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Conquering cervical cancer, sparing fertility

Cancer of the cervix can strike women at almost any time, but it usually appears between ages 30 and 55.

Fortunately, it’s a slow-growing disease that is detected by a Pap smear more than 90 percent of the time. What’s more, preinvasive cervical cancer is highly curable with new procedures that allow surgeons to preserve fertility in women hoping to get pregnant.

The sooner the better

Early detection with regular Pap testing is the key, since the disease doesn’t normally produce symptoms in its beginning stage. Pap tests can spot suspicious cervical cells that, left untreated, might form a lesion—a precursor to cancer called cervical dysplasia—or a confined, superficial tumor called carcinoma in situ (CIS).

As long as the cancer hasn’t pierced the outer layer of skin cells that line the cervix, women whose overall health is good and who want children can be treated with:

  • Lasers. Now the treatment of choice for most dysplasia, carbon dioxide lasers emit narrow beams of light that vaporize suspicious cells. Usually an outpatient procedure, this therapy offers rapid healing and only mild discomfort.

  • Cryosurgery. In this technique, liquid nitrogen contained in a cryoprobe is placed against the suspicious cells to fast-freeze them. Dead cells are then shed through the vagina over the next month.

  • LEEP excision. In loop electrosurgical excision procedure, a thin wire loop is energized with radio waves and used to snip a small amount of tissue. LEEP is used under local anesthesia for both biopsies and surgery.

  • Conization. This therapy is also used for biopsies or surgery in cases where colposcopy—examining the cervix with a lighted magnifying lens—cannot determine if the cancer has invaded cervical tissue. Surgeons use either an instrument or a laser to remove a cone-shaped portion of cervical tissue.

Limited surgical options

Unfortunately, when cancer spreads beyond the CIS stage, the chances of preserving fertility diminish greatly. That’s because curing advanced cervical cancer typically requires a hysterectomy—surgical removal of the uterus and, as needed, other reproductive organs—along with chemotherapy and radiation.

However, recent advances have given hope to some women with a stage one tumor—that is, invasive cancer of the cervix that hasn’t spread—who want children. Using a minimally invasive procedure called a radical trachelectomy, doctors make several small incisions in the abdomen and remove the cancerous tissue, then reconstruct the cervix. Women who undergo this therapy can still give birth to their babies by cesarean section.

Through such innovations, researchers and surgeons are discovering new ways to safeguard the womb from cancer. Though the campaign against this disease hasn’t ended, regular Pap smears combined with modern techniques mean many women can now be called both survivors and moms.