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More than 10 million Americans are cancer survivors. That number is
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examines how a cancer diagnosis changes people's lives and outlooks.
Scott and Melissa Gilbert had a special reason to celebrate on Valentine's Day.
It was the day their daughter Kendall was born.
It was also the first time in more than two years that the couple could breathe easily.
The Gilberts have lived with insecurity since October 2003, when Melissa was diagnosed with cervical cancer at age 27, just 18 months after delivering their first child.
Melissa's diagnosis could have ended her hopes of having more children. Doctors traditionally treat cervical cancer by removing a woman's uterus. However, her doctors offered her an alternative: an experimental surgery to remove her cervix and nearby lymph nodes but leave her uterus intact.
"My first concern was my health," says Gilbert, now 29, of Glenville, N.Y. "I wanted to do whatever was the safest thing. But if there was an alternative that would spare my fertility, I was very interested."
French surgeons pioneered the procedure, called a trachelectomy, about a decade ago. It has been performed in the USA only for the past five years or so.
Only a few hundred procedures have been performed worldwide, says Gilbert's doctor, Nadeem Abu-Rustum, director of minimally invasive surgery at Memorial Sloan-Kettering Cancer Center in New York.
More options than ever
Gilbert is one of a growing number of cancer survivors who want to protect their ability to have children, says Kutluk Oktay, who heads the fertility preservation program at the Center for Reproductive Medicine & Infertility at Weill Medical College of Cornell University.
As cancer patients live longer, many are eager to plan for the rest of their lives, Oktay says. But the treatments that cure their cancers may leave patients infertile.
About 10% of cancer patients -- or 140,000 people a year -- are under 45 when diagnosed, according to Fertile Hope, which provides information on childbearing options to disease survivors. More doctors today offer fertility-sparing options to their cancer patients, Oktay says. He's helping rewrite guidelines on fertility preservation for the American Society of Clinical Oncology, one of the world's leading organizations for cancer specialists.
Although doctors can make few guarantees, they can offer patients more options than in the past.
Men can bank sperm, for example. Couples can freeze embryos for future use. A few centers even allow girls and women to freeze slices of ovarian tissue, which doctors re-implant after patients complete cancer treatment, Oktay says. The first child of a woman with an ovarian tissue transplant was born in 2004. That procedure remains experimental, and doctors are still learning how the transplanted tissue functions in the body.
Trachelectomy and hysterectomy appear to be equally safe, says Edward Trimble, head of gynecologic cancer therapeutics at the National Cancer Institute. Cancer returns in fewer than 5% of patients who choose either treatment.
"This is not a compromise operation at all," Abu-Rustum says. "We are doing a very good cancer operation."
Procedure out of reach for some
All of the 41 women who have undergone the experimental surgeries at Memorial Sloan-Kettering remain cancer-free, Abu-Rustum says. Six of these patients had very aggressive disease that could not be contained with a trachelectomy. Three needed chemotherapy and radiation, while the other three needed a full hysterectomy.
But trachelectomies may be out of reach for many poor or immigrant patients, who are hit hardest by this disease, Trimble says. Screening exams have drastically reduced the number of cervical cancer cases and deaths. Women who lack access to these critical tests are more likely to develop cervical cancer, but less apt to be seen by the handful of surgeons skilled at performing trachelectomies, Trimble says.
Even for women with good medical care, having a baby after cervical cancer is complicated. Some women develop scar tissue around the surgical site and have trouble getting pregnant naturally, Abu-Rustum says.
After the Gilberts couldn't conceive on their own, they turned to in vitro fertilization. But the process -- which involved threading a catheter into her uterus -- was very painful, Gilbert says.
Any pregnancy following a trachelectomy is considered high-risk, Trimble says. Women tend to deliver prematurely, at 34 or 35 weeks, instead of the normal 40.
Gilbert was advised to avoid all strenuous activities during her pregnancy. She spent six weeks in bed to avoid going into premature labor. Her doctor scheduled a cesarean section at 38 weeks.
Today, with Melissa cancer-free and their new baby at home, the Gilberts say they can finally relax.
"We didn't really believe this was going to happen, even days before we went to the hospital," Scott Gilbert says. "It didn't sink in until we were actually holding her."
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