Also called trachelectomy, cervicectomy
Radical trachelectomy is a surgical procedure that removes the cervix, upper part of the vagina and lymph nodes in the pelvis to treat early stage cervical cancer. Some women may be given chemotherapy before having a radical trachelectomy to try to shrink the size of the cervical tumour.
Why radical trachelectomy is done
A radical trachelectomy is sometimes done instead of a hysterectomy to treat cervical cancer. It may be an option for younger women with small, early stage cervical cancer who want to maintain their fertility (ability to have children).
How radical trachelectomy is done
A radical trachelectomy is an operation that is done in the hospital under general anesthesia.
- The lymph nodes in the pelvis are removed first. The lymph nodes are checked under a microscope to look for cancer cells. If no cancer is found, the surgeon will then perform the radical trachelectomy. If cancer is found, the radical trachelectomy will be stopped. A woman will then have another form of treatment, such as radiation therapy and chemotherapy given together.
- The cervix and upper part of the vagina are removed, but the rest of the uterus is left in place. Some of the tissue around the cervix (called the parametrial tissue) is also removed. The cervix and the nearby tissue are usually removed through the vagina (a procedure called a vaginal radical trachelectomy, or VRT) but may also be removed through the abdomen (abdominal radical trachelectomy).
- A special stitch (cerclage) is used to partially close the opening of the uterus where the cervix used to be. This opening allows the flow of menstrual blood during a woman's period. A temporary catheter may be inserted to help keep this opening from closing.
- The cervical tissue that is removed during surgery is checked under a microscope to see if there are any cancer cells at the edge of the tissue. If cancer cells are found, the surgeon may try to remove more tissue or may have to do a hysterectomy to make sure that all of the cancer is removed.
- If only the cervix and upper part of the vagina are removed (no lymph nodes), this is called a simple trachelectomy.
What happens after radical trachelectomy
If a catheter was placed in the artificial opening between the vagina and uterus, it will need to be removed about 3 weeks after the surgery.
Potential side effects
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.
Short-term side effects can happen during, immediately after or a few weeks after radical trachelectomy. They are usually temporary. Side effects may include:
- problems with urination such as not being able to empty the bladder completely
- painful sexual intercourse
- vaginal discharge
- bleeding
- infection
- numbness in the thighs
Long-term side effects can show up long after surgery is over and can last a long time. Most women do not have long-term side effects after a radical trachelectomy. Some women may experience:
- lymphedema (because lymph nodes in the pelvis are removed)
- stress incontinence
- high-risk pregnancy
- There is a high risk of miscarriage and premature birth of the baby after a radical trachelectomy.
- After trachelectomy, a woman will be unable to give birth vaginally. The baby is delivered by Cesarean section (C-section).
- infertility
Radical trachelectomy is not commonly done and is not widely available in all treatment centres.