19 July 2013
A new type of scan could help women avoid radical surgery for early-stage cervical cancer, by providing high-resolution images of the cancer within the cervix.
Research published today (Friday) in the British Journal of Cancer showed that specialist high-resolution magnetic resonance imaging (MRI) can limit the extent of surgery in younger women with early-stage disease.
A team from The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust found the new scan changed doctors’ plans for surgical management in 39 per cent of women due to have a type of surgery called a trachelectomy.
The study was funded by the Medical Research Council and conducted in the Cancer Research UK and EPSRC Cancer Imaging Centre at The Royal Marsden Hospital and The Institute of Cancer Research (ICR).
The standard treatment for cervical cancer in the UK is either radical hysterectomy (removal of the uterus), or radiotherapy, both of which come at the cost of the woman’s fertility. Surgeons at The Royal Marsden helped pioneer the technique of trachelectomy, which removes part of the cervix but leaves the uterus intact, allowing patients to retain their fertility.
But while women who have had a trachelectomy are usually still able to conceive, the surgery can lead to increased risk of pre-term delivery and pregnancy loss. Babies born to women after trachelectomy are born by caesarean section.
Researchers scanned 57 women with suspected stage 1A or stage 1B cervical cancer, at which point the cancer is confined to the cervix and can be cured by surgery to remove the tumour. Some 31 patients were due to undergo a trachelectomy.
The researchers showed that the new MRI scan produces a greater resolution and contrast between tumour tissue and normal tissue, giving more detailed information about the extent of disease in the cervix than information provided by current diagnostic tests. The new information altered treatment for 12, or 39 per cent, of the women due to have a trachelectomy.
Nine women due for a trachelectomy received a less radical form of surgery called extended cone biopsy, and one had no further treatment because the scan showed her tumour had been removed by an earlier biopsy procedure. Two women had more extensive cancer than earlier tests had indicated, and opted for a combination of chemotherapy and radiotherapy.
Study leader Professor Nandita deSouza, Professor of Translational Imaging at The Institute of Cancer Research, and Honorary Consultant at The Royal Marsden, said:
“Cervical cancer predominantly affects younger women, with more than half of cases in women below the age of 45. Thanks to modern screening and advances in surgery some women are able to opt for treatments which retain their fertility, as long as we catch the cancer early.
“However, the more cervix that can be preserved, the better a woman’s chances are of a successful pregnancy. In our study, we were very pleased to show that new imaging technology could help in planning surgical management and limit the extent of surgery in cases where it was safe. In the future, this technology will also be able to reduce the extent of surgery further.”
“Our study demonstrates how new imaging technologies are having a real impact on patient outcomes from cancer. At the ICR, we’re planning to drive forward further advances in this area through a new Centre for Cancer Imaging, which is under construction as we speak.”
Dr Chris Watkins, Director of Translation and Industry at the MRC, said:
“This is a very important piece of research in developing an innovative new type of diagnostic device and showing that it can have a significant, and almost immediate, clinical impact in the treatment of cervical cancer. The MRC is committed to funding translational projects such as this, which allows advances in medical research to reach the clinic as quickly as possible, to the benefit of patients.”
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