Anesthesia for Cervical Cancer Surgery
Cervical cancer is the fourth most common cancer among women globally, and 90% of new cases. Management of cervical cancer includes primary prevention, secondary prevention, tertiary prevention and palliative care (Sung, et al., 2021). Once diagnosed, cervical cancer is one of the most successfully treatable forms of cancer (Sung, et al., 2021). Surgery may be required in the diagnosis and management of cervical cancer. Method of diagnosis or surgical treatment determines the extent and type of anesthesia used. Regardless of surgical method used, all anesthesia management for cervical cancer-related surgery must involve preoperative, perioperative and postoperative monitoring.
Diagnostic methods for cervical cancer can be very uncomfortable and painful for patients and may require use of anesthesia. These are excisional methods and may be required when diagnosis is unclear and may aid in treatment as well. Some patients require an electrical wire loop, also known as a loop electrosurgical excision procedure (LEEP) to obtain a small tissue sample. This can be done in the clinician office with local anesthesia (Wright, et al., 2022). A cone biopsy, also known as cervical conization, is completed with a scalpel rather than a loop. This is usually done in the operating room with a patient receiving general anesthesia or regional anesthesia, which can be epidural or spinal (Wright, et al., 2022), (“Cervical Cancer Surgery: How to Remove Cervical Cancer”).
Less intensive methods of management of cervical cancer may include ablative methods such as cryosurgery or laser ablation. In ablation, cancerous tissue is destroyed rather than removed. Laser ablation may be done outpatient with local anesthesia or in the operating room with general anesthesia (“Cervical Cancer Surgery: How to Remove Cervical Cancer”). Cryosurgery can be done outpatient without any anesthesia (Wright, et al., 2022).
More intensive surgical management of cervical cancer depends on the stage and lymph node involvement of the cancer and patient comorbidities. Treatment options include surgical resection, radiation, chemotherapy, or a combination of all three. For surgical management, there are various types of hysterectomy procedures used for treatment, depending on extent of cancer, including simple hysterectomy, modified radical hysterectomy, and radical hysterectomy (Wipperman, et al., 2018). Sometimes, these procedures can be done laparoscopically. Minimally invasive laparoscopic surgeries are associated with faster return to normal activities, fewer febrile episodes, and fewer wound or abdominal wall infections (Aarts, et al., 2015). Regional anesthesia can sometimes be used during laparoscopic or vaginal surgery for cervical cancer. However, regional anesthesia can only be utilized in less invasive surgeries. Otherwise, general anesthesia must be used (“Cervical Cancer Surgery: How to Remove Cervical Cancer).
Brachytherapy, a form of internal radiation therapy, is also used to treat cervical cancer. A study found that when comparing spinal and general anesthesia approaches for MRI-guided brachytherapy for cervical cancer, intraepidermal spinal anesthesia led to significant decreases in postprocedural narcotic usage compared with OR-based general anesthesia (Frankart, et al., 2018).
Ultimately, though cervical cancer is often successfully managed, careful consideration must be taken for anesthetic approaches used in diagnosis and treatment. These must incorporate patient risk factors and preferences.
References
Aarts, Johanna W M et al. “Surgical approach to hysterectomy for benign gynaecological disease.” The Cochrane database of systematic reviews vol. 2015,8 CD003677. 12 Aug. 2015, doi:10.1002/14651858.CD003677.pub5
“Cervical Cancer Surgery: How to Remove Cervical Cancer.” Cervical Cancer Surgery | How to Remove Cervical Cancer, 3 Jan. 2020, https://www.cancer.org/cancer/cervical-cancer/treating/surgery.html.
Frankart AJ, Meier T, Minges TL, Kharofa J. Comparison of spinal and general anesthesia approaches for MRI-guided brachytherapy for cervical cancer. Brachytherapy. 2018;17(5):761-767. doi:10.1016/j.brachy.2018.05.002
Sung, Hyuna et al. “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.” CA: a cancer journal for clinicians vol. 71,3 (2021): 209-249. doi:10.3322/caac.21660
Wipperman, Jennifer et al. “Cervical Cancer: Evaluation and Management.” American family physician vol. 97,7 (2018): 449-454.
Wright , Jason D. “Patient Education: Management of a Cervical Biopsy with Precancerous Cells (Beyond the Basics).” UpToDate, 1 Mar. 2022, https://www.uptodate.com/contents/management-of-a-cervical-biopsy-with-precancerous-cells-beyond-the-basics#H12.