Women diagnosed with cancer of the reproductive organs are often told hysterectomy is their best cancer treatment – a procedure that prevents their ability to become pregnant. My patient, Britni Adams from Denton, Texas, was diagnosed with cervical cancer at the young age of 32 and faced this life-altering surgery.
Britni came to see me in hopes of another treatment option. In June 2016, she became the first UT Southwestern patient to undergo robotic radical trachelectomy, a procedure to treat cervical cancer by removing the cervix, upper part of the vagina, and parametria (tissue around the cervix) but not the uterus in order to preserve fertility after treatment.
Performing surgery robotically offers benefits such as smaller incisions, less pain, and faster recovery. But not every cervical cancer patient is a candidate for radical trachelectomy. The tumor should be 2 centimeters or smaller and the cancer must not have spread, among other strict guidelines.
Britni also underwent bilateral pelvic lymph node dissection and placement of a cerclage. I invited Britni to talk about her experience of being diagnosed and treated for cervical cancer using this procedure. Here’s her story in her own words:
A shocking diagnosis
I’ve always been good about getting recommended Pap smears. And until 2016, the results always came back normal.
I had been experiencing some vaginal bleeding before my annual exam in February 2016, but I didn’t think much about it. I recently had the contraceptive implant Nexplanon inserted, and I thought it was a hormonal side effect related to that. When my Pap smear came back abnormal, my doctor sent me to a gynecologist for a biopsy.
I got the diagnosis in March: cervical cancer. Luckily, we caught it early. It was stage 1B1, which means it was small and hadn’t spread. However, the gynecologist said I’d need a hysterectomy.
I’ve never been the girl who couldn’t wait to have children. I’ve always liked them, but I wasn’t in a rush to have them. So I was a little shocked by how hard the thought of not being able to have kids hit me emotionally.
I told the gynecologist I wanted children someday and asked if there were other options. She told me in no uncertain terms that there weren’t, and I needed a hysterectomy. I was devastated.
That night, I broke the news to my family. I also told my boss, whose friend was a gynecologist. My boss’s friend suggested I see Dr. Richardson at UT Southwestern. That chance connection changed everything.
A second chance at fertility
After looking over my charts and examining the biopsy results, Dr. Richardson told me there might be an option other than hysterectomy – one that would preserve my fertility. I was stunned. There was a glimmer of hope.
Dr. Richardson explained what the radical trachelectomy would involve, why I was a good candidate for it, and how my body would work a little differently afterward. She answered every question I had. I sent her messages as I thought up questions, and she called me back to answer each one.
We scheduled the surgery for mid-April. Dr. Richardson wanted to do her own biopsy before the procedure, and those results came back as noncancerous. She suggested that we try a cone biopsy because the tests were conflicting and she wanted to avoid major surgery if possible. In this procedure, the doctor takes off a wedge of tissue from the top of the cervix. Dr. Richardson wasn’t positive this would be enough but thought it was worth a try.
Unfortunately, the cone biopsy test showed cancer cells. The radical trachelectomy was rescheduled for June.
It was a difficult surgery. I’ve had surgery before, and this recovery was tough. But it was successful, and I didn’t need further treatment – no radiation or chemotherapy. And if I want to in the future, I should still be able to have a baby.
Overcoming a sense of guilt
Strange as it may sound, guilt was among the many emotions I experienced after my cervical cancer diagnosis and learning I might not be able to give birth. I once burst into tears in Dr. Richardson’s office, and when she asked what was wrong, I said, “This is my fault.”
Human papillomavirus (HPV) is the most common sexually transmitted infection. In fact, nearly one in four people in the United States is currently infected, according to the Centers for Disease Control and Prevention. Most people who have had sex will contract HPV in their lifetime. This virus often causes no symptoms and goes away on its own, but in some cases it can cause cervical, vaginal, vulvar, anal, penile, or head and neck cancers.
The HPV vaccine came out when I was in my early 20s. While it’s recommended that boys and girls get the vaccine at age 11 or 12, it can be given to young women up to age 26. My doctor at the time recommended I get the three-dose vaccine series. I got the first shot but never went back for the other two.
I was naïve and thought cancer would never happen to me. But after my diagnosis, I couldn’t stop thinking that I could have prevented it. What if I had just gotten those last two shots?
Of course, there’s no guarantee that I wouldn’t have gotten cervical cancer even if I had the full dose of the vaccine. But it did make me think that we need to do a better job of educating the public about this cancer vaccine.
It also provided an opportunity for my family to discuss things we had never talked about before. While it can be difficult to talk about topics such as sex and HPV, it’s important to understand that anyone who has had sex even once can get HPV. It should not be associated with promiscuity or being “dirty.”
What I learned from cervical cancer
I know more than I did before my diagnosis – and not just medical terms! I learned a lot about myself and what’s truly important.
Find a doctor you’re comfortable with
One important lesson I learned through this experience is you shouldn’t continue seeing a doctor with whom you’re not comfortable. The first gynecologist I saw after the abnormal Pap smear was not a good fit. I left the office that day without a clear idea of what was next.
I felt comfortable with Dr. Richardson from the first appointment. She made sure I understood every step of the process.
Don’t stick with a doctor or a practice you aren’t comfortable with, no matter how long he or she has been your doctor. And if you’re told you don’t have options, get a second opinion. You may be glad you did.
Seek and accept support from family and friends
I’ve always been a private person. Before my diagnosis, I preferred to work through my feelings on my own. I didn’t tell anyone about the abnormal Pap smear or the biopsy until I was diagnosed because I didn’t want to worry anyone. I went to my early appointments on my own because I didn’t want anyone to feel like they had to be strong for me – and, at that point, I wasn’t up to being strong for them.
I learned that you need to be honest about what you’re feeling. Cancer is an emotional roller coaster. One day I would feel ready to take on the world, and the next I didn’t want to face it. My family and friends were there for me every step of the way, listening to me and checking in on me.
I also received support from wonderful new friends I met through the Cancer Support Community of North Texas. I found it therapeutic to talk with people who had survived cancer or were going through cancer treatment. They understood what I was going through. The organization offers social events and classes on topics such as nutrition, fitness, and stress management for cancer patients, survivors, and their loved ones.
I'm now happy to be able to return the favor and help other patients through their cancer journey by serving on the Cancer Support Community North Texas Young Leadership Board.
Destroying cancer, preserving fertility
Patients like Britni who are diagnosed with stage 1B1 cervical cancer have very good survival rates. Preserving fertility is more challenging.
As part of the radical trachelectomy, we put in a cerclage (or permanent suture) where the cervix used to be to help reduce the risk of second trimester pregnancy loss.
Radical trachelectomy has been proven to preserve the option to have a child for many women. One study shows that 70 percent of women who underwent radical trachelectomy and attempted to become pregnant were successful. However, there is an increased risk of miscarriage and a future pregnancy requires that the baby be delivered by cesarean section.
As of Britni’s October 2016 follow-up, she’s doing great. She has no sign of cancer, and we’re optimistic that should she want to get pregnant she will be able to do so. I’d encourage women who are told they have no option besides hysterectomy to seek a second opinion. With cancer, as with any disease, it’s important to know all of your options before you make a treatment decision that could affect the rest of your life.
Follow guidelines for Pap smears and HPV vaccinations
Britni’s cervical cancer was caught early thanks to a Pap smear. Screening offers the best chance to catch cancer at an early stage, when successful treatment is more likely.
Cervical cancer screening guidelines include:
- A Pap smear every three years for women age 21 to 29
- A Pap smear and HPV test every five years for women age 30 to 65, or a Pap smear alone every three years
Women older than 65 can stop regular screening if they have had three negative Pap test results in a row or two negative Pap and HPV tests in a row within the past 10 years.
We can’t prevent our children from getting all types of cancer, but we can protect them from some forms of the disease. The HPV vaccine is FDA-approved for females age 9 to 26 and males age 9 to 21. We recommend that boys and girls get the vaccine at age 11 or 12 before they’re likely to be exposed to HPV.
The CDC in October 2016 said boys and girls 14 and younger can receive two doses of the HPV vaccine six months apart rather than the previously recommended three doses. Young adults 15 to 26 should continue to get three doses.
Though HPV is far and away the most common sexually transmitted infection, we can stop the spread of the virus before it can turn into cancer. Ask your child’s doctor about the HPV vaccine to protect them today against certain cancers in the future.
