Will I be able to have children after surgery? Do I have to have a hysterectomy? These are both natural questions women ask when they’re told they have to have surgery for cervical cancer. The answer to the second question is: it depends. It depends on how early your cancer was caught. If it’s still just local and smaller than 2 cm (which is a little less than an inch), then you should be able to avoid a hysterectomy. The answer to the second question is: it depends, but probably yes as long as you don’t have a hysterectomy.
Surgery to remove a small, localized cervical cancer will require one of these surgeries: LEEP, cone biopsy or trachelectomy. Sometimes you may have more than one, like a LEEP followed by a cone biopsy. The reason for two surgeries is because you may have a LEEP to remove severe dysplasia, and they find a small tumor in the tissue. Then you may have a followup cone biopsy to make sure it was all removed.
Okay, now your surgery is over, you have waited 6 months to a year to heal, can you have children? Provided you don’t have any other reason to be infertile, you should be able to, but you might encounter a few hurdles. These hurdles are cervical stenosis (or stiffness of the cervix), decreased cervical mucus, blocked fallopian tubes and incompetent cervix. You may not have any of these, or you may have all of them.
I had micro-invasive cervical cancer, and after 3 surgeries, I had a baby five years later. I was terrified that I would suffer from preterm labor because all the doctors warned about that due to the dreaded “incompetent cervix.” That is when your cervix won’t stay closed to keep the baby inside. It can happen because your cervix is shorter after the surgeries, but, interestingly, the length of your cervix may still be long enough. An “incompetent cervix” is more likely to happen to women who are born with short cervixes or who have a genetic defect in the shape of their uterus.
Nobody can guarantee that you won’t have premature dilation of your cervix, so you will go see a perinatologist once you get pregnant, and the doctor can measure your cervix length on ultrasound. The doctor will see you once a month once you’re about 3 months pregnant, and if your cervix looks like it’s shortening, you may need a cerclage to keep it closed.
A cerclage is a fancy word for a stitch in the cervix. Literally, they put in a stitch to close the cervix. That stays in until about 2 weeks before you’re due to have the baby. I think the important thing to know is that there is life after cervical cancer, and it can include having children if you catch the cancer early. Go to your doctor for regular Pap smears and pelvic exams! Whether or not you have children later is something that you should get to decide, not have cancer decide it for you.