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Cone Biopsy Treatment May Help Early-Stage Cervical Cancer Patients Preserve Fertility (dateline November 19, 2001)

Most women who are diagnosed with early stage cervical cancer must undergo a hysterectomy, a treatment that results in permanent infertility. However, a new study has found that some cervical cancer patients may be candidates for a different procedure called a cone biopsy which can preserve fertility. In the study, three out of four women with early invasive cervical cancer who underwent cone biopsies instead of hysterectomies were able to become pregnant and deliver babies after the treatment. Though the researchers caution that cone biopsy should not be a standard treatment for early-stage cervical cancer, it may be an appropriate option for some well-informed women who are aware of the potential benefits and risks of the treatment.

To conduct the study Dr. Bradley J. Monk of the University of California at Irvine and his colleagues treated 133 women who had been diagnosed with an early form of cervical cancer called adenocarcinoma. Each woman received one of three treatments: a radical hysterectomy (surgical removal of the uterus, nearby tissues, upper vagina, and pelvic lymph nodes), simple hysterectomy (surgical removal of the uterus) or a cone biopsy (removal of a cone-shaped region of cervical tissue). The study showed that cone biopsy was successful at treating cervical cancer and preserving fertility. Of the three out of four women who delivered babies after treatment, none had experienced a recurrence of cancer after an average of four years.

Cone biopsy is usually performed to diagnose cervical cancer, but this study shows that it may be an effective treatment for some women. There are two main methods used to perform cone biopsy. The LEEP (also called LLETZ) method, short for loop electrosurgical excision procedure, removes the tissue by using a wire that is heated by an electrical current. Patients are given local anesthesia and the procedure can be performed quickly in a physician's office. Another method of cone biopsy involves using a surgical scalpel or laser to remove the tissue. This procedure typically requires general anesthesia and may be performed in a hospital or outpatient facility. However, an overnight hospital stay is not usually required.

The standard treatment for early stage cervical cancer is a hysterectomy. A simple hysterectomy involves surgically removing the uterus through an incision in the abdomen or vagina under general or epidural (regional) anesthesia. A simple hysterectomy is typically performed in a hospital and involves a few days of recovering in the hospital (approximately three to five days for abdominal hysterectomy). Patients take approximately four to six weeks to heal from a simple hysterectomy. Possible complications of a simple hysterectomy include excessive bleeding, wound infection at the surgical site, or damage to the urinary or intestinal systems. A hysterectomy will result in permanent infertility.

While cone biopsy may be an appropriate treatment option for some cervical cancer patients, Dr. Monk warns that it should not become a standard treatment procedure. Candidates for cone biopsy include cervical cancer patients with small tumors less than three millimeters deep and seven millimeters wide. Also, the cancer must be confined to the cervix. Women should be advised by their physicians of the risks of a recurrence of cervical cancer that can also be associated with cone biopsy.

The most common side effects of cone biopsy include cramping/discomfort and moderate or mild bleeding for a few weeks after the procedure. Patients should avoid sexual intercourse, tampons, and douching until the incision is completely healed, which may take several weeks. Patients should also discuss other possible side effects of cone biopsy prior to the procedure.

The American Cancer Society estimates that in 2001, 12,900 new cases of invasive cervical cancer will be diagnosed in the United States and approximately 4,400 American women will die from the disease. The International Agency for Research on Cancer estimates that nearly 380,000 women are diagnosed with cervical cancer worldwide each year. The number of cases and number of deaths from cervical cancer are higher in less developed countries where routine screening is not widespread.

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