Cervical Cancer SMALL AND WELL LOCATED

In the presence of invasive cervical cancer (the term "invasive" opposed to "in situ"), a surgical approach with total removal of the uterus (radical hysterectomy =) and lymph nodes in the pelvis (= lymphadenectomy) is the rule.

However, sometimes a type of cancer occurring in a young woman old enough to have kids. Can I receive some of these young women, and under strict security, limited surgery, leaving open the possibility of having a child?

We can compare this approach to that used when conservative treatment of breast (lumpectomy) has been proposed at the time the removal of the breast was the rule and that, whatever the size of the tumor. It took solid studies, and several years in order to offer it in good conscience for patients with small tumor well localized.
In the case of cervical cancer, a team of Italian researchers conducted a trial of treatment for young women with cervical cancer, small and well localized to retain their uterus.

The principle is to initially reduce the size of the tumor with chemotherapy first (called "neoadjuvant") chemotherapy that will destroy any cancer cells that may already exist in the peri-cervical tissues and pelvic lymph nodes, then surgery involves very limited.


Method
Between 1995 and 1997 were included 21 patients, aged under 40, nulliparous, with cancer of the cervix located less than 3 cm, without lymph node invasion or uterus, confirmed by MRI (magnetic resonance imaging = Nuclear ) and a PET scan, whenever possible.
Treatment includes chemotherapy with neoadjuvant combination of three anti-cancer and surgery with a cervical cone biopsy (removal of the cervix =) associated with the removal of all pelvic lymph nodes (lymphadenectomy pelviennne total). These nodes are of course fully analyzed. This time is essential to ensure maximum safety.

Results

→ Epidemiology:
- The average age of patients was 30 years (17-39 years);
- The average size of the tumor is 15 mm (10-30 mm);
- Histological type is adenocarcinoma (cancer of glandular type =) in 57% of cases of carcinoma or epithelial type in 43% of cases;
- Histological grade reflecting the aggressiveness of the cells is: 33% Grade I, Grade II 19% and 48% grade III, aggressiveness is increasing according to rank.
→ Results after neoadjuvant chemotherapy:
In all cases, there is a dramatic clinical regression. Microscopically, there was complete remission in 5 cases out of 21 have accepted the protocol, a small residue in 12 cases and 4 cases of invasive carcinoma penetrating more than 3 mm deep.
→ Surgical treatment:
- Four patients were deemed unsuitable for conservative treatment and underwent radical hysterectomy with lymphadenectomy;
- But the majority, 17 patients, have benefited from conservative treatment.
The postoperative course is simple.

→ Long-term monitoring:
After an average follow-up of 69 months, 17 patients as well as the 4 hysterectomy are alive without recurrence. More than half of the patients chose this treatment in hopes of motherhood.
Ten pregnancies occurred in six patients. One of them was interrupted by a spontaneous abortion. nine have been completed seven caesarean sections, and two by natural means.