Rare surgical technique enables healthy pregnancy after cervical cancer
From the time she was a young girl, Jennifer Mason Zinga knew she wanted to have three children when she was ready to start a family. Then at age 31, Zinga was diagnosed with early stage cervical cancer in March 2012, just six months after her second son was born.
“My husband, Tim, and I were devastated by the news,” said Zinga, of North Lake, Ill. “In my heart of hearts, I knew three was our magic number.”
Zinga began searching the Internet for alternative procedures that might allow her to get pregnant again. She came upon a procedure called radical vaginal trachelectomy (RVT), also called trachelectomy, radical trachelectomy or cervicectomy. RVT involves removal of the cervix, surrounding tissue and upper 2 centimeters of the vagina — leaving the uterus intact. Then the uterus is connected to the remaining portion of the upper vagina, and a cerclage (a permanent suture) is placed where the cervix used to be to help maintain a pregnancy.
During an appointment for a second opinion, she asked about RVT. The doctor brought up Ernst Lengyel, MD, PhD, as one of few physicians in America who is experienced in radical trachelectomies. He referred her to Lengyel at the University of Chicago Medicine Comprehensive Cancer Center.
“We know Dr. Lengyel is the reason we have Rocco, our miracle baby. Along with our other boys, Giovani and Dominic, our family is now complete," said Zinga.
In May 2012, Lengyel met with Jennifer and Tim to deliver encouraging news: While the standard of care for early stage cervical cancer is a radical hysterectomy with pelvic lymphadenectomy (removal of one or more lymph nodes), he believed a radical trachelectomy combined with a laparoscopic pelvic lymphadenectomy might preserve Zinga's fertility. An MRI confirmed she met the qualifications for this innovative procedure.
“Until recently, this diagnosis always meant undergoing a radical hysterectomy,” Lengyel said. “You can imagine what this means to a young woman whose life plan is to have children. Radical trachelectomy surgery allows us to balance a patient’s need to live and treat and cure the cancer with her desire to maintain her fertility.”
Few cervical cancer patients are good candidates for the procedure, which can be performed only on those with squamous cell carcinoma or adenocarcinoma, and a tumor less than 2 centimeters in diameter. There can be no tumor in the upper cervical canal and no evidence that the cancer has spread. In addition, the patient must be interested in future fertility and have no extensive history of infertility. “Fortunately, Jennifer met all of the criteria so this surgery made sense for her,” Lengyel said.
Lengyel performed the procedure in June 2012, and Zinga was discharged from the hospital three days later.
Surgical expertise from abroad
In 2010, Lengyel spent a few months in London learning how to perform the surgery from world expert John H. Shepherd, MD, professor of surgical gynecology at St. Bartholomew’s and the Royal London School of Medicine and Dentistry and consultant gynecologic surgeon and oncologist at The Royal Marsden Hospital in London. Since then, Lengyel has performed the procedure 12 times, most often on women who had not yet had children.
“This surgery is an opportunity to save young women from having a hysterectomy. However, it requires a high level of expertise and is technically challenging, which is why it is done in so few medical centers,” Lengyel said.
When Zinga returned home after surgery, she experienced some pain and constipation. “I immediately phoned Dr. Lengyel, who returned my call within the hour,” she said. “Still, there were not as many bumps in the road as I expected. I have an amazing family and my parents live next door, so they were able to provide round-the-clock care for our two sons (at the time, age 9 months and 12 years) during my surgery and recovery.“
"Our family is now complete"
One year after surgery, Zinga discovered she was pregnant. “I immediately called Dr. Lengyel, who was very excited by the news.” On Thanksgiving, her father-in-law announced to the family that she was carrying a boy. Shortly thereafter, she was put on bed rest, which meant she was unable to finish the school year as a first-grade teacher.
“The school was very understanding, but it was hard to walk away from my class because I love teaching so much,” Zinga said. “Still, we knew that getting to 20 weeks was a big deal. Anything after that was a bonus.”
Her third child, Rocco, was delivered at 36 weeks by Cesarean section. He weighed 6 pounds, 7 ounces, measured 20 inches long and did not require time in the neonatal intensive care unit. “We were lucky to have another healthy son,” Zinga said. “We know Dr. Lengyel is the reason we have Rocco, our miracle baby. Along with our other boys, Giovani and Dominic, our family is now complete.”
Zinga continues to see Lengyel every three months for cervical cancer screenings. “I have an amazing relationship with the doctor and his staff," Zinga said. "I feel comfortable with them because they know everything that’s happened to me. It’s reassuring to know they’re always just a phone call away.”
At UChicago Medicine, our gynecologic cancer team is comprised of experts from gynecologic, medical and radiation oncology, as well as pathologists, radiologists and nurses all focused on providing personalized, leading-edge cancer care.Learn more about our gynecologic cancer care
Ernst Lengyel, MD, PhD
Ernst Lengyel, MD, PhD, is the Arthur L. and Lee G. Herbst Professor of Obstetrics/Gynecology and chairman of the Department of Obstetrics/Gynecology at UChicago Medicine. He is an internationally known expert in the research and treatment of gynecologic cancers.Read more about Dr. Lengyel