Fertility-Sparing Surgery for Gynaecological Cancer: What Are the Options?

Being diagnosed with a gynaecological cancer is frightening at any age. For women who have not yet started or completed their family, there is often a second worry: whether treatment will mean losing the chance of a pregnancy. For some women with early cancer, fertility-sparing surgery can treat the disease while protecting that possibility.

What is fertility-sparing surgery?

Standard treatment for many gynaecological cancers involves removing the womb, and sometimes the ovaries. Fertility-sparing surgery aims to remove the cancer safely while keeping the organs needed for pregnancy. It is only suitable in carefully selected cases, usually when the cancer is small, found early and has not spread. You can read more on our fertility-sparing surgery page.

Fertility-sparing surgery for cervical cancer

For very early cervical cancer, removing a small cone of tissue from the cervix may be enough. If the cancer is a little larger but still small and confined to the cervix, a radical trachelectomy may be an option. This operation removes most of the cervix, the top of the vagina and the surrounding tissue, while leaving the womb in place. The nearby lymph nodes are usually checked as well.

A stitch is placed at the base of the womb to help support a future pregnancy. Pregnancy after a trachelectomy is possible, but it carries a higher risk of miscarriage and premature birth, so you will need specialist care and usually a caesarean birth. Our page on total laparoscopic radical trachelectomy explains the keyhole approach in more detail.

Options for ovarian and womb cancer

Some women with early ovarian cancer confined to one ovary, or with a borderline ovarian tumour, may be able to have only the affected ovary and fallopian tube removed. The womb and the other ovary are left in place, and careful checks are made to ensure the cancer has not spread. Whether this is safe depends on the type and grade of the tumour.

For a small number of younger women with very early, low-grade womb cancer, or with precancerous changes in the womb lining, hormone treatment may be used instead of immediate surgery. This approach needs close monitoring with regular hysteroscopies and biopsies. A hysterectomy is usually recommended once your family is complete.

Who may be suitable for fertility-sparing surgery?

Suitability depends on several factors, including the type, size and stage of the cancer, how it looks under the microscope and your general health. Your wishes about future pregnancy are central to the discussion, and so is your understanding of any additional risk. Fertility-sparing surgery is never offered if it would significantly reduce your chance of cure.

Decisions about fertility-sparing surgery are made by a specialist multidisciplinary team, including gynaecological oncologists, radiologists and pathologists. You may also be referred to a fertility specialist to discuss options such as egg or embryo freezing before treatment begins. This is worth raising early, so that there is time to plan.

Life after treatment

Afterwards, you will have regular follow-up appointments, examinations and sometimes scans to check that the cancer has not returned. Your team will advise how long to wait before trying to conceive. Many women go on to have healthy pregnancies after fertility-sparing surgery, although some will need fertility support.

Cancer Research UK has detailed information on cervical cancer and its treatment. Macmillan Cancer Support offers emotional and practical support for anyone affected by cancer, including advice on fertility. Talking to others who have been through similar experiences can help too.

If you have been diagnosed with an early gynaecological cancer and want to know whether fertility-sparing surgery could be right for you, please contact our team to arrange a consultation with Mr Abu. We will make sure you have time to ask every question.