Surgery Type Matters In Cervical Cancer

Cervical cancer screening is a routine part of women’s health care.  I do Pap tests and HPV screens every week to check for this problem.  Luckily I rarely make a cancer diagnosis (although abnormal Pap tests are fairly common).

Cervical cancer is one of the most common cancers in women worldwide, with over half a million cases diagnosed per year.  About 13,000 new cases are expected to be diagnosed in the US in 2018.  Approximately 4000 American women will die of cervical cancer this year, according to the American Cancer Society.  Women are most commonly diagnosed in their 30s and 40s, but it can happen in women over age 65 as well.

It’s important to realize that this disease is more common in black and Hispanic women, but much less likely to occur in women who get regular screening.  Cervical cancer is preventable with vaccination, regular screening and treatment of abnormal cells found on Pap tests.

Once a diagnosis of cervical cancer is made, surgery is the most effective treatment.  Hysterectomy and removal of lymph nodes in the pelvis is necessary.  What hasn’t been understood until recently is whether the TYPE of hysterectomy mattered.

In this country, most surgery that CAN be done in a minimally invasive way IS done in that fashion.  Laparoscopic and robot-assisted surgeries are associated with less pain, shorter recovery, less blood loss and less risk of infection.  However, recently it has been found that these minimally invasive surgical techniques are actually associated with a HIGHER death rate from cervical cancer.

Two articles (1, 2) published in the New England Journal of Medicine this week showed that open abdominal hysterectomy was much better as far as survival goes than laparoscopic or robot-assisted hysterectomy for cervical cancer.  The number needed to harm in one study was 19 which is really low.  This means for every 19 patients who were treated with a minimally invasive rather than open procedure, one went on to die of cervical cancer who would have survived with the open procedure. In the other study the number needed to harm was 26.

I have two take-home points from this frankly shocking finding.  First, if you know anyone with cervical cancer make sure they know a “keyhole surgery” approach is not as safe as an open procedure.  We can’t assume that an operation that’s right for one condition (like gallbladder removal and appendectomy) is the best for all problems.

The second point is that there needs to be more research done on minimally invasive surgery in cancer patients.  There must be some reason for the difference.  Neither of these studies really addressed WHY there is such a difference between open and minimally invasive operations for cervical cancer.  There are any number of possibilities.  Minimally invasive surgery is as safe for uterine cancer as an open procedure, for instance.

Could it be because cervical cancer is caused by a viral infection?  Or because affected  lymph nodes in cervical cancer are smaller or more subtle or harder to see through the laparoscope?  I really don’t know, and clearly no one else does either.

But with less pain, shorter recovery time, less bleeding and less risk of infection, minimally-invasive surgery is best IF scientists can figure out how to make it safer for cervical cancer patients.  That would be the best result of all.

QUESTION: Do you know anyone who has or had cervical cancer?  What was their experience like?

Share

Leave a Reply

Your email address will not be published.