Radical vaginal trachelectomy

19 Feb

Ok – if you have made it past the title, then hold onto your hats and I will explain the excitement that awaits me next week!

I posted a while back about the potential treatments I may have, and one of them was the Radical Tracelectomy.

As a result of all the various tests, the surgeons are happy to do the Trachelectomy. That is what I had been hoping for, so it’s a good result, although still quite scary.

Extract from the earlier post

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.

As you know, I’ve had the lymphandectomy. It seems that in a lot of cases they do both these operations at the same time, but I have had it done separately. I’m fine with them being done separately, as I believe it reduces the uncertainty with this next operation. They know at this stage that the lymph nodes look clear, so it is more likely that the trachelectomy would go ahead as planned without any surprises.

So, a bit more here about the Trachelectomy for those that want to know.

Trachelectomy:

The goal of this surgery is to remove all the cancer, as well as surrounding tissue to try to reduce the chance of recurrence. The team keep reminding me that getting rid of the cancer should be the primary focus, and in the past,  surgeons would just perform a full hysterectomy – ie the removal of pretty much everything from the cervix up – including ovaries, womb, cervix and the surrounding tissue to be sage. That’s a pretty intense operation in itself, and clearly it completely removes any chance of having children. Plus immediate menopause and other fun things.

So, being human beings, doctors looked to create a less extreme surgery, especially as cervical cancers are regularly found a lot earlier these days due to pap smears.

Radical Trachelectomy was developed (in part by my actual surgeon) to try and be a little more conservative for early stage cancers. It is becoming more common, and my surgeon has done the operation about 220 times, but he said there have only been about 1000 worldwide.

The image below is a summary of the operation. The cervix is a link between the womb and the vagina, so if the cervix is removed then those two elements have to be stitched together instead. The surgeon will make an assessment during the surgery as to how much cervix to remove. They will try to leave some cervix (at the upper end) if possible, as reduces the risk of early miscarriage.

Image3

Now, the NHS website says that no surgeon can promise that they won’t have to change and do a hysterectomy once they get started. However, one of the other surgeons said he had never heard of that happening… but he wasn’t a specialist. So I will ask the surgeon on Friday if possible. Maybe the fact that I have had the lymphandectomy reduces the risk of there being a change mid operation.

You can see from the image that there are blood vessels and things that need to be moved and re-routed where necessary.

Without a cervix (or only a partial cervix), the surgeons also have to put in a new ‘tie’ at the bottom of the womb. It’s called a a cerclage – which is a permanent stitch. I believe that if I do get pregnant, I would have to have another small procedure to close up the stitch properly to try to, again, reduce the risk of miscarriage.

Image4

So, that’s it really.  Remove a bit in the middle, and tie the remaining bits together! Easy. I don’t know how long it will take, maybe a couple of hours. There is no surgical scar – the whole thing is done via.. ahem.. the existing access point! I can’t understand how, and have decided not to investigate.

Sometimes they do the lymphandectomy at the same time, but I had mine done last week. So they KNOW that it hasn’t spread – I think therefore the risk of them widening the surgery is low, as they already know it hasn’t spread. Well.. that’s what I hope anyway.

The image above also highlights a few of the other risks. The white ‘blobs’ in front of and behind the cervix area are my bladder and bowels. These have to be moved out of the way. One of the reasons for a longer stay in hospital is that normally women have trouble with their bladders for a while, as it’s near impossible to avoid the nerves around the bladder.

There are other nerves that run in the area, specifically the nerves for upper legs. I have heard stories from women recently (via the Macmillan site) who have had quite bad upper leg pain from damaged nerves, either due to direct surgical damage, or from the position you are in for the operation. That is also something I would rather not know about. As far as I am concerned, I go to sleep on a nice trolley, and wake up on a bed. I don’t want to know how they manhandle me in between!

But, overall the complication rates for this surgery are much lower than for a hysterectomy, and the long term prognosis is good. I will continue to have 3 monthly checkups for the first year, then 4 monthly for a few years… etc until at 10 years they discharge you back to your GP. The only potential fly in the ointment is if they do further analysis on the tissue removed and decide the trachelectomy isn’t enough. I’m not fully sure what they are looking for, but so far most results have come back clean, so I’m hoping that will continue.

As I said, this should be the beginning of the end. I’m pretty healthy at the moment, so that will stand me in good stead for the operations. I’ll be in hospital for 3-5 nights, and I think the main reason is that I will have various tubes in me which will stop me moving – mainly related to the previously mentioned ‘blobs’ above!

After that – recovery is 4-6 weeks, and they say you tend to be weaker and more tired etc for up to 6 months.

I think that’s all… any questions?

Edited to ad: I think you can see the video now. I’m made it public. Nina… I apologise in advance!

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3 Responses to “Radical vaginal trachelectomy”

  1. karen October 25, 2013 at 9:58 pm #

    This has to be the most honest, real account ive read on he internet. Your personality shines through and you sound just like me. Oh my word I thank you so much for taking the time to write this for the likes of me to read at such a stressing time – the hardestpart is the waiting and anxiety. I like you just want it over and done with, thanks so much

    • kathclear October 31, 2013 at 7:24 pm #

      Hi Karen,

      Thanks for the comment I hope the information helps. I’m happy to keep in touch if you need someone to chat to. Normally I’d respond properly but you have caught me on holiday and I only have the phone with me so it’s too annoying to type!

      It’s just about one year ago that I was rushing about to get to the gp for my regular smear… What a year it has been! But I’m out the other end, and hopefully soon to get back on the trying to conceive wagon. 🙂

      Good luck with your treatment, and feel free to contact me if I can help at all, or just to be as friendly email when needed.

      Kath

Trackbacks/Pingbacks

  1. Farewell 2013 | Kath's Cervical Cancer Journey - December 30, 2013

    […] that’s all covered in the rest of this blog really. Operations, and another one , lots of daytime TV (including a wedding!), some travel, fundraising for Macmillan and Cancer […]

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