Radical hysterectomy for cervical cancer - Hystersisters Hysterectomy Article

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Radical hysterectomy for cervical cancer

Radical hysterectomy for cervical cancer

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Hello Sisters,

I would like to share my hyst-story in the hope that other women who are in a similar situation will not feel alone.

I am a 31-year-old married women with no children. My husband have no children, and were in fact trying for our first pregnancy when I had an abnormal pap smear (CIN III). I had never had an abnormal pap smear before.

I had a repeat colposcopy followed by a cone biospy in December 2004, and was diagnosed with cervical cancer Stage 1B1. The tumour was completely removed by the cone biopsy with clear margins, but this is not good enough for 1B1 cancer. This news devastated my husband and I - we desperately wanted children and now I needed a hysterectomy. I was terrified not that I was going to die, but that I would die a horrible protracted death. I scoured the city for gynaecologic oncologists - and consulted four of them. All of them felt great sympathy for me and suggested a radical trachelectomy rather than a hysterectomy.

This involves removal of the cervix and upper vagina as well as all the other internal pelvic tissues and lymph nodes that a radical hysterectomy removes, but leaves the main part of the uterus, newly attached to the top of the vagina. It has its own problems, but gives you a small chance to have a baby.

I read all the medical literature about the subject. I was VERY well informed. I really wanted to have a trachelectomy because I wanted a baby, but I knew that for my type of tumour there was a potential risk that they may not be able to offer me the best chance of cure. After weeks of soul-searching and countless tears I chose to have a hysterectomy. A week after my decision, my gynae-onc called to tell me that the tumour board at his hospital also agreed with this treatment. I felt vindicated as for the past few weeks I was surrounded by people telling me to have the trachelectomy - I felt that they didn't understand or didn't care that I had high-risk features in my tumour seen on the cone biopsy specimen which made trachelectomy a bit less safe. I soon realised that after feeling vindicated I felt very scared that the disease was as bad as my fertile imagination kept telling me, despite my bevy of smiling, well-meaning doctors who wanted me to stop worrying about dying.

On 10 February 2005 I was admitted to hospital for my hysterectomy. There had been a deliberate delay of some seven weeks, necessary for the tissues inside to heal after the cone biopsy to reduce the chances of serious complications during the surgery. I worried if this meant that there was a chance that any left over tumour cells not removed by the cone biopsy would have a chance to spread first. I tried to trust my gynae-onc.

I met the anaesthetist (anesthesiologist) on the day of my surgery - a great man - and he ordered me a pre-med. I wasn't nervous and didn't need one, but because I work in the operating theatre normally, he thought it was a good idea. I also now think it was a very good idea. I told him that although it was ridiculous, I was worried about being awake during the surgery. He reassured me and I knew I was in excellent hands.

I was taken down to the theatre complex, woozy from the premed injection. My anaesthetist put in an IV then 'topped me up' with a touch more intravenous sedation.

The next thing I knew I was waking up in recovery with my husband holding my hand. I remember being told that they lost a pair of forceps, and had an abdominal x-ray in recovery to make sure that they didn't leave it inside. They didn't.

I was relieved it was over. I had no pain to speak of. I was calm and sleepy. My abdomen was numb. In total I had a radical hysterectomy, bilateral pelvic lymphadenectomy, bilateral ovarian transposition, appendicectomy, insertion of suprapubic catheter, and omental biopsy. Surgery took about 4 or 5 hours. I was taken to my room with a PCA machine and had short visits from my family and my surgeon and anaesthetist before I slept.

I will now relay the rest of the information as accurately as possible. This may frighten some women, but this is not my intention. I wish to be honest with you all.

The first night I slept little. I was a bit stiff but otherwise not in any real pain. I hardly needed my morphine PCA. The nurses came in every hour to do my observations. I just lay looking out the window at the street below waiting for morning.

Morning came, and I realised how weak I was, and there was a small amount of pain which was well controlled with a few pushes of the PCA. I started to feel some nausea and was given medicine to stop it. My whole wound area and my pubic mound were numb to touch although I could feel aching underneath. I was gotten out of bed by the physio to walk around the ward about 12 hours after I arrived back from recovery. I could not believe that I could be so weak. I could not stand up straight from the tension in my wound (horizontal). I was so exhausted that I could not have a shower afterwards and stayed in bed on that first day.

Over the next few days I had ongoing nausea with some retching/heaving but no vomiting. The meds sometimes helped, sometimes didn't. I just didn't feel well. The PCA was stopped on the second day post-op. The pain changed to burning/tearing feelings which is normal. I wanted to exercise, but didn't want to too because it exhausted me. When I did walk it was hunched over and very slow. But I always felt a little better when I came back.

It hurt to sit up, lie down, lie on my side, walk, shower, and move around the bed - I felt completely disabled. I had constant nausea - I was afraid to take pain medicines because I thought that they would make me nauseated. I was afraid to tell the nurses I was nauseated because my IV had packed it in and was removed and I couldn't face another injection. I was starving with burning abdominal pains and hunger pangs, yet because my bowels did not open would only drink fluids for four days post-op. I was afraid to tell the nurses that I was still feeling sick because every time I did, they downgraded my diet to clear fluids. I was desperate for food, to help relieve my stomach pains. I felt every single second that passed.

I was miserable. I knew I was getting stronger but the pain and constant nausea was wearing me down. I feared post-op chemo and radiation. I feared another operation (like exenteration) if the tumour came back. I could not go on. I told my husband and family that if I needed something else done I was going to refuse. I couldn't take it. I would rather die, truly. I vowed to tell my story here as honestly as I could so as not to deceive any of the other women here. I howled and cried in the absolute depths of despair. I have never ever known such sorrow, not even when I first found out about my cancer.

The Universe must have heard me that sad day.

That night I was able to lie on my side for the first time (albeit with a lot of pain). I was determined not to spent another night on my a**. The next morning I woke up and the nausea was gone. I had a sandwich for lunch - it was bliss. The burning wound pain was there but it was OK. I saw the light.

The time came on the 5th post-op day to start my trial of void. I had to get out of bed which was painful, walk to the toilet in my room (painful), get on and off the toilet (also painful), pass urine normally intol the toilet, measure the volume in the container hanging in the toilet, record it, flush it down the tiolet, then wash the container in the toilet (you guessed it, painful).

At one stage I had severe burning pain in my wound so couldn't stand up straight, but by now my back was killing me from hunching over for five days, so I had back pain too. After I emptied my bladder I had terrible pains in my bladder and urethra when I sat or lay down because the tip of the catheter was poking into the other side of my now deflated bladder. I was just standing there, half hunched over, crying about all the pain. I didn't want a pain tablet as I was afraid it would make me more sick and then I wouldn't be allowed to eat. I kept telling myself that I had improved so much, I was going to be fine.

I pulled my own suprapubic out after Dr gave the OK. It hurt a bit - kind of like your insides are being pulled with a sharp sting at the end. It needed a lot more force than I thought. I was relieved it was gone.

The next morning I was allowed to take my own stitch out. It was one continuous nylon stitch under the skin which I cut then gradually pulled out from one side. I barely felt it.

I went home on day 6 with an armament of bowel drugs (I did have them open in hospital with much joy, but the bowel thing has been happily sort of under control).

Today I am at home, and am Day 10 post-op. I have lymphodema of my lower abdomen and pubic mound which I am hoping goes away (but may not). I have not taken any pain meds since the day before discharge and there is only vague fullness and pulling there. I have swelly belly. I am so much stronger now - on the day of discharge I could barely walk to the bathroom and back, and two days ago I walked for two hours(slowly). I even cleaned the kitchen and bathroom yesterday.

My pathology is negative (that is, no lymph node disease). I probably won't need chemo or radiotherapy. It is not a 'cure' but it is the best news I could have hope for given the circumstances.

I want to tell you all that despite the awful time in hospital, I feel fantastic now, even after only ten days. I had to really try to remember what it was like in hospital, because already the memory has faded. Now I am one of those women who say 'it was a breeze, don't worry about it'. I WOULD go through more surgery. I WOULD have chemo/radio if required. I just made a promise to myself to be as honest with you all as possible

Good luck to all of you who have to face this too. Yes, it is tough, but you will emerge the other side like me, thinking that is wasn't so bad after all. My advice: love and trust your gynae-onc. If you don't, find another. Mine is an angel and I could not have done it without him. xxx

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Find A Doctor Near You

Clifford Rogers, M.D. The Everett Clinic, Dept. of Surgery and Gynecology 1330 Rockefeller Ave, Suite 120 Everett WA 98201 425 339 5424	David Zisow, M.D. 2005 Rock Spring Rd Ste. 3 Forest Hill - Baltimore MD 21050 410-879-1139	Scott Dinesen, M.D. 599 W State Street Suite 301 Doylestown PA 18901 215 489-2066
Aram Bonni, M.D. 25108 Marguerite Parkway Suite A-259 Mission Viejo CA 92692 949-916-2100	Kym Boyman, M.D. 1775 Williston Rd., Ste. 110 South Burlington VT 05403 802-735-1252	Wilfredo R. Ramos, M.D. 5301 F Street, Suite 210 Sacramento CA 95819 (916) 453-3440
Aarathi Cholkeri-Singh, M.D. 120 Osler Drive Ste. 100 Napeville IL 60540 630-428-2229	Quanita Crable, M.D. 8160 Walnut Hill Lane Ste. LL-001 Dallas TX 75231 (469)364-3764	Gerald Harkins, M.D. Department of OB-Gyn P.O. Box 850, H-103 Hershey PA 17033 717-531-6447

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