was considerable heterogeneity of results. Abortions, ectopic pregnancies, and terminations were also reported.ConclusionsReproductive cancers may be associated to subsequent adverse fetal birth outcomes; however, the quality of evidence is still insufficient to infer a relationship between reproductive cancers treated conservatively and adverse fetal birth outcomes in subsequent pregnancies.
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24
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The Adolescent and Young Adult With Cancer: State of the Art—Epithelial Cancer. Curr Oncol Rep 2013; 15:287-95. [DOI: 10.1007/s11912-013-0322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Analysis of a Continuous Series of 34 Young Patients With Early-Stage Cervical Cancer Selected for a Vaginal Radical Trachelectomy. Int J Gynecol Cancer 2013; 23:331-6. [DOI: 10.1097/igc.0b013e31827ef759] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Downey K, Riches SF, Morgan VA, Giles SL, Attygalle AD, Ind TE, Barton DPJ, Shepherd JH, deSouza NM. Relationship between imaging biomarkers of stage I cervical cancer and poor-prognosis histologic features: quantitative histogram analysis of diffusion-weighted MR images. AJR Am J Roentgenol 2013; 200:314-20. [PMID: 23345352 DOI: 10.2214/ajr.12.9545] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
OBJECTIVE The purpose of this study was to determine whether histogram analysis of apparent diffusion coefficient (ADC) values from diffusion-weighted MRI can be used to differentiate cervical tumors according to their histologic characteristics. SUBJECTS AND METHODS Sixty patients with International Federation of Gynecology stage I cervical cancer underwent MRI at 1.5 T with a 37-mm-diameter endovaginal coil. T2-weighted images (TR/TE, 2000-2368/90) followed by diffusion-weighted images (TR/TE, 2500/69; b values, 0, 100, 300, 500, and 800 s/mm(2)) were acquired. An expert observer drew regions of interest around a histologically confirmed tumor on ADC maps by referring to the T2-weighted images. Pixel-by-pixel ADCs were calculated with a monoexponential fit of data from b values of 100-800 s/mm(2), and ADC histograms were obtained from the entire tumor volume. An independent samples Student t test was used to compare differences in ADC percentile values, skew, and kurtosis between squamous cell carcinoma and adenocarcinoma, well or moderately differentiated and poorly differentiated tumors, and absence and presence of lymphovascular space invasion. RESULTS There was no statistically significant difference in ADC percentiles between squamous cell carcinoma and adenocarcinoma, but the median was significantly higher in well or moderately differentiated tumors (50th percentile, 1113 ± 177 × 10(-6) mm(2)/s) compared with poorly differentiated tumors (50th percentile, 996 ± 184 × 10(-6) mm(2)/s) (p = 0.049). Histogram skew was significantly less positive for adenocarcinoma compared with squamous cell carcinoma (p = 0.016) but did not differ between tumor grades. There was no significant difference between any parameter with regard to lymphovascular space invasion. CONCLUSION Median ADC is lower in poorly compared with well or moderately differentiated tumors, while lower histogram-positive skew in adenocarcinoma compared with squamous cell carcinoma is likely to reflect the glandular content of adenocarcinoma.
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Affiliation(s)
- Kate Downey
- CRUK/EPSRC Cancer Imaging Centre, MRI Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, UK.
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27
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Kardakis S. Fertility-preserving surgery in patients with early stage cervical carcinoma. ISRN ONCOLOGY 2012; 2012:817065. [PMID: 23320192 PMCID: PMC3539444 DOI: 10.5402/2012/817065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 11/23/2022]
Abstract
Fertility preservation is an important issue for patients in reproductive age with early stage cervical cancer. In view of recent developments, our purpose was to review and discuss available surgical alternatives. A literature search was conducted using PUBMED, including papers between 1980 and December 2011. In patients with stage IA1 cervical cancer, conization is a valid alternative. Patients with stage IA2-IB1 disease can be conservatively treated by radical trachelectomy. This is as well-established conservative approach and appears to be safe and effective in allowing a high chance of conception. Prematurity is the most serious issue in pregnancies following trachelectomy. Less invasive options such as simple trachelectomy or conization seem to be feasible for stages IA2-IB1, but more and better evidence is needed. Neoadjuvant therapy might allow conservative surgery to be performed also in patients with more extensive lesions. Ovarian transposition is important when adjuvant radiation is needed. In conclusion, available literature shows that there are interesting fertility-sparing treatment alternatives to the “golden standard” for the management of early cervical cancer in young women.
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Affiliation(s)
- Spyridon Kardakis
- Department of Obstetrics and Gynaecology, Oncologic Clinic, Västerås Hospital, 72212 Västerås, Sweden
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28
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Lindsay R, Paul J, Siddiqui N, Davis J, Gaffney DK. Survey on the management of early cervical cancer among members of the GCIG. Int J Gynecol Cancer 2012; 22:1617-23. [PMID: 23038419 DOI: 10.1097/igc.0b013e31826fd66b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To establish the different imaging and treatment options offered to patients with early cervical cancer by members of the Gynecologic Cancer Intergroup. METHODS A questionnaire was developed and disseminated electronically to members of the Gynecologic Cancer Intergroup and was completed online. RESULTS One hundred sixty-two members viewed the questionnaire; 88 members started it; however, only 64 members fully completed it. Most (89.9%) of respondents used the International Federation of Gynecology and Obstetrics classification system when staging cervical cancer, using adjuncts to clinical staging: 33 respondents (37.5%) advocated computed tomography, 61 respondents (69.3%) advocated magnetic resonance imaging, 26 respondents (29.6%) positron emission tomography-computed tomography, and 36 respondents (40.9%) advocated staging lymphadenectomy, with 69.4% (50) performing lymphadenectomies laparoscopically. The external iliac nodal group was the nodal group that was consistently part of the lymphadenectomy with other nodal groups variably removed depending on the stage. All centers offered fertility-conserving surgery in stage IA1 cervical cancer and most up to and including stage IB1 with no lymphovascular space invasion. The fertility-conserving procedures performed varied among respondents: 20.3% (15 respondents) abdominal radical trachelectomy, 47.35 (35 respondents) radical vaginal trachelectomy, 58.1% (43 respondents) trachelectomy, 97.3% (72 respondents) cone biopsy, and 67.6% (50 respondents) large loop excision of the transformation zone. When fertility conservation was not desired, there was variation in the surgical techniques offered. Chemotherapy was used to downstage tumors preoperatively in 16.4% (11) before fertility-conserving surgery and 50.8% (34) before radical surgery. CONCLUSIONS There are wide variations in the use of preoperative imaging, when pelvic and para-aortic lymph nodes are removed, and as to which surgical procedure should be offered in the management of cervical cancer both when fertility conservation is and is not an issue.
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Affiliation(s)
- Rhona Lindsay
- Department of Gynaecological Oncology, Princess Royal Maternity, Glasgow Royal Infirmary, Glasgow, UK.
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29
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Fertility-sparing surgery for early-stage cervical cancer. Int J Surg Oncol 2012; 2012:936534. [PMID: 22830004 PMCID: PMC3399357 DOI: 10.1155/2012/936534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/12/2012] [Indexed: 11/24/2022] Open
Abstract
Nowadays cervical cancer is diagnosed in many women who still want to have children. This led to the need to provide fertility-sparing treatments. The main goal is to maintain reproductive ability without decreasing overall and recurrence-free survival. In this article, we review data on procedures for fertility preservation, namely, vaginal and abdominal trachelectomy, less invasive surgery and neoadjuvant chemotherapy. For each one, oncological and obstetrical outcomes are analyzed. Comparing to traditionally offered radical hysterectomy, the overall oncologic safety is good, with promising obstetrical outcomes.
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30
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Ilancheran A, Low J, Ng JS. Gynaecological cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012; 26:371-7. [PMID: 22301055 DOI: 10.1016/j.bpobgyn.2011.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
Abstract
Cancer in pregnancy, fortunately, is uncommon. This is even more so for gynaecological cancer. Fertility preservation in gynaecological cancer is already a difficult issue, as the common gynaecological cancers affect organs intimately associated with conception and delivery. The presence of a viable pregnancy with gynaecological cancer presents tremendous challenges to the clinician, especially if the woman wants to conserve both her pregnancy and fertility. In this chapter, we address issues involved in such circumstances and suggest management decisions.
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Affiliation(s)
- Arunachalam Ilancheran
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore.
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31
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Lanowska M, Morawietz L, Sikora A, Räber G, Mangler M, Speiser D, Hasenbein K, Chiantera V, Köhler C, Schneider A. Prevalence of lymph nodes in the parametrium of radical vaginal trachelectomy (RVT) specimen. Gynecol Oncol 2011; 121:298-302. [DOI: 10.1016/j.ygyno.2011.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 01/06/2011] [Accepted: 01/10/2011] [Indexed: 11/24/2022]
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32
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Valea FA. Cervical Carcinoma. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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33
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Ottosen C. Trachelectomy for cancer of the cervix: Dargent’s operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III. Best Pract Res Clin Obstet Gynaecol 2011; 25:217-25. [DOI: 10.1016/j.bpobgyn.2010.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/31/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
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34
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Charles-Edwards E, Morgan V, Attygalle AD, Giles SL, Ind TE, Davis M, Shepherd J, McWhinney N, deSouza NM. Endovaginal magnetic resonance imaging of stage 1A/1B cervical cancer with A T2- and diffusion-weighted magnetic resonance technique: effect of lesion size and previous cone biopsy on tumor detectability. Gynecol Oncol 2011; 120:368-73. [PMID: 21093895 DOI: 10.1016/j.ygyno.2010.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/11/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effects of previous cone biopsy and lesion size on detectability of stage 1a/1b cervical cancer using endovaginal T2- and diffusion-weighted magnetic resonance imaging. METHODS One hundred and thirteen patients with cervical tumor were imaged using an endovaginal coil with T2-weighted (T2-W) and diffusion-weighted single-shot echo-planar sequences; 85 managed surgically (58 with prior cone biopsy/LLETZ) were evaluated. T2-W images and ADC maps viewed simultaneously were scored positive or negative for tumor and compared with histology at surgery. MRI tumor volumes, maximum radiological and histological dimensions were recorded. ROC analysis determined the MRI volume with optimal sensitivity/specificity for identifying tumor in those without and with prior cone biopsy/LLETZ and the maximum histological dimension for correctly identifying tumor with MRI. Mean apparent diffusion coefficients (ADCs) from tumor and adjacent normal epithelium were compared. RESULTS Sensitivity and specificity for detecting tumor in those without (100%; 100% respectively) and with (80%; 78.9% respectively) prior cone biopsy/LLETZ were significantly different (p<0.001). Following cone biopsy/LLETZ, MRI tumor volume of 83 mm3 detected tumor with 80% sensitivity, 94.7% specificity; a 5.3mm maximal histological dimension was detected on MRI with 100% sensitivity, 100% specificity. Tumor ADCs were significantly lower (p<0.001) than paired normal epithelial tissue (median, 988×10(-6) mm2/s vs. 1564×10(-6) mm2/s) but neither tumor nor epithelial ADCs differed significantly between patients with or without prior cone biopsy/LLETZ (p=0.48 and 0.15, respectively). CONCLUSIONS Endovaginal MRI with T2- and diffusion-weighted sequences has significantly lower sensitivity and specificity for tumor detection following cone biopsy/LLETZ.
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Affiliation(s)
- Elizabeth Charles-Edwards
- Cancer Research UK Clinical Magnetic Resonance Group, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
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35
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Questionnaire survey of the current status of radical trachelectomy in Japan. Int J Clin Oncol 2010; 16:141-4. [DOI: 10.1007/s10147-010-0146-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 10/21/2010] [Indexed: 11/26/2022]
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Carter J, Sonoda Y, Baser RE, Raviv L, Chi DS, Barakat RR, Iasonos A, Brown CL, Abu-Rustum NR. A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer. Gynecol Oncol 2010; 119:358-65. [PMID: 20817227 DOI: 10.1016/j.ygyno.2010.07.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/19/2010] [Accepted: 07/21/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To prospectively assess and describe the emotional, sexual, and QOL concerns of women with early-stage cervical cancer undergoing radical surgery. METHODS Seventy-one women who were consented for radical trachelectomy (RT) or radical hysterectomy (RH) were enrolled preoperatively in this 2-year study; 52 women (33 RT; 19 RH) were actively followed. Patients completed self-report surveys composed of 4 empirical measures in addition to exploratory items. Data analyses for the 2 years of prospective data are presented. RESULTS At preoperative assessment, women choosing RH reported greater concern about cancer recurrence (x=7.27 [scale from 0 to 10]) than women choosing RT (x=5.66) (P=0.008). Forty-eight percent undergoing RH compared to 8.6% undergoing RT reported having adequate "time to complete childbearing" (P<0.001). Both groups demonstrated scores suggestive of depression (based on the CES-D scale) and distress (based on the IES scale) preoperatively; over time, however, CES-D and IES scores generally improved. Scores on the Female Sexual Functioning Inventory (FSFI) for the total sample were below the mean cut-off (26.55), suggestive of sexual dysfunction; however, the means increased from 16.79 preoperatively to 23.78 by 12 months and 22.20 at 24 months. CONCLUSION Measurements of mood, distress, sexual function, and QOL did not differ significantly by surgical type, and instead reflect the challenges faced by young cervical cancer patients treated by RT or RH without adjuvant treatment. Points of vulnerability were identified in which patients may benefit from preoperative consultation or immediate postoperative support. Overall, patients improved during the first year, reaching a plateau between Year-1 and Year-2, which may reflect a new level of functioning in survivorship.
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Affiliation(s)
- Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Suh DH, Kim JW, Aziz MF, Devi UK, Ngan HYS, Nam JH, Kim SC, Kato T, Ryu HS, Fujii S, Lee YS, Kim JH, Kim TJ, Kim YT, Wang KL, Lee TS, Ushijima K, Shin SG, Chia YN, Wilailak S, Park SY, Katabuchi H, Kamura T, Kang SB. Asian society of gynecologic oncology workshop 2010. J Gynecol Oncol 2010; 21:137-50. [PMID: 20922136 DOI: 10.3802/jgo.2010.21.3.137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 08/30/2010] [Indexed: 12/22/2022] Open
Abstract
This workshop was held on July 31-August 1, 2010 and was organized to promote the academic environment and to enhance the communication among Asian countries prior to the 2nd biennial meeting of Australian Society of Gynaecologic Oncologists (ASGO), which will be held on November 3-5, 2011. We summarized the whole contents presented at the workshop. Regarding cervical cancer screening in Asia, particularly in low resource settings, and an update on human papillomavirus (HPV) vaccination was described for prevention and radical surgery overview, fertility sparing and less radical surgery, nerve sparing radical surgery and primary chemoradiotherapy in locally advanced cervical cancer, were discussed for management. As to surgical techniques, nerve sparing radical hysterectomy, optimal staging in early ovarian cancer, laparoscopic radical hysterectomy, one-port surgery and robotic surgery were introduced. After three topics of endometrial cancer, laparoscopic surgery versus open surgery, role of lymphadenectomy and fertility sparing treatment, there was a special additional time for clinical trials in Asia. Finally, chemotherapy including neo-adjuvant chemotherapy, optimal surgical management, and the basis of targeted therapy in ovarian cancer were presented.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Radical trachelectomy for clear cell carcinoma of the cervix in a 6-year old: a case report, review, and description of the surgical technique. J Pediatr Surg 2010; 45:E1-5. [PMID: 20713196 DOI: 10.1016/j.jpedsurg.2010.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 05/14/2010] [Accepted: 05/17/2010] [Indexed: 11/22/2022]
Abstract
Clear cell carcinoma is a rare pediatric cervical cancer, seen primarily in the setting of in utero diethylstilbesterol exposure. Historically, this type of cancer has been treated with radical hysterectomy and lymph-node dissection, rendering patients incapable of carrying a pregnancy in the future. We describe a young patient with clear cell carcinoma of the cervix who, through a multidisciplinary collaboration, was managed by a fertility-sparing alternative surgical approach--a radical trachelectomy. We present the surgical technique and review the current evidence regarding the use of radical trachelectomy as a fertility-sparing procedure in young patients with cervical cancer.
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Abstract
There are several types of fertility saving procedures that can be done in patients with cervical cancer, which differ in terms of surgical approach and extent of paracervical resection. This review assesses oncological and pregnancy results after different procedures. The oncological results of vaginal radical trachelectomies (VRT) and abdominal radical trachelectomies (ART) are similar for tumours less than 2 cm in size, and are now considered safe surgical procedures. Oncological outcomes of VRT and ART in tumours larger than 2 cm are also identical, but the results cannot be considered satisfactory. Preliminary findings of less radical procedures (ie, deep cone and simple trachelectomy) in patients with tumours less than 2 cm, and negative sentinel and other pelvic lymph nodes, are comparable with the results of VRT and ART. Downstaging tumours larger than 2 cm by neoadjuvant chemotherapy is still an experimental procedure and will need multicentre cooperation to verify its oncological safety. Pregnancy results vary statistically with the different methods.
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Fertility-sparing options for early stage cervical cancer. Gynecol Oncol 2010; 117:350-7. [DOI: 10.1016/j.ygyno.2010.01.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 01/16/2010] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Sreenivas K, Campo-Engelstein L. Domestic and international surrogacy laws: implications for cancer survivors. Cancer Treat Res 2010; 156:135-52. [PMID: 20811830 PMCID: PMC3086466 DOI: 10.1007/978-1-4419-6518-9_10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2024]
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Martin A, Torrent A. Laparoscopic Nerve-Sparing Radical Trachelectomy: Surgical Technique and Outcome. J Minim Invasive Gynecol 2010; 17:37-41. [DOI: 10.1016/j.jmig.2009.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/18/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
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Payne GS, Schmidt M, Morgan VA, Giles S, Bridges J, Ind T, DeSouza NM. Evaluation of magnetic resonance diffusion and spectroscopy measurements as predictive biomarkers in stage 1 cervical cancer. Gynecol Oncol 2009; 116:246-52. [PMID: 19875159 DOI: 10.1016/j.ygyno.2009.09.044] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 09/28/2009] [Accepted: 09/30/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To establish whether ADC and total choline were significantly different between cervical tumors with different histological characteristics (type, degree of differentiation, presence or absence of lymphovascular invasion, lymph-node involvement) in order to establish their role as predictive biomarkers. METHODS 62 patients with stage 1 cervical cancer were scanned at 1.5 T. T2-weighted imaging (TR/TE=4500/80 ms), to identify tumor and normal cervix, was followed by diffusion-weighted imaging (TR/TE=2500/69 ms; 5 b-values 0, 100, 300, 500 and 800 s/mm(2)) and MR spectroscopic imaging (15 mm slice, 7.5 mm in-plane resolution, TR=888 ms). Regions of interest in normal cervix and tumor were drawn on apparent diffusion coefficient (ADC) maps by an expert observer with reference to the T2-weighted images. ADCs were calculated using a monoexponential fit of data from all b-values. MR spectra in voxels designated as tumor (>30% tumor) or non-tumor were quantified using LCModel and referenced to tissue water. RESULTS There was a statistically significant difference between the ADC of tumor regions (1117+/-183x10(-6) mm(2)/s) and of selected normal regions (1724+/-198x10(-6) mm(2)/s; p<0.001), and between tumors that were well/moderately differentiated (1196+/-181x10(-6) mm(2)/s) compared with those that were poorly differentiated (1038+/-153x10(-6) mm(2)/s; p=0.016). There was no significant difference between the ADCs of the tumors when separated by other characteristics (tumor type, lymphovascular invasion, lymph-node metastases), or between measured total choline in any of the groups. CONCLUSION ADCs are lower in cancer compared to normal cervical tissue, with degree of tumor differentiation contributing to this difference.
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Affiliation(s)
- Geoffrey S Payne
- CRUK/EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, MRI Unit, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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