Cervical Cancer Operation that Saves...

Cervical Cancer Operation that Saves Women's Fertility

About 3,000 women a year are diagnosed with cervical cancer and for many the only option has been a hysterectomy.

Emmeline Collin, 34, a bank worker from Whittlesey, near Peterborough, underwent a procedure that spared her fertility.

About two-and-a-half years ago, I got a letter from my GP’s surgery reminding me to book a routine smear test. I’ve always taken good care of my health, so I went for the test straight away.


But two weeks later I got a letter from our local hospital saying I had severe abnormalities in my cervix. I had to go back for another test — a colposcopy — which is where they look at the cervix through a microscope.

I was worried, but I had some friends who’d had abnormalities which turned out to be nothing, so I tried not to panic.

My husband, Dave, came with me to the appointment. After the examination, the registrar said I had precancerous cells. She explained she would do a procedure there and then to burn away the cells.

She also sent off some samples to check it wasn’t cancer — though she reassured me that was unlikely.

Two weeks later, however, the hospital rang to say the consultant wanted to see me the next day. We knew then something was very wrong.

When I saw the consultant, he said I had a cancerous tumour in my cervix.

I couldn’t believe it. I was a busy mum in my 30s, fit and healthy. How could I have cancer?

Our daughter, Lucy, was just three and in my darkest moments I wondered if I’d see her grow up.

I was referred to a specialist at Addenbrooke’s Hospital in Cambridge who said the traditional treatment was a hysterectomy — removing my uterus, or womb, to get rid of the cancer.

Dave and I were devastated. It was major surgery and, worst of all, we’d been trying for another baby. I knew this meant we would never be able to have a longed-for little brother or sister for Lucy.

A week later, I saw another specialist, Dr Robin Crawford.

He said there was a new operation which meant that as long as the cancer hadn’t spread, I wouldn’t need a hysterectomy.

Instead of taking away the whole of the uterus, they would remove the cancerous part of the cervix.

Then he could put a strong stitch across the neck of the womb to keep it closed, so it would support a growing baby like a normal cervix. He’d leave a small gap, too, so I would still be able to conceive.

Suddenly, it felt as though someone had waved a magic wand. They would take away the cancer and we could still try for a baby.

Dr Crawford sent me for an MRI scan, which confirmed the cancer hadn’t spread as they’d caught it early, so we could go ahead with the operation.

I had the surgery in May 2009 and it took three hours. I was groggy afterwards, but two days later I went home with strong painkillers.

Tests six months later showed no sign of any recurrence of the cancer.

Then, in November, Dr Crawford said Dave and I could start trying for another baby.

Our lovely daughter Evie was born on November 4 last year. She was delivered by Caesarean, as Dr Crawford had warned that the stitch would not be strong enough to support a baby later than 36 weeks of pregnancy.

I go back for regular checks and they’ve all been clear, so we hope the cancer has gone for good.

Evie feels like a miracle. I’m so thankful I went for that smear test.

 

THE SURGEON

Dr Robin Crawford is consultant gynaecological oncologist at Cambridge University Hospitals NHS Foundation Trust. He says:

Cervical cancer — or cancer of the neck of the womb — is the cancer most commonly diagnosed in women under 35 in the UK.

We now know that cervical cancer is caused by the human papilloma virus (HPV). The virus affects more than 80 per cent of men and women, and in most cases our bodies simply deal with the infection. But in some people it causes cancer for reasons doctors don’t fully understand — though smoking and hormones may play a part.

The current programme to vaccinate 12-year-old schoolgirls is very exciting, as this safe procedure could mean a huge reduction in cervical and other genital cancers, and head and neck cancers, which are also related to HPV virus.

We have an excellent screening programme in the UK for cervical cancer, meaning we can spot the early cell changes that precede the disease.

However, 1,000 women die each year from it and, sadly, around half of the cervical cancers in the UK are found in the 20 per cent of women who don’t go for their screening appointments.

If it’s caught early, cervical cancer is much easier to treat.

We can treat early precancerous changes with a procedure called  a Lletz (Large Loop Excision of  the Transformation Zone), which means cutting away the abnormal cells using an electrical current fed through a loop of wire, under local anaesthetic.

For about 90 years, the only surgical option for women diagnosed with the cancer was a radical hysterectomy, which meant removing the uterus and sometimes the ovaries, too. It was felt that even if the cancer was small, a big operation was the best way to be sure it was all removed.

It meant the patient would be in hospital for up to two weeks and would lose their fertility, which could be devastating.

We can also offer radiotherapy or chemoradiotherapy. However, both have side-effects, including early menopause and narrowing of the vagina, and loss of fertility.

Trachelectomy was first done in France in the late Eighties and a colleague and I brought it to the UK in 1994. In this operation, we simply remove most of the cervix, with a safety margin around it.

We put a stitch through the cervix, to keep it partly closed. This is strong enough to support the weight of a baby up to around 36 weeks — so women can be free of the cancer and go on to have a baby by Caesarean. Women also recover faster than with a hysterectomy. Most go home the next day.

Trachelectomy is suitable for the majority of women with early stage cervical cancer, with a tumour up to 2cm across, and is done at a few specialist centres in the UK. It takes around three hours under general anaesthetic.

First, we remove the pelvic lymph nodes from around the cervix to check the cancer has not spread, making several incisions of up to 1cm and using a laparoscope or rigid tube with a camera on the end.

Using MRI imaging to guide me, I use a diathermy, which is a hot wire loop device, to remove the top section of the vagina and dissect or cut around the cervix, freeing it from surrounding tissue so I can cut the lower part away.

I aim to leave about 20 per cent of the cervix at the top, so the patient can still conceive naturally and menstruate as normal.

Then I put a cerclage through the cervix, to keep it partly closed, and rejoin the vagina using stitches. Once we have checked there is no bleeding, the patient goes off to recovery.

The operation carries standard surgical risks, including bleeding, infection and blood clots. There is also a small chance the surgeon takes too little tissue so a further procedure is needed, because the cancer is more extensive than we thought; or takes too much, leaving the uterus incompetent.

We also test the lymph nodes and tissue from around the cervix. In about 15 per cent of cases, the cancer has spread to the lymph nodes.

In these cases, we will then offer radiotherapy, but unfortunately this destroys fertility.

In Emmeline’s case, it hadn’t spread and I’m delighted that she has made a full recovery.

 

 

Carol Davis - MailOnline