Hysterectomy- choices

Hi, I have 1b1 adenocarcinoma. Grade 1. No LVSI

I got two options. Very different.

Opinion 1 - simple hysterectomy. Laproscopic, leave ovaries, sentinel lymph node dose too

Opinion 2 - simple hysterectomy, open abdominal, take ovaries, full lymph node dissection

What’s everyone else done in similar cases? I am risk adverse with two young children.

Hi Blueflower and welcome

Whilst my cancer was a bit more advanced than yours I think i can understand your dilemma and thought I’d share a few thoughts especially as you haven’t had any replies yet.

For background: my initial diagnosis was 1B2 (designated 1B1 in 2017 before the new Figo system) squamous cell cc, grade 2. I followed advice to have a laparoscopic radical hysterectomy with full lymph node dissection plus ovaries removed. Post op histology revealed LVSI, PNI (perineural invasion) and a close margin; I was restaged to 2A1 and went on to have chemo-radiotherapy.

I hear that you are risk averse but of course you can’t avoid risk in this situation: either increased risk for recurrence of cancer or increased risk of side effects. Maybe it would help to try and establish the stats for those risks plus how significant is the difference between those stats - hopefully your consultant(s) can advise. I was in my 60s when diagnosed and I think I was equally concerned about risk for recurrence and the risk of side effects, maybe leaning towards the latter. I can imagine my younger self with young children might have been more concerned about the former.

From the start I was concerned about the risk for lymphoedema and personally would have jumped at the chance of removal of sentinel lymph nodes (not a choice in my case) rather then full dissection. Whilst it’s only a minority (?20-30%) of women who develop lymphoedema, even with full dissection, lymphoedema can be a very challenging condition to live with - as I can unfortunately testify!! I’m not sure what the stats are for recurrence of cancer/ developing lymphoedema with sentinel node removal versus full dissection; maybe knowing the stats would help with making a decision about that.

I was in my 60s when diagnosed so removal of of ovaries wasn’t a big deal, but I’m sure I would have deliberated about the prospect of a premature menopause had I been 15-20+ years younger. Maybe another question for your medical team - what are the stats for developing ovarian cancer following cervical cancer treatment?

Although your stage and grade of cc is lower than mine, yours is adeno versus my squamous. Maybe something else to try and understand the stats for.

I don’t quite understand why you only have 2 options. Is it because you have seen two different consultants? For example, option 2 could be done without taking the ovaries - your ovaries can’t be removed without your consent. By the same token option 1 is possible with removal of ovaries. I would have thought sentinel lymph node removal was an interchangeable option. Maybe more questions for your consultant(s)?

I seem to recall reading that open abdominal hysterectomy has a very slightly lower risk for recurrence than laparoscopic? Something else to ask about?

I wish you all the best with your decision making.

x

Thanks for responding. I guess I could ask for any combination of the two options and see if the second surgeon would be willing to “cut corners” as she put it. She told me the chance of lymphodema was 1% but if we missed a lymph node it was a “death sentence”.

The fact I had radiotherapy, as well as full lymph node removal, increased my risk for lymphoedema. I think my ?20-30% risk stat for lymphoedema relates to the type treatment I had, but I don’t have any evidence those figures are reliable. My oncology team were very vague about the risk for lymphoedema when I asked them.

x