Fertility and horrible cancer treatment options

7 Feb

First posted 15 Jan: http://community.macmillan.org.uk/blogs/b/kaths_cervical_cancer_blog/archive/2013/01/15/fertility-and-horrible-cancer-treatment-options.aspx

Some of the more attentive of you may have noticed that I don’t yet have children.

Despite rumours of screaming, and no sleep, and tantrums in shopping centres, for some reason I still seem interested in them! So far in life the fertility gods have not been that helpful, and that was before they decided to add cancer to the mix.

As you can probably imagine, cervical cancer is quite close to some pretty important baby making machinery. Boys – you may want to look away now… in fact, you may want to look away for most of this blog!

In many ways, I was much more concerned (and still am) about the impact of all this on fertility rather than the cancer risks. I don’t really believe the cancer is that serious (which is an odd thing to say I realise) but the impact on fertility to front and centre. I’m starting to learn more about the cancer, but for now lets talk fertility.

Potential treatments for Cervical cancer:

1.    Radical Hysterectomy + lymphectomy+ removal of ovaries: (+ possibly Chemo/Rad later)

ectomy is surgical speak for ‘removing’.

Radical means they take a decent amount of tissue around the organ – so with radical hysterectomy they remove the uterus, and a lot of the surrounding tissue. 

This, to me, is worst case scenario. Sadly it is considered the ‘standard of care’, so it is what doctors have in mind as the nomal treatment, so I have to keep them distracted while I search for other options!

Obviously this means zero fertility, with immediate menopause thrown in for fun. Having spent a week on drugs to mimic menopause, I can tell you it isn’t much fun. If I was older, and had had kids, or was past menopause, this would be the automatic treatment. It seems like crazy overkill to me, for something that is only a few cm in size, but I am learning that size isn’t everything.

You only find out after the tissue is removed if you need to also have radiation.

Name Treatment Intended Effect Side effect
Radical hysterectomy Remove uterus and cervix and surrounding tissue. Remove all areas which could be affected by the cancer. Complete infertility.
Lymphectomy Remove as many lymph nodes as they can find in the groin area Lymph nodes are normally the first areas impacted by spreading cancer. Best to get rid of them! Leg swelling. Not sure if that is forever.
Removal of ovaries Removal of ovaries There is a high link between cervical and ovarian cancer. So they prefer to remove them Menopause. Infertility.
Chemo/Radiation See below

2.  Radical trachelectomy + lymphectomy: (+ possibly Chemo/Rad later)

Trachelectomy is a relatively new treatment, and is referred to as fertility sparing surgery. The idea is that they remove the cervix (and surrounding tissue… see you are learning already!), thus leaving the womb intact.

Name Treatment Intended Effect Side effect
Radical Trachelectomy Remove cervix and surrounding tissue. Remove area affected by the cancer. Can still carry a baby, but not give birth naturally. Very high risk of late miscarriage.
Lymphectomy Remove as many lymph nodes as they can find in the groin area Lymph nodes are normally the first areas impacted by spreading cancer. Best to get rid of them! Leg swelling. Not sure if that is forever.

This is the surgery I would prefer. Without the Chemo/Radiation. I am currently being assessed to see if I qualify.

They only let a limited group of people do this surgery, as it isn’t a foolproof as a full hysterectomy. The stats for re-occurance with those who get this surgery are actually better than the hysterectomy group, but the reflects the selection criteria, not the treatment itself.

ie. Those who get this treatment tend to be earlier, and lower risk, healthier patients anyway – so the re-occurance rate would be lower anyway.

Without a cervix, which basically holds the womb closed, there is clearly a risk with any pregnancy. The womb would basically be surgically stitched closed, and then a c-section for delivery. There is a high risk of late term miscarriage, but at least the option still exists.

3. Radiation/Chemotherapy.

I don’t know much about this, as I don’t want to really think about it.

What I do know is that radiation is very dangerous for everything in the area, including bowel, bladder, as well as womb and ovaries. It is possible to surgically move the ovaries out of the way, but this isn’t foolproof, and the act of moving them can also cause them to stop working.

If I get to this stage, fertility is pretty much gone – but it would be good to still try to keep ovaries to stop going through menopause.

A side note on removing ovaries.

The doctor mentioned the other day that if I get to keep my ovaries, then they would be monitored regularly for cancer, and would be removed once I get to natural menopause.

A side note on my notes.

This is all just my interpretation of what I have been told. I reserve the right to be completely wrong and change all information later!

(This post seems to have turned into a general explanation of the cancer treatment options. Which is good I suppose!)

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2 Responses to “Fertility and horrible cancer treatment options”

  1. Michelle McKenna May 14, 2013 at 8:47 pm #

    Hi I was diagnosed with stage 1b1 adenocarcenoma in July 2011. I was given fertility sparing surgery but my consultant decided not to go as radical as a tracalectomy and gave me a repeat large LLETZ (1st didn’t have clear margins) and key hole lymph node removal. Eights weeks ago at a day short of 39 weeks I delivered a baby girl. Not sure what stage you are at but there is hope out there x

  2. kathclear May 15, 2013 at 9:28 am #

    Hi Michelle,

    Thanks for the comment, and congrats on your new baby! I’m still not allowed to start trying for kids, but we are hopeful that we will have some options in the future. As my doc said, it was the whole point of the exercise!

    Always good to hear positive stories though. Thanks

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