Can a hysterectomy be deferred for 12 months to allow pregnancy?

Recently diagnosed with cervical cancer
1

Hi All, 

I'll do my best to make a long story short: 

Aug 2017 miscarried at 6 weeks

Aug 2017 received results from smear test taken in early July confirming abnormalities 

Sep 2017 Bopsy carried out - High Grade CGIN / AIS

Oct 2017 - LLETZ prcoedure carried out - marins not clear 

Jan 2018 - 2nd LLETZ procedure carried out - 3 margins clear, 1 margin not clear

Mar 2018 - MDT meeting to discuss, referred to Gyn Oncology team 

April 2018 - MRI scheduled 

May 2018 - Outpatients meeting scheduled to discuss findings of MRI

Now, I have no children, am married and would absolutely love to ahve a family. We were in the process of trying for one when all this began. 

I've been told I do not have cancer, the cells are precancerous, but could develop if untreated. The MRI will give a better idea of where I am at, and a treatment plan can be discussed following the results of this, but hysterectomy has been mentioned a few times. 

Here's where I'm at with that:

1) had I not miscarried, I'd have a baby by now and treatment would have been carried out afterward.

2) had I continued to TTC following the miscarriage, I'd be pregnant now (possibly) and treatment would have just had to wait. 

3) by the time I meet with the Doctors to discuss the findings of the MRI 4 months will have gone by since my last treatment. If 4 months can be allowed to go by without treatment, how urgent can a hysterectomy be? 

 

Don't get me wrong, I've been up and down and all over the place. I've been looking into surrogacy and egg retirieval in the bakground, and every other possible avenue there is to try to ensure me and my husband can become parents. More recently, following a lot of research online, I am wondering.... given the rate at which precancerous cells develop into cancer, with the correct supervision and regular screening, could a hysterectomy be delayed to allow me to try for a baby? 

 

I should probably mention that I am 35, but have ready many posts where doctors encouraged women younger than me to complete there families following similar diagnosis, and then have hysterectomy afterwards. I'm just wondering if that could be an option for me - Heck, I'd go straight for IVF if I thought it would give me a better chance of conceiving ASAP, whatever it takes! 

 

I'd really appreciate any feedback on this, and thanks for reading. 

 

 

2

Hello Rosey2018,

I was diagnosed with stage 1b adenocarcinoma (low grade) while trying to have a baby (I had a couple of miscarriages within the last 2 years). 

I know how painful this can be.

My gynecologist/oncologist told me that I am qualified for a radical trachelectomy. I had the PET/MRI just before my cone biopsy and it showed that the cancer is confined to the cervix. However, I was told that adenocarcinoma sometimes skips and I gave the consent for both trachelectomy and hysterectomy in case the doctors think that hysterectomy will have better outcomes. This can be determined during the operation while doctors are checking the tissues.

I chose to have an open surgery instead of robotic one. In all cases, I will keep my ovaries but the surgeon may have to move them higher in case I have to do radiation.

After trachelectomy, the rate of pregnancies remains high (about 75%). However, pregnancies considered being of a higher risk due to the higher risk of miscarriages and premature pregnancies. Women can carry their kid and they can deliver by c-sections. IVF can be more challenging due to stenosis. Gynecologists, though, have seen many natural and normal pregnancies. After a hysterectomy, women can only have kids with a surrogate mother and IVF can be more challenging too.

I don't know whether an IVF could be an option for you. Did the cone biopsy show low-grade cancer? I suggest you consult both your gynecologist/oncologist and fertility specialist. I have 2 frozen embryos before my cone biopsy but I decided not to have another IVF just before my follow up surgery. I have a low reserve of eggs (I am in my late 30s) and the random stimulation for IVF would not give us the optimal embryos.

Hope I gave you some useful information.

Best,
3

Hi, thanks for the reply Pontia. I had the MRI on Tuesday and I'm waiting on the results from that. From what I understand this will give a much clearer picture of where we're at. 

I have High Grade CGIN / Adenocarcinoma in situ, and have received 2 lletz procedures to date, the last of which was carried out in January. The results came back with 3 of the 4 margins clear, and 1 of the margins margins not clear.

At my last meeting it was still described as Stage 0, and the last 3 months have been spent being referred from one team of specialists to another, without any actual treatment. 

My next meeting is scheduled to take place on May 10th, and I suppose my frustration and confusions lies in the fact that there seems to be no urgency on one hand, and yet repeated talk of hysterectomy, which seems quite extreme given the delays between one treatment and another. 

 

4

I have my MRI results!! 

Normal T2 low signal identified throughout cervix

cervix measures 1.1cm

normal appearance of endocervical junction.

Normal appearance of parametrium

normal appearance of the anteverted uterus

nornal endometrial thickness. No uterine mass 

physiological follicles are identified in both ovaries (MRI taken just before ovulation) 

no free fluid. 

No adnexal mass.

normal appearance of bladder 

large and small bowel normal 

no adenopathy 

not sure what what it all means but my next meeting is May 10th. 

 

 

5

Hi, so.... I met with my new consulatant and he's probably been the most positive part of this experience so far. 

We discussed all the options, and I've to go back for a smear, HPV and colposcopy in July. Based on the results of this, we may proceed with a cone biopsy (of the tiny bit of cervix I have left) and we'll see where we go when the results of that come back, or if by some miracle all the tests come back clear, we may opt not to treat, to have a stitch inserted and to TTC under his supervision and care, and the care of the High Risk pregnancy unit. 

6

Hi Rosey,

Im sorry to read about your situation, whilst mine was different, I was only 6/7 weeks pregnant when I received a diagndiagnosis of CIN3. We did have to have some very difficult conversations with consultants over the risk of progression during my pregnancy and the posibility of early delivery of termination. Cutting a long story short, they supported my decision to progress with pregnancy and monitored me throughout. I now have a healthy 8 month old daughter. It could have been different and we accepted that she may have had to be delivered early or that we may have lost her but it was a risk we were willing to take. As you say, if you had been pregnant when diagnosed your treatment would have had to wait. 

Sending you lots of love and hope everything works out well for you xxx

7

Hi, I’m a little worried now and hoping someone can please help me. 

I’m due back for smear, hpv and colposcopy next week (6 months since my last lletz). 

Last month (May 21) period was a week late, I was totally surprised as I’d been under massive stress in March & April. It was quite a painful period and very different to my norm. 

This month my period arrived 28 days after the one in May. I had red blood for two days, then nothing most of day three but it kicked back in that evening and ran for 2 more days (making 5 days in total). 

That was 4 days ago, and today I have some rusty coloured spotting. 

Im really worried about it. When I google, it says spotting between periods can be a sign of cancer. I as hopeful that I was coming out the other side of all this. The result from he MRI was good and my consultant (May 10)  seemed to think that the margins have have just been shy of an all clear at the lletz and that this upcoming smear, HPV and colposcopy could show that the situation had improved. 

What other reasons could there be for this spotting??? It’s not normal for me and I am really worried that something is wrong. 

I don’t know what to do. I’m due for all those tests next week anyhow, so it’s unlikely I could be seen to before then even if I did go to the doctor now?

 

Someone please tell me I’m overreacting and there’s perfectly logical explanations for what’s happening?! 

8

Hi there, I just wanted to update my post because it drives me crazy when you're searching a particular topic and come across a thread that totally describes your situation and then there is no follow up and you always wonder what happened.... 

So I'll tell you! 

Smear in November 2018 finally returned clear result

Had cervical cerclage in December 2018

Had cervical canulation in Feb 2019 (due to stenosis)

IVF in April and now pregnant 

:) :) :)

9

I am delighted to read this! 

Congratulations and good luck xxx