Wednesday, January 28, 2009

New fertility preservation at NGMC option for cervical cancer patients

Gainesville, FL
In the past, a diagnosis of early stage invasive cervical cancer would usually lead to infertility because of the recommended treatment necessary to cure the cancer. Treatment typically includes a radical hysterectomy and sometimes radiation therapy and/or chemotherapy. Over the past decade, there has been an increased focus towards fertility preservation in the treatment of cervical cancer since a little less than half of all women diagnosed with cervical cancer are 45 years old or younger.

“Traditionally, we have been able to offer women diagnosed with cervical cancer fertility preserving options such as embryo freezing, with vitro fertilization (IVF); and ovarian transposition, where we move the ovaries away from the target zone for radiation therapy treatment,” says Andrew Green, MD, a gynecologic oncologist with Southeastern Gyenocologic Oncology, LLC in Gainesville. “But these measures only preserve a woman’s eggs; because of the radical hysterectomy she is unable to carry the child and must use a surrogate. The radical trachelectomy, on the other hand, gives certain women the option of carrying their child to term after treatment for cervical cancer.”

Developed by Daniel Dargent in 1995, the radical trachelectomy is a complex surgerical procedure that removes the cervix; parametrium, or the tissue adjacent to the cervix; pelvic lymph nodes; and a portion of the vagina, then connects the uterus to the vagina. A cerclage is also performed, which is a procedure that involves sewing the opening of the uterus closed to prevent preterm labor if a patient does become pregnant.

“Unfortunately, not all cervical cancer patients are a good candidate for a radical trachelectomy,” says Dr. Green. “There are certain criteria that a patient must meet in order to be considered for this procedure. Such criteria include being less than 40 years old with a strong desire to preserve fertility, no clinical signs of impaired fertility and stage IA-IB1 cervical cancer that shows no signs that it has spread.”

Although more complicated, the success rate of the procedure for treating cervical cancer is equivalent to that of a radical hysterectomy. In addition, according to the MD Anderson Cancer Center, of the approximate 500 patients around the world who have been treated with a radical trachelectomy about half have tried to become pregnant and of those, roughly 60 percent have delivered full-term babies via cesarean section.

“It is wonderful that NGMC is now able to offer this highly specialized procedure through our new Gynecologic Oncology service,” says Tom Enright, director of Oncology Services at NGMC. “Dr. Green has already preformed one radical trachelectomy since joining the medical staff at NGMC. We are proud that women in North Georgia no longer have to travel for this kind of specialized care.”

The Gynecologic Oncology service is a new component of the Cancer Center at NGMC. It is also a relatively new field of medicine. In the early 1970’s, the American College of Obstetrics and Gynecology identified the need to train people specifically to attend to the surgical and chemotherapeutic needs of patients with cancer of the female genital tract. These disease sites include cancers and precancers of the ovary, uterus, cervix, vagina and vulva. To meet this need, fellowship programs (training in addition to the standard four years of medical school and four years of residency that all OB/GYN’s must complete) were developed. Each year, approximately 33 people are accepted into fellowships in the United States. Currently, there are only 650 gynecologic oncologists in the United States.

For more information about the Cancer Center at NGMC call 770-533-8800 or visit

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