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Cervical Cancer- Hysterectomy?

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If you are considering a hysterectomy, the study linked and excerpted below should communicate one simply concept. And that concept is that less is more.

I’m not being critical of conventional medicine when I say this. However, the study below indicates that hundreds, perhaps thousands of women who underwent “radical procedures” may have developed serious short, long-term and late stage side effects when they did not have to.

There are breast cancer survivors out there who had all of their lymph nodes removed when more recent research shows that removing the sentinel lymph node is all that is needed. And that keeping ones lymph nodes can be beneficial .

The article below lists some of the side effects that resulted from radical procedures in hysterectomies as if these side effects were to be expected. I am here to tell you that short, long-term and late stage side effects can and should be avoided at all costs!

I can’t read the phrase “early stage cervical cancer” without mentioning those evidence-based but non-conventional theories such as

  • anti-angiogenic nutrition
  • anti-angiogenic supplementation and
  • anti-cancer lifestyle therapies

Integrative and complementary therapies such as these are not intended to replace conventional therapies but to add to the newly diagnosed cancer patient’s armamentarium.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Simple Hysterectomy Noninferior to Radical Procedures in Cervical Cancer

“Compared with radical hysterectomy and pelvic node dissection, simple hysterectomy demonstrated noninferiority in those with low-risk, early-stage cervical cancer, according to findings from the Canadian Cancer Trials Group CX.5/SHAPE trial (NCT01658930) presented during a press briefing for the 2023 American Society of Clinical Oncology Annual Meeting.1

At a median follow-up of 4.5 years, the 3-year pelvic recurrence rate in the intent-to-treat population, was 2.52% in patients who underwent a simple hysterectomy compared with 2.17% in patients who had a radical hysterectomy. This equates to a 0.35% difference with an upper 95% confidence limit of 2.32%, which was below the prespecified limit of 4%.

 “Following adequate and rigorous preoperative investigation […] simple hysterectomy can now be considered the new standard of care for patients with low-risk, early-stage cervical cancer, leading to surgical de-escalation.”

The overall cervical cancer incidence has decreased over the past 20 years, Plante said, although there are a higher proportion of women who present with the disease at both a younger age and with low-risk, early-stage disease.

“Although radical surgery is highly effective for the treatment of that low-risk population, women are at risk of suffering ‘survivorship’ issues particularly in relation to long-term surgical side effects including

compromised bladder,

bowel, and

sexual function,”

Plante said, adding that the radical approach also includes removal of the parametrium and upper vagina. “So, radical surgery requires more extensive surgical skills and training, and is associated with more surgical complications.”

Retrospective data have suggested that less radical surgery, which would be considered a surgical de-escalation approach, may not only be a safer option for patients, but would be associated with decreased morbidity.2

The SHAPE trial, which is a Gynecologic Cancer Intergroup study led by the Canadian Cancer Trials Group, was comprised of 700 patients with low-risk cervical cancer, which was defined by squamous cell, adenocarcinoma, or adenosquamous carcinoma; stage IA2 or IB1 disease; less than 10 mm stromal invasion on loop electrosurgical excision/cone; less than 50% stromal invasion on MRI; a maximum dimension of 20 mm; and disease that was either grade 1 to 3 or not assessable…

Patients were stratified by Cooperative Group, SN mapping (yes vs no), stage (IA2 vs IB1), histological type (squamous vs adenocarcinoma/adenosquamous), and grade (1 to 2 vs 3 vs not assessable).

The primary end point is 3-year pelvic recurrence rate…

Furthermore, data showed that pelvic recurrences occurred in 3.1% of those who underwent a simple hysterectomy (n = 350) compared with 2.9% of patients who had a radical hysterectomy (n = 350). Extra pelvic recurrences occurred in 2.0% and 0.6% of patients, respectively, and the pelvic and extra pelvic recurrence rates were 0.9% and 0.6%, respectively. Extra pelvic-only recurrence rates were 1.1% in the simple hysterectomy group vs 0% in the radical hysterectomy group; pelvic or extra pelvic recurrence rates were 4.3% and 2.9%, respectively.

Seven deaths occurred in both arms (2.0% in each). Four deaths (1.1%) in the simple hysterectomy group were due to cervical cancer vs 1 death (0.3%) in the radical hysterectomy group. Deaths from another primary malignancy and other medical conditions were 0.3% (n = 1) and 0.6% (n = 2), respectively, in the simple hysterectomy group and 0.9% (n = 3) and 0.9% (n = 3) in the radical hysterectomy group.

Regarding postsurgical complications, intraoperative injuries occurred in 7.1% (n = 24) of patients who underwent simple hysterectomy and in 6.4% (n = 22) of those who had radical hysterectomy (P = .77). These occurred in the bladder (n = 3 vs n = 9, respectively; P = .14), ureter (3 vs 5; P = .73), nerve (5 vs 2; P = .28), bowel (n = 2 each; P = 1.00), vein (4 vs 1; P = .21), and other (7 vs 3; P= .22).

Surgical-related adverse effects (AEs) occurred within 4 weeks of surgery, known as acute AEs, in 42.6% of patients on the simple hysterectomy arm vs 50.6% of those on the radical hysterectomy arm (P = .04). Late AEs, which occurred 4 weeks after surgery, occurred in 53.6% and 60.5% of patients, respectively (P = .08).

There were fewer acute urinary incontinence AEs in the simple hysterectomy arm (2.4%) than in the radical hysterectomy arm (5.5%; P = .048); the rate of late urinary incontinence AEs were 4.7% and 11.0%, respectively (P = .003). Acute urinary retention AEs were seen in 0.6% and 11.0% of patients, respectively (P <.0001) and late urinary retention AEs occurred in 0.6% of those on the simple hysterectomy arm and in 9.9% of those on the radical hysterectomy arm (P <.0001). These data were statistically significant, Plante noted.

Quality of life and sexual health were also assessed via sexual-vaginal functioning (EORTC QLQ-CX24) and sexual pain (FSFI Pain Scale). Sexual-vaginal functioning was improved with simple hysterectomy at 3, 6, and 12 months (all P <.0001). Findings were similar regarding sexual pain with simple hysterectomy at 3 months (P = .003), 6 months (P = .02), and 12 months (P = .002).

Plante added that both approaches were further assessed via sexual health scores and favored the simple hysterectomy group, including the EORTC QLQ-C30 pain scale (effect estimate, -4.53; P = .02), EORTC QLQ-CX4 symptom experiences (effect estimate, -2.12; P = .02), EORTC QLQ-CX4 body image (effect estimate, -5.22; P = .02), EORTC QLQ-CX4 sexual worry (effect estimate, -6.67; P = .04), EORTC QLQ-CX4 sexual activities (effect estimate -7.59; P = .003), EORTC QLQ-CX4 sexual enjoyment (effect estimate, -7.67; P = .049), FSFI Desire (effect estimate, 0.37; P = .002), FSFI Arousal (effect estimate 0.38; P = .003), FSFI Lubrication (effect estimate, 0.36; P = .008), FSFI Total Score (effect estimate 1.82; P = .006), and FSDS Total Score (effect estimate, -2.47; P = .02)…

“The SHAPE trial shows that amongst those carefully selected tumors, radical hysterectomy can be converted to a simple hysterectomy, including minimally invasively. You still have to do nodes—that’s an important thing to remember,” Moore emphasized. “But you can do this without loss of oncologic control and importantly with reduction in surgical complications, postoperative morbidities—specifically, urologic morbidity. The moment this is presented, this will be the new standard of care.

It represents a huge step forward in the care of women with early-stage cervical cancer. Honestly, the de-escalation may allow these women in low- and middle-income countries […] better access to curative surgical interventions.”

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