Early Cervical Cancer: Can Fertility Be Safely Preserved?

  • Lukas Rob
  • Ruud Bekkers


Controversies exist about indication criteria for fertility-sparing surgery, optimal preoperative and intraoperative management, sentinel lymph node mapping, and intraoperative frozen section. We discuss optimal surgical radicality of fertility-sparing procedures that vary according to the radicality of the resection of paracervical tissue, surgical technique of lymphadenectomy, and technique to reconstruct the neocervix. Neoadjuvant chemotherapy incorporation into the management is one of the topics under current research. Follow-up of the patients needs to include long-term oncological results, fertility and pregnancy results, and quality of life.


Cervical Cancer Sentinel Lymph Node Radical Hysterectomy Freeze Section Stromal Invasion 
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  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–916.PubMedCrossRefGoogle Scholar
  2. 2.
    Rob L, Skapa P, Robova H. Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol. 2011;12:192–200.PubMedCrossRefGoogle Scholar
  3. 3.
    Rob L, Pluta M, Skapa P, Robova H. Advances in fertility-sparing surgery for cervical cancer. Expert Rev Anticancer Ther. 2010;10(7):1101–14.PubMedCrossRefGoogle Scholar
  4. 4.
    De Souza NM, Dina R, McIndoe A, Soutter WP. Cervical cancer: value of an endovaginal coil magnetic resonance imaging technique in detecting small volume disease and assessing parametrial extension. Gynecol Oncol. 2006;102:80–5.CrossRefGoogle Scholar
  5. 5.
    Fischerova D, Cibula D, Stehnova H, Vondrichova H, Calda P, Zikan M, Freitag P, Slama J, Dundr P, Belacek J. Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int J Gynecol Cancer. 2008;18:766–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Stegeman M, Louwen M, van der Velden J, ten Kate FJ, den Bakker MA, Burger CW, Ansink AC. The incidence of parametrial tumor involvement in select patients with early cervix cancer is too low to justify parametrectomy. Gynecol Oncol. 2007;105(2):475–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Frumovitz M, Sun CHC, Schmeler KM, Deavers MT, Dos Reis R, Levenback CF, Ramirez PT. Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. Obstet Gynecol. 2009;114(1):93–9.PubMedGoogle Scholar
  8. 8.
    Covens A, Rosen B, Murphy J, Laframboise S, DePetrillo AD, Lickrish G, Colgan T, Chapman W, Shaw P. How importance is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol. 2002;84:145–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Kinney WK, Hodge DO, Egorshin EV, Ballard DJ, Podratz KC. Identification of a low-risk subset of patients with stage 1B invasive squamous cancer of the cervix possibly suited to less radical surgery treatment. Gynecol Oncol. 1995;57:3–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Singh N, Arif S. Histopathologic parameters of prognosis in cervical cancer – a review. Int J Gynecol Cancer. 2004;14:741–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Rob L, Halaska M, Robova H. Nerve – sparing and individually tailored surgery for cervical cancer. Lancet Oncol. 2010;11(3):292–301.PubMedCrossRefGoogle Scholar
  12. 12.
    Landoni F, Bocciolone L, Perego P, Maneo A, Bratina G, Mangioni C. Cancer of cervix, FIGO stages IB and IIA: patterns of local growth and paracervical extension. Int J Gynecol Cancer. 1995;5:329–34.PubMedCrossRefGoogle Scholar
  13. 13.
    Zivanovic O, Leitao MM, Park JK, Zhao H, Diaz JP, Konner J, Alektiar K, Chi DS, Abu-Rustum NR, Aghajanian C. Small cell neuroendocrine carcinoma of the cervix: analysis of outcome, recurrence pattern and the impact of platinum-based combination chemotherapy. Gynecol Oncol. 2009;112(3):590–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Chenevert J, Tetu B, Plante M. Indication and method of frozen section in vaginal radical trachelectomy. Int J Gynecol Pathol. 2009;28(5):480–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Rob L, Strnad P, Robova H, Charvat M, Pluta M, Schlegerova D, Hrehorcak M. Study of lymphatic mapping and sentinel node identification in early stage cervical cancer. Gynecol Oncol. 2005;98:281–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Altgassen C, Hertel H, Brandstädt A, Köhler CH, Dürst M, Schneider A. Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO study group. J Clin Oncol. 2008;26:2943–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Pluta M, Rob L, Charvat M, Chmel R, Halaska M, Skapa P, Robova H. Less radical surgery than radical hysterectomy in early stage cervical cancer: a pilot study. Gynecol Oncol. 2009;113(2):181–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Plante M. Vaginal radical trachelectomy: an update. Gynecol Oncol. 2008;111:S105–10.PubMedCrossRefGoogle Scholar
  19. 19.
    Fader AN, Edwards RP, Cost M, Shakir AK, Kelley JL, Shwartz B, Sukumvanich P, Comerci J, Sumkin J, Elishaev E, Rohan LC. Sentinel lymph node biopsy in early-stage cervical cancer: utility of intraoperative versus postoperative assessment. Gynecol Oncol. 2008;111(1):13–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Euscher ED, Malpica A, Atkinson EN, Levenback CF, Frumovitz M, Deavers MT. Ultrastaging improves detection of metastases in sentinel lymph nodes of uterine cervix squamous cell carcinoma. Am J Surg Pathol. 2008;32(9):1336–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Smith JR, Boyle DC, Corless DJ, Lawson AD, Ungar L, Del Priore G, McCall JM, Lindsay I, Bridges JE. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynaecol. 1997;104(10):1196–200.PubMedCrossRefGoogle Scholar
  22. 22.
    Cibula D, Slama J, Svarovsky J. Abdominal radical trachelectomy in fertility sparing treatment of early stages cervical cancer. Int J Gynecol Cancer. 2009;19(8):1407–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Nishio H, Fujii T, Kameyama K. Abdominal radical trachelectomy as a fertility – sparing procedure in women with early – stage cervical cancer in a series of 61 women. Gynecol Oncol. 2009;115(1):51–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Muraji M, Sudo T, Nakagawa E, Ueno S, Wakahashi S, Kanayma S, Yamada T, Yamaguchi S, Fujiwara K, Nishimura R. Type II versus type III fertility – sparing abdominal radical trachelectomy for early-stage cervical cancer. A comparison of feasibility of surgical outcomes. Int J Gynecol Cancer. 2012;22:479–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim JH, Park JY, Kim DY, Kim YM, Kim YT, Nam JH. Fertility – sparing laparoscopic radical trachelectomy for young women with early stage cervical cancer. Br J Obstet Gynaecol. 2010;117(3):340–7.CrossRefGoogle Scholar
  26. 26.
    Ramirez PT, Schmeler KM, Malpiga A, Soliman PT. Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. Gynecol Oncol. 2010;116(3):512–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Persson J, Kannisto P, Bossmar T. Robot – assisted abdominal laparoscopic radical trachelectomy. Gynecol Oncol. 2008;111(3):564–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Shepherd JH, Crawford RAF, Oram DH. Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer. Br J Obstet Gynaecol. 1998;105(8):912–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Covens A, Shaw P, Murphy J, Petrillo D, Lickrish G, Laframboise S, Rosen B. Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? Cancer. 1999;86(11):2273–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Plante M, Renaud MC, François H, Roy M. Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An update series of 72 cases and review of the literature. Gynecol Oncol. 2004;94(3):614–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Shepherd JH, Milliken DA. Conservative surgery for carcinoma of the cervix. Clin Oncol. 2008;20(6):395–400.CrossRefGoogle Scholar
  32. 32.
    Speiser D, Mangler M, Kohler C, Hasenbein K, Hertel H, Chiantera V, Gottschalk E, Lanowska M. Fertility outcome after radical vaginal trachelectomy. A prospective study of 212 patients. Int J Gynecol Cancer. 2011;21:1635–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Rob L, Charvat M, Robova H, Strnad P, Pluta M, Halaska M, Hrehorcak M, Schlegerova D, Taborska K. Sentinel lymph node identification (SLNI) in the management of conservative surgery in early cervical cancer: is it acceptable? Gynecol Oncol. 2005;99:S147–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Strnad P, Robova H, Skapa P, Pluta M, Hrehorcak M, Halaska M, Rob L. A prospective study of sentinel lymph node status and parametrial involvement in patients with small tumour volume cervical cancer. Gynecol Oncol. 2008;109:280–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Rob L, Pluta M, Strnad P, Hrehorcak M, Chmel R, Skapa P, Robova H. A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer. Gynecol Oncol. 2008;111:S116–20.PubMedCrossRefGoogle Scholar
  36. 36.
    Maneo A, Sideri M, Scambia G, Boveri S, Dellanna T, Villa M, Parma G, Fagotti A, Fanfani F, Landoni F. Simple conisation and lymphadenectomy for the conservative treatment of stage IB1 cervical cancer. An Italian experience. Gynecol Oncol. 2011;123(3):557–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Raju KS, Papadopoulos JA, Montalto AS, Coutts M, Culora G, Kodampur M, Mehra G, Devaja O. Fertility – sparing surgery for early cervical cancer – approach to less radical surgery. Int J Gynecol Cancer. 2012;22:311–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Landoni F, Parma G, Peiretti M, Zanagnolo V, Sideri M, Colombo N, Maggioni A. Chemo-conization in early cervical cancer. Gynecol Oncol. 2007;107:S125–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Maneo A, Chiari S, Bonazzi C, Mangioni C. Neoadjuvant chemotherapy and conservative surgery for stage 1B1 cervical cancer. Gynecol Oncol. 2008;111(3):438–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Plante M, Lau S, Brydon L, Swenerton K, LeBlanc R, Roy M. Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage 1B1 cervical cancer: case report. Gynecol Oncol. 2006;101(2):367–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Robova H, Pluta M, Hrehorcak M, Skapa P, Rob L. High dose density chemotherapy followed by simple trachelectomy: full-term pregnancy. Int J Gynecol Cancer. 2008;18(6):1367–71.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Lukas Rob
    • 1
    • 2
  • Ruud Bekkers
    • 3
  1. 1.Department of Obstetrics and Gynaecology2nd Medical Faculty, Charles University PraguePragueCzech Republic
  2. 2.Department of Obstetrics and Gynaecology2nd Medical Faculty, University Hospital MotolPragueCzech Republic
  3. 3.Obstetrics and Gynaecology 791Radboud University Nijmegen Medical CenterNijmegenThe Netherlands

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