The radical step that saved my chances of having a baby- UK - radical trachelectomy

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The radical step that saved my chances of having a baby
Last updated at 00:06am on 27th March 2007

Around 3,500 women a year are diagnosed with cervical cancer in Britain.
The standard treatment - a radical hysterectomy - means women will no
longer be able to have children.

However, when Tina Guinness, 28, was diagnosed with the disease, she
underwent a form of surgery designed to spare her fertility. Here, Tina
tells ANGELA BROOKS about her experience and her surgeon explains the
procedure:

THE PATIENT

In May I went for a routine smear test and was shocked when I got a letter
a month later from the NHS telling me abnormal cells had been found and
that a doctor?s appointment had been made for me.

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At Crawley Hospital, the gynaecologist carried out a colposcopy ? where
the cervix is dabbed with a clear fluid to make any abnormality easier to
spot under a microscope.

As it was applied, I saw the area turn chalky white. He didn?t say
anything to put my mind at rest. Instead, he began talking about possible
treatments for abnormal cells. He then did a biopsy in which he removed a
piece of suspicious tissue and I was told I would have the results in four
to six weeks.

I went back to my car, called my partner Andy and cried. Five days later,
the hospital asked me to get in touch.

Alarm bells started to ring. I thought: "This is the NHS ? things don?t
move that fast unless there?s a problem."

Andy came with me to the appointment and the consultant, Mr Butler-Manuel,
told me part of my cervix was cancerous.

He said he thought it was early-stage cancer but he would have to do a
cone biopsy ? where a cone-shaped segment of the cervix is removed to
establish that for certain.

Treatment options included radiotherapy, chemotherapy and radical
hysterectomy, he said.

At 28, being told you might need to have a hysterectomy when you hope to
have a family is devastating.

I had an MRI scan and, a few days later, the cone biopsy to identify the
size of the tumour and whether it had spread. A few weeks later, in early
July, I returned.

The cancer was at an early stage, which gave me the option of radical
trachelectomy - and the chance of having a family. Mr Butler-Manuel said
the cervix is a strong muscle around the neck of the womb and its purpose
is to hold a pregnancy in place. The operation would mean removing it and
creating a tiny opening at the base of the womb.

But, he warned me that the surgeon would need to check my lymph nodes
first, and that if these showed any signs of cancer, this would indicate
that the cells might have begun to spread. The operation would then be
cancelled and I would be treated with radiotherapy and chemotherapy
instead.

The operation was carried out at the Gatwick Park Bupa Hospital in July by
Mr Butler-Manuel.

After the operation, I was told my lymph nodes were free of cancer and
that the trachelectomy had been a success.

It?s now eight months since my operation. My most recent follow-up
appointment was in January, where I was given the all-clear. I?m riding,
dancing and running. Andy and I are due to get married.

I knew it would be an emotional rollercoaster and I was right. But I tell
myself I got cancer. It didn?t get me.

THE SURGEON

Mr Simon Butler-Manuel, consultant gynaecologist at Crawley Hospital and
the Royal Surrey County Hospital, says:

Tina's cancer was small and confined to the cervix. The standard treatment
for women with tumours of this size is radical hysterectomy, a reasonable
option for women who have had their family.

It?s a huge blow for young women who have not yet had children ? which is
why radical trachelectomy is such a good alternative, providing the woman
has an early stage cancer.

Once the patient has been placed under anaesthesia, our first step is to
remove a sample of lymph nodes using keyhole surgery. Four tiny incisions
are made in the tummy, allowing the retrieval of samples from the nodes
closest to the cervix.

Provided these are clear, we pop on steri-strips - sticky skin-fasteners
to close the tiny wounds - and proceed with the rest of the operation,
which is done through the vagina.

Using retractors to hold it open, we first make a cut encircling the top
of the vagina. The cervix is a muscular plug with a pinhole opening that
connects to the vagina. The objective in radical trachelectomy is to
remove the cervix and create something similar using part of the remaining
vaginal tissue.

The new "cervix" prevents the neck of the womb from opening during
pregnancy and helps the baby to remain in place. A woman who has had this
operation must have a Caesarean section.

Tina?s cancer was 6mm x 8mm - very small. Before taking out her cervix, we
cut away two centimetres of healthy skin just to make sure we had a
cancer-free margin. We made another cut, just beneath where the womb
funnels down and would normally join the cervix.

Next, we cut the supporting ligaments which hold the cervix in place. Then
we gently teased out the cervix.

This is very delicate surgery. Many organs, such as the bladder, are
squashed up close to the cervix.

Once the cancerous cervix was removed, the ligaments were then re-attached
and we put a stitch just beneath the womb to create a pinhole opening
similar to that of a cervix, popping in a little catheter to prevent the
tiny opening from scarring and then closing up.

This catheter is removed a few days later. We then attached the cut edge
of the vaginal skin to the womb using dissolvable stitches ? the tissue
here is naturally stretchy.

We also put a catheter into the bladder at the end of the operation to
allow it to drain while the tissues heal.

This is much more complex than a hysterectomy but it offers enormous hope
to young women who want to go on to have a family.

Radical trachelectomy costs the NHS pproximately £5,000. Privately, it
costs around £6,000. For more information, visit www.jotrust.co.uk

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