More women with cervical cancer can go on to have children

Published on Wednesday 23 January 2008 21:19

NEW treatments to preserve the fertility of cervical cancer patients should be offered to more women in Scotland, experts said yesterday.

Advice for the NHS in Scotland emphasises that treating the disease does not have to mean that a woman will be unable to have children at a later stage, as most patients fear at present.

Experts from the Scottish Intercollegiate Guidelines Network (Sign) urged surgeons to consider alternatives to hysterectomy for women with cervical cancer in its early stages.

Campaigners pointed out that in many cases where women were diagnosed later a hysterectomy would still be necessary to give them the best chance of survival.

It is hoped the new guidelines, which cover all areas of cervical cancer treatment, will mean that variations in care in Scotland will be removed.

About 300 cases of cervical cancer are diagnosed in Scotland each year, and while the disease can be cured, treatment can be very intensive.

The Sign experts said many patients assumed that surgical treatment for the disease would mean having a hysterectomy, ending their chances of conceiving a child.

They said procedures that allow women to retain their ability to become pregnant included radical trachelectomy, to remove the cervix, and a technique called "cold knife conisation".

Sign said that, although these procedures had not been tested in full clinical trials, many such operations had now been carried out in leading hospitals.

Another Sign recommendation was for women with advanced cancer to have access to a special type of test combining a CT and Pet scan to see exactly what the cancer was doing inside the body, to help doctors rule out inadequate or inappropriate treatments. It is thought that about 150 women a year in Scotland would require the Pet/CT scan.

Sign also sets out the use of chemotherapy and radiotherapy in cervical cancer patients, and standards of psychological support.

Dr Nadeem Siddiqui, who chairs the guideline group, said: "The need for guidance on the management of cervical cancer was highlighted by variation in practice over different aspects of disease management.

"When this guideline was proposed, not all regions in Scotland had adopted chemotherapy and were still treating women with radiotherapy alone.

"Not all women were having MRI to assess tumour volume and palliative care services were neither standardised nor available to the same extent in all regions."

Pamela Morton, of cervical cancer charity Jo's Trust, welcomed the new guidelines.

She said treatments for the disease that preserved fertility were "fantastic" and had already resulted in women giving birth.

But she said hysterectomy should remain an option for women with the most serious stages of disease.

"Tracheloectomy is really a wonderful procedure, but can only be used in the early stages of the disease," Ms Morton said.

FERTILITY INTACT

SEVERAL procedures can be used to treat cervical cancer while retaining a woman's fertility. These include:

&#149 Trachelectomy: Developed in recent years in specialist centres around the world, this can be used in early cases of cancer. The cervix, the upper part of the vagina, the tissue around the lower end of the uterus, and the pelvic lymph nodes are removed. But the womb and the ovaries are not removed.

&#149 Cold knife conisation: This involves taking a cone-shaped biopsy from the cervix. This may be used either for diagnostic purposes, or to remove pre-cancerous cells.

&#149 Large loop excision: This is usually used to treat abnormal cells. A wire is inserted by the doctor through which an electrical current is passed to destroy abnormal cells.