Approximately 14,000 American women will be diagnosed with cervical cancer in 2022. While cervical cancer screening and survival rates have dramatically improved in recent years, particularly when the disease is diagnosed early, treatment processes like chemotherapy and radiation can have a negative effect on fertility.
Since this gynecological cancer is most often discovered between the ages of 35 and 44, clinicians may want to discuss fertility-sparing surgery and other fertility preservation options with cancer patients who plan on having a family following their recovery.
Cervical Cancer and Fertility
Once cancerous cells have been identified and the extent of the disease has been confirmed via ultrasound or MRI, physicians should ask their patients if fertility should be a consideration when discussing treatment options.
Providers must be upfront and clear with patients about the risks and success rates with each option, as well as the likelihood of fertility-sparing surgery leading to a live birth in the future. Additionally, patients should be encouraged to consult with a maternal-fetal specialist to better understand whether or not any future pregnancies will be considered high risk.
Fertility-Sparing Surgery Options
After considering all the factors, if a cervical cancer patient wishes to proceed with fertility-sparing surgery, they may have one or multiple options:
- Cryosurgery: Best for stage 0 squamous cell carcinoma in situ. A cold metal probe kills abnormal cells by freezing them.
- Laser surgery: Best for stage 0 squamous cell carcinoma in situ. A laser is inserted through the vagina and burns off or removes abnormal cells.
- Conization: Best for stage 0 adenocarcinoma in situ or IA1 cervical cancer. Using a knife or thin wire, the physician removes a cone-shaped piece of tissue for examination. If the edges don't contain cancer cells, the patient doesn't require any additional immediate treatment but must be closely monitored. If the edges do contain cancer cells, the procedure may be repeated or followed by a radical trachelectomy.
- Radical trachelectomy: Best for stages IA2, IB1 and IIA1 cervical cancer. The doctor removes the patient's cervix, upper part of the vagina and nearby lymph nodes through the vagina, or via abdominal or laparoscopic surgery. In place of a cervix, the physician places a "purse-string" stitch. After this procedure, future deliveries must be made via Cesarean section.
Radical trachelectomy is still a relatively new procedure, and research on its long-term outcomes is ongoing. However, one study published in the Journal of Clinical Medicine found no difference between the survival rate of women with early-stage cervical cancer who received fertility-sparing surgery and those who did not.
When Fertility-Sparing Surgery is Not Feasible
If the cervical cancer is deemed stages IB2, IIA2, IIB, III, IVA or IVB, fertility-sparing surgery is no longer a viable option. Instead, patients will be advised to proceed with chemoradiation or a radical hysterectomy.
However, depending on the aggressiveness of the cancer, your patient might be able to quickly undergo an oocyte preservation cycle prior to treatment. Even though a gestational surrogate would likely be required in the future, patients might prefer to use their own eggs if the option is available.
Receiving a cervical cancer diagnosis can be overwhelming and frightening. It's important for physicians to help patients think ahead and take control of their bodies by asking them if their fertility should be a part of the treatment conversation.
