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A simple trachelectomy is a surgical procedure used in early-stage cervical cancer that involves removing only the cervix and not any of the surrounding tissues
A simple trachelectomy is a surgical procedure used in early-stage cervical cancer that involves removing only the cervix and not any of the surrounding tissues.
Trachelectomy is also called fertility-sparing surgery because it does not involve the removal of the uterus, therefore leaving the possibility of future pregnancy.
An increasing amount of research has reported that trachelectomy is as effective at removing cervical cancer as hysterectomy, which is the removal of the uterus.
What are different types of trachelectomy?
- Simple trachelectomy: Removal of the cervix
- Radical Trachelectomy: Removal of the cervix, parametrium (tissues around the uterus), and some part of the upper vagina
- Lymph node removal (lymphadenectomy): Removal of the lymph nodes in the pelvis
When is a simple trachelectomy recommended?
Trachelectomy is considered a safe and effective treatment for early-stage cervical cancer that measures 2 cm or less or is in stages IAI, IAII, or IBII and has not spread or involved lymph nodes.
Eligibility criteria for trachelectomy is as follows:
- Lesion size of 2 cm or smaller
- International Federation of Gynecology and Obstetrics (FIGO) stage IAI with the presence of vascular space invasion or FIGO stage IAII and IBI
- No lymph node involvement
- No involvement of the upper endocervical canal (confirmed with magnetic resonance imaging)
- Patient desire to preserve fertility
How is a simple trachelectomy performed?
Doctors may recommend certain tests before a trachelectomy to measure the length of the cervix, preserve fertility, and ensure the effectiveness of trachelectomy on a case-to-case basis. These tests may include:
- Colposcopy
- Hysteroscopy
- Cone biopsy
During a laparoscopic trachelectomy, a thin tube-like instrument with a light and lens (laparoscope) is inserted through a small surgical cut in the abdomen. The laparoscope and other instruments are then passed into the abdomen to remove the cervix.
Pain at the incision site may occur after the procedure and can last for about 4-6 weeks. There may also be vaginal bleeding and discharge, which can last up to 6 weeks.
What are possible complications of trachelectomy?
- Excessive bleeding during surgery
- Cuts made to the ureters, bladder, bowel, or blood vessels
- Heavy vaginal bleeding post-surgery
- Signs of infection, such as passing blood clots or foul-smelling vaginal discharge
- Cervical stenosis (narrowing and scarring of the cervical opening)
- Lymphocytes or lymphoceles (fluid-filled lumps)
- Lymphedema (accumulation of lymph fluid, causing swelling in the groin or legs)
- Bladder issues or urinary tract infections
- Sexual problems
- Increased risk of premature births
What are signs and symptoms of cervical cancer?
Cervical cancer is the fourth most common cancer in women worldwide and occurs when the cells lining the cervix (connection between the vagina and the upper part of the uterus) grow out of control. It is primarily caused by human papillomavirus (HPV) infection. Many women have no symptoms; however symptoms that do occur may include:
- Abnormal vaginal bleeding
- Spotting or bleeding between or after a period
- Menstrual bleeding that is heavier or longer than usual
- Foul-smelling, watery, or bloody vaginal discharge
- Vaginal bleeding after menopause
- Pain during intercourse
- Bleeding after intercourse or douching
- Persistent pelvic or back pain
What are other treatments for cervical cancer?
Treatment for cancer depends on the stage and may consist of one or a combination of the following:
- Cryosurgery
- Laser surgery
- Hysterectomy
- Radiation therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
