Does anyone know why trachelectomy is only offered to women who want children?

I’m kind of at a loss. Mine’s in situ and I already had a LEEP but they want to do a hysterectomy. I would vastly prefer a trachelectomy but they ‘don’t usually do that’ for women who are done having children. (Which I am.)

From what I understand, the outcomes between the two surgeries for the actual cancer are about the same. Trachelectomy is far less invasive, less painful, has a shorter recovery time (which is very helpful as I’m a single parent) and doesn’t carry the risk of early menopause- even with the ovaries left intact- and all that entails. Longterm risks of hysterectomy are not exactly something to sneeze at. There have been a lot of recent studies and the attitudes about therapeutic hysterectomies are changing.

Am I missing something here? Trachelectomy seems like the optimal route to take. I don’t think I’m done with my uterus just because I’m done having children. That’s ridiculous IMO. Is this just something that’s being done because it’s the way that it’s always been? It seems much less than ideal. I mean, I realize that cancer is something that’s scary to some and a lot of patients and doctors may wish to be hyper cautious, but it’s not like I won’t have further testing during the surgery- the lymph nodes are biopsied and all that. If it’s invasive at all they’d still perform a hysterectomy. But I’d prefer to take the least invasive path before escalating things and I don’t think my childbearing status should affect that.

Thoughts? Advice?

Hi Cygnus,

I don't know for certain but I imagine that a trachelectomy is a much more fiddly and complicated procedure. I would expect that HRT would resolve any early-menopause issues. I think that fertility preservation is reserved only for those who actually require it.

Be lucky :-)

Hi there. I had a trachelectomy for fertility preservation. The docs are extremely selective about who they give this procedure to and it is always about fertility preservation. I know very young ladies who have had hysterectomies because they were finished with child bearing. tivoli is right as well, it is still a very specialised, complex operation. I was upside down on an operating table for 6 hours! There are also some side effects such as cervical stenosis resulting in blood pooling and not beimg able to get out during the menstural cycle, which I believe that be quite painful. They also watch us trach ladies incredibly carefully after the op. We have to go for 3 monthlycheck ups which include MRI (for me anyway) and smears. This can be quite stressful. I believe that the checkups are not quite so invasive after a hysterectomy. definitely something to think about.

i know exactly where you are coming from though and maybe in the future there will be more trachs for other purposes, they are still learning about them though. 

Out of interst, why do they want to do a hysterectomy? Did you not have clear margins from the LEEP? are there other risk factors? I ask because people are often offered another LEEP or a deep cone biopsy With cc in situ/stage 1A1. the docs know their stuff though so I'm wondering why they are suggesting it and whether this has been explained to you properly? I would imagine they'd be far more likely to offer another LEEP/ deep cone over a trach. They can also do lymph removal with that as women on here have had it. 

They mentioned a hysterectomy the second that I came back positive for cancer- in situ- simply because I was done having kids. They didn't even mention what kind I had or what stage I was, I had to find it out from my GP. After my initial LEEP I found out it was stage 1A1 ('microinvasive') adenocarcinoma, and only because I asked. Again the mention of hysterectomy was made before I was given any results. I wasn't told what my margins were, but I am having a repeat LEEP done in February.

I'm just getting the impression that hysterectomy is a catch-all because it's been the standard for so long. I don't agree with that at all. I've since done a lot of research and read many studies and journal articles about this 'standard' changing. I should be more clear, I am seeking a simple trachelectomy- not a radical- as this is also being determined to be a completely safe and oncologically sound treatment option, as is conization. I'm also planning on demanding an MRI.

I've had a lot of what I feel is completely inaccurate scare tactics used on me. What I've been told does not appear to match the science, and I believe that the choices for treatment are completely out of date where I am.

Good luck with getting less invasive treatment - you should absolutely have a say and not be forced into something unnecessarily. xx