Fertility-Preserving Surgery in Patients with Early Stage Cervical Carcinoma

Spyridon Kardakis

doi:10.5402/2012/817065

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.

Highlights

Cervical cancer is the seventh most common malignancy in developed countries, and the second most common cancer in developing countries [1]
The golden standard treatment of early stage disease ranges from simple hysterectomy to a radical hysterectomy (RH) and pelvic lymphadenectomy (IA2 to IB1)
Cervical conization is a feasible treatment for stage IA1 and radical trachelectomy with laparoscopic lymphadenectomy has become a surgical alternative for stages IA2 and IB1

Summary

Introduction

Cervical cancer is the seventh most common malignancy in developed countries, and the second most common cancer in developing countries [1]. In 2004, 30,570 new cases of invasive cervical cancer were diagnosed in the European Union [1]. Gynecological malignancies often affect women in reproductive age and about 28% of all cervical cancers is diagnosed prior to 40 years of age [3]. Where a screening program is present, the disease is often diagnosed in early stages with high survival rates. The golden standard treatment of early stage disease ranges from simple hysterectomy (stage IA1) to a radical hysterectomy (RH) and pelvic lymphadenectomy (IA2 to IB1). The high survival rates and the delayed childbearing in our society result in more cervical cancer patients who desire preserving their fertility. The aim of this paper was to review available literature on fertility preserving surgery in early cervical cancer, focusing on safety and reproductive outcomes

Stage IA1

Stage IA2-IB1

Conservative Surgery and Neoadjuvant Chemotherapy

Findings

Conclusions