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Cervical Cancer

Radical trachelectomy

Radical trachelectomy is not a standard procedure used to treat cervical cancer. Only a few of the large cancer centres offer this procedure to patients and only to those women who fulfil specific criteria, such as, those who have very early invasive cervical cancer and a strong desire to preserve their fertility.

The cervix, the upper part of the vagina, and the lymph glands in the pelvic area are removed, but the womb is left in place. After this operation it may still be possible for a woman to have a child. A stitch is made at the bottom of the uterus and this takes the place of the cervix during pregnancy. Women may experience fertility problems, difficulties in conception, late miscarriage/preterm labour and the baby needs to be delivered by caesarean section. However, initial research on a small number of women who have had a radical trachelectomy suggests several do go on to have successful pregnancies.

We interviewed two women who had had a radical trachelectomy. One woman explains how she had made a decision to have a trachelectomy rather than a hysterectomy.

 

She explains how getting a second opinion led to her having a radical trachelectomy rather than a...

She explains how getting a second opinion led to her having a radical trachelectomy rather than a...

Age at interview: 39
Sex: Female
Age at diagnosis: 31
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My husband's a doctor and he happened to be working at a particular hospital in London and he bumped into a registrar who worked for a consultant there, a gynaecological oncologist who, and the registrar said "Don't do anything until you've seen this consultant." So [my husband] arranged it through the secretary and asked if we could have a second opinion and he was willing. But we had to get a letter from the original consultant so we phoned his secretary and she arranged for a letter to be sent so that I could be referred to the new consultant in London.

We had a big meeting that time with several members of his team, the registrar, the Macmillan nurse, everybody was there and we had a very open discussion about what was available. And it came down to the fact that either it was going to have to be a hysterectomy or they had just seen a new operation carried out in France that they were willing to try here if I was willing to let them do it and that was the radical trachelectomy.

So how did you feel about that?

We felt we had nothing to lose because if it didn't work then they could still do the hysterectomy afterwards so we thought it had to be worth a try to see if it would give us the results that we needed.

Removing the cervix, top of the vagina and supporting tissues is done through the vagina as a surgical operation. A laparoscope (telescope) is inserted through the abdomen to remove the pelvic lymph glands and describe how they felt physically, immediately after their operation.

 

She describes what is like having a radical trachelectomy.

She describes what is like having a radical trachelectomy.

Age at interview: 39
Sex: Female
Age at diagnosis: 31
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Yes I went into theatre. They put all the monitoring leads on you, blood pressure cuff, a thing on your finger to test your blood/oxygen level and then you have a little needle in the back of your hand and have your anaesthetic and you just drift off to sleep and you don't know any more, nothing, until you wake up. You hear someone calling you in recovery. And my first recollection, I can still feel it now, is such a dry mouth. I had such a dry mouth it was unbearable and the nurse was putting some lemon and glycerine on little spongy sticks and wiping my mouth around to try and unstick it because it was so dry. And that's my first recollection of when I woke up. I wasn't in any particular pain. I had a pain control pump which you just press a button as you need pain killers and that keeps you fairly comfortable. I was obviously a little bit sore but nothing, I wouldn't say I was in agony or anything. I just spent the next day feeling, or the rest of the day really feeling just really woozy from the anaesthetic.
 

She describes how she felt physically immediately after her radical trachelectomy.

She describes how she felt physically immediately after her radical trachelectomy.

Age at interview: 38
Sex: Female
Age at diagnosis: 34
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And then the actual, after the operation, I don't really remember any of the being in recovery. I remember waking up downstairs in, in the ward and I was very, very thirsty, I remember that and I remember that because of the risk to your gut they wouldn't let me drink and I remember really being so thirsty and that was the worst thing, that night was so long because I was so thirsty and I just wanted to drink water. That, that was the worst bit, apart from, I mean I had, you have strong pain relief, morphine afterwards but the worst bit was being thirsty and not being able to get up. 

I was, I did have a reaction to the morphine and it made me itch, it made me itch a lot. And they gave me something for that but I didn't realise, I didn't realise that even though I was itching like mad I didn't think to tell the nurses for ages and I wish I had now because I wouldn't, I wouldn't have itched for twelve hours and scratched so much. And I was quite sick as well but I had something for that. And it was very painful. It was painful definitely and I didn't expect it to be so painful and I didn't expect the bleeding to be so heavy as well. I think I really wasn't very realistic. I thought I would be up and out because I was young and relatively fit I thought I would be up within two or three days and back to normal. I think I just wasn't realistic about it all.

Both women felt very weak for the first few days after their operation. One explains how she found her initial recovery in hospital difficult because she had expected to be able to do things for herself more quickly than she was able to.

One of the women interviewed left hospital after five days, the other after ten days. Both explained that they were surprised by how weak they felt at first, but after about two or three weeks they had regained their strength. A woman describes why she is glad she took a full 3 months off work. She temporarily had painful periods and on/off bleeding for four months, but felt that the incentive of her sister's wedding helped her quick recovery.

 

She describes her recovery from her radical trachelectomy.

She describes her recovery from her radical trachelectomy.

Age at interview: 38
Sex: Female
Age at diagnosis: 34
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I didn't expect to feel as weak as I did. Because I'd always been quite active, I'd walked a lot, I was really quite surprised that just standing for any length of time made me very tired. I was quite surprised by that, how weak I felt. And I remember the first time I went for a walk on my own I had to sit down half way and I was only going down the road, and I was quite surprised by that. That I felt quite vulnerable because I didn't feel as strong as I normally felt. 

I mean the initial two, three weeks, it was uncomfortable and painful. And I think maybe looking back now I should have relaxed more but I was quite adamant I was going to get going and do things and I was going to do my housework and I was going to be active.

I have to say I quite enjoyed my post-op time at home. I, I enjoyed, I did quite a lot, I think I was quite active and I enjoyed it. And I was quite surprised.

So how long was that period?

That was twelve weeks, I think probably I could have gone back a little bit earlier. But I think once, you mustn't rush too quickly to get back to it because once you're back in work, you're back in work and people will make allowances for you but really, and especially with my job, you're on your feet, once you're back you have to be back and be fully recovered. So I wouldn't rush to go back, take, take that time. And do nice things, don't feel guilty about being off work. Do nice things, go to the beach, go for a walk you don't have to adopt a sick role and be in the house all the time.

 

She describes her recovery from her radical trachelectomy.

She describes her recovery from her radical trachelectomy.

Age at interview: 38
Sex: Female
Age at diagnosis: 34
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I didn't expect to feel as weak as I did. Because I'd always been quite active, I'd walked a lot, I was really quite surprised that just standing for any length of time made me very tired. I was quite surprised by that, how weak I felt. And I remember the first time I went for a walk on my own I had to sit down half way and I was only going down the road, and I was quite surprised by that. That I felt quite vulnerable because I didn't feel as strong as I normally felt. 

I mean the initial two, three weeks, it was uncomfortable and painful. And I think maybe looking back now I should have relaxed more but I was quite adamant I was going to get going and do things and I was going to do my housework and I was going to be active.

I have to say I quite enjoyed my post-op time at home. I, I enjoyed, I did quite a lot, I think I was quite active and I enjoyed it. And I was quite surprised.

So how long was that period?

That was twelve weeks, I think probably I could have gone back a little bit earlier. But I think once, you mustn't rush too quickly to get back to it because once you're back in work, you're back in work and people will make allowances for you but really, and especially with my job, you're on your feet, once you're back you have to be back and be fully recovered. So I wouldn't rush to go back, take, take that time. And do nice things, don't feel guilty about being off work. Do nice things, go to the beach, go for a walk you don't have to adopt a sick role and be in the house all the time.

Neither woman experienced any long term side effects. One said she had a very small scar which was hardly noticeable, the other had only needed three or four small stitches.

One of the women we interviewed was undergoing fertility investigations at the time that she was diagnosed with cancer. She explained that after three failed IVF treatments she is pleased she was able to have the option to have a trachelectomy because she would have found a radical hysterectomy very hard to come to terms with.

The other women had two children after her treatment; the first was born just over a year after her trachelectomy. She describes her feelings during her first pregnancy and explains that both her children were delivered safely.

 

She describes how she felt during her two successful pregnancies after having a radical...

She describes how she felt during her two successful pregnancies after having a radical...

Age at interview: 39
Sex: Female
Age at diagnosis: 31
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I suppose you don't feel as relaxed as may be, I mean every pregnant woman worries but you have that additional worry because there's a risk of premature labour. You have to have a lot more scans and you seem to constantly be at the hospital. You have some steroid injections to make sure that the baby's lungs develop quicker in case there's a premature labour. So it is I think a bit more nerve-wracking and as I say you do feel like you're at the hospital all the time. And the first pregnancy I worried from one appointment to the next about what's going to happen next because [son's name], my son was the first child born after a trachelectomy so nobody knew what was going to happen. So, but the second one it was a lot, I felt a lot more relaxed because we'd done it once so we could do it again, so it wasn't such a problem.
 

She describes the birth by caesarean section of her two children after she had radical...

She describes the birth by caesarean section of her two children after she had radical...

Age at interview: 39
Sex: Female
Age at diagnosis: 31
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I didn't go into labour with my first one but he was born at 35 weeks. I had a strange pain and they weren't sure what it was so they said oh the baby's big enough, we'll just deliver him now to be on the safe side. And he was absolutely fine, didn't have to go to special care or anything. The second one, my waters broke at 36 weeks. I didn't go into labour but obviously I could have done having left it a few more, but you have to get to the hospital quickly because they have to deliver you before you go into labour, you can't let the womb go into labour after a trachelectomy. So we got to the hospital and they were there waiting, did the caesarean section straight away and she was fine as well and didn't need special care. They're both bonny babies.

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Last reviewed July 2017.

Last updated July 2017.

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