Being a young woman diagnosed with cervical cancer brings up a flood of emotions about family. Many women worry they won’t be able to get pregnant after treatment. And with more women waiting to have children until later in life, questions about fertility may be a concern for many young women.
Nearly 26 percent of women diagnosed with cervical cancer are between ages 35 and 44. Another 14 percent are between ages 20 and 34, according to the National Cancer Institute (NCI). At the same time, the proportion of first births to women aged 35 or older grew eight-fold between 1970 and 2006.
January is Cervical Cancer Awareness Month and we wanted to devote this space to a discussion about cervical cancer treatment options that may preserve fertility. Cervical cancer ranks 20th among the most common cancers in the United States. The NCI estimates 12,340 women will be diagnosed this year, while another 250,000 women are living with the disease.
Dr. Giuseppe Del Priore, National Director of Gynecologic Oncology, says young women often ask if they still will be able to have children after cervical cancer treatment. Fortunately, Dr. Del Priore says, early diagnosis and new treatment approaches can preserve fertility.
When possible, surgeons recommend less invasive and less radical treatment options for women who want to have children. These treatments include:
Cone biopsy: Mainly used to diagnose cervical cancer, a cone biopsy may be the only treatment needed for women with early stage cervical cancer (stage 0 or stage IA1). A cone-shaped piece of tissue is removed from the cervix during the procedure. If the biopsy removes all of the cancer and the specimen does not have cancer cells around the edges, the patient may bear children before further treatment is recommended. She would be monitored closely during this time.
Trachelectomy: This surgery removes the entire cancerous cervix and the upper part of the vagina while leaving intact the uterine fundus, the top of the uterus that carries a pregnancy. After a trachelectomy, women have been able to carry to term and deliver healthy babies by Cesarean section. Even women with more advanced stages may be candidates for a trachelectomy if chemotherapy first destroys enough cancerous cells to bring the cancer down to an earlier stage.
Dr. Del Priore was part of a team of researchers that found that abdominal radical trachelectomy is an alternative to radical hysterectomy or chemoradiation for women with stage IA2 and IB cervical cancer who want to conceive. The study focused on 33 women who underwent abdominal radical trachelectomy. The cancer of each woman did not recur after the surgery. Of the five women who attempted to conceive, two delivered healthy babies at term.
“Worldwide, the number of cervical cancer cases continues to grow and remain a problem of young, reproductive-age women,” says Dr. Del Priore, who was recently interviewed on CNN about uterine transplants after cervical cancer. “As doctors, we have become more sensitive to the importance of fertility preservation and now have more options to address the needs of young women.”
Cervical cancer, caused almost exclusively by human papillomavirus (HPV), typically grows slowly and women may not experience any symptoms of the disease. Regular Pap tests, though, are an effective way to identify the early signs of HPV and allow for early treatment before infections can develop into cancer.
Lear more about cervical cancer.