This guide will tell you how to prepare for your radical trachelectomy surgery at Memorial Sloan Kettering Cancer Center (MSKCC).
Figure 1: Diagram of uterus with rectangle showing area that may be removed during trachelectomy
You have learned that you have cancer of the cervix. The usual treatment is to remove the uterus. However, your tests indicate that the cancer may only be in your cervix. The cervix is the tip of the uterus. It opens into the vagina (see Figure 1). A radical trachelectomy removes only the cervix and nearby tissue. Since you have told your doctor that you would like to have children, you may be able to have just your cervix removed. The rest of the uterus is left in your body, which may allow you to have children.
Figure 2: Diagram showing remaining lower uterus after trachelectomy with a suture being placed
The surgeon will use 1 large incision or several small ones. He or she will first examine the abdomen, the organs in the pelvis, and the lymph nodes. If no cancer is visible outside of the cervix, the lymph nodes will be removed. They will be sent to be examined. This is called a frozen section. If they appear free of cancer, the operation will proceed as planned.
A large portion of the cervix and tissue around it is removed. The rest of the uterus is left in place. The remaining lower part of the uterus is then stitched. This is so it can support a future pregnancy. Most women will continue to have their periods.
All of the tissue that is removed will be examined in the lab. This takes 5 to 10 business days. Your doctor will tell you what was found during your post-operative visit. You will need more treatment if:
- The cancer was not completely removed.
- The surgeon thinks there is a high risk for recurrence of the cancer.
Before Your Surgery
- Ten Days Before Your Surgery
- Aspirin, NSAIDs, and vitamin E can cause bleeding problems. Do not take medicine that has them unless your doctor says it is okay. Your nurse will give you information about what medicines you cannot take and what you can use instead.
- The Day Before Your Surgery
- Starting with breakfast, have only clear liquids for the entire day. Your nurse will give you information about a clear liquid diet.
- Begin the bowel preparation as instructed by your doctor..
- Take antibiotics if you were instructed to do so.
- Do not eat or drink anything after midnight the night before your surgery. This includes water, gum, and hard candy.
- The Day of Your Surgery
- Do not eat or drink anything the morning of your surgery. This includes water, gum, and hard candy.
- A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. He or she will tell you what time you should arrive at the hospital for your surgery. If you are scheduled for surgery on a Monday you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call (212) 639-5014.
- You will go to the Pre-Surgical Center in the main hospital. Take the B elevator to the 6th floor. After you check in, your nurse will get you ready for surgery. When you are called for the operation, you may walk or go in a wheelchair.
After Your Surgery
- You will wake up in the Post-Anesthesia Care Unit. When you are awake and the anesthetist says it is safe for you to leave, you will be taken to your room.
- You will get out of bed and walk that day or early the next day.
- You will have patient controlled analgesia (PCA) for pain control. Your nurse will show you how to use the pump to give yourself medicine. You may also be given a booklet describing how the pump works. Some patients have epidural analgesia. If you have this, you will get a fact card describing it.
- A Foley catheter is placed during surgery to drain urine from your bladder. It is usually kept in for 1 to 2 weeks after surgery. Your nurse will teach you how to care for it at home.
- Most patients are in the hospital for 3 days.
Call Your Doctor or Nurse If You Have:
- A temperature of 100.4° F (38° C) or higher
- Pain that is not relieved with the pain medicine prescribed
- Heavy vaginal bleeding
- Blood in your urine
- Any questions or problems you did not expect
Your doctor will see you in 1 to 2 weeks to check you and remove the Foley catheter. Your pathology report should be available before this visit. Your doctor will give you the results and tell you if you need more treatment, such as surgery, chemotherapy, or radiation.
Your doctor will discuss all of these with you if they will be needed. Each can affect your ability to become pregnant.
At the end of treatment, you will need to have a Pap smear, a colposcopic exam, or both every 3 to 4 months for 2 years. You will then have them every 6 months. We recommend that you use oral contraception for 6 months. Do not try to become pregnant until 6 months after your surgery.
You may need to see a fertility specialist to get pregnant. Please speak to your surgeon about your options. Ask about seeing a specialist before you have the operation. You may want counseling before or after surgical treatment for cancer. If you get pregnant, you will need to be watched closely by your obstetrician. There is a good chance you could go into early labor. The baby will most likely be delivered by cesarean section.