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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. A mother of two at age 31, Zinga was well on the way to achieving her dream family. Then, she was diagnosed with early-stage cervical cancer in March 2012 -- just six months after her second son was born.

“In my heart of hearts, I knew three was our magic number.”

One month after diagnosis, Zinga underwent a procedure that showed the cancer was more extensive than originally thought. Her doctor recommended a radical hysterectomy (removal of the uterus), which would end her hopes of conceiving a third child.

“Needless to say, my husband Tim and I were devastated by the news,” said Zinga, a resident of North Lake, Ill. “In my heart of hearts, I knew three was our magic number.”

Jennifer Zinga

Not Ready to Give Up Hope

Zinga immediately began searching the Internet for alternative procedures that might allow her to get pregnant again. This is how she first learned about radical vaginal trachelectomy (RVT), also called trachelectomy, radical trachelectomy or cervicectomy. The RVT procedure requires removal of the cervix, surrounding tissue and the upper two centimeters of the vagina -- leaving the uterus intact. The uterus is then 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 Zinga's appointment for a second opinion, the doctor mentioned Ernst Lengyel, MD, PhD, one of few physicians in America -- and the only one in Illinois -- who performs radical trachelectomies. He referred her to Lengyel at the University of Chicago Comprehensive Cancer Center.

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), Lengyel believed that a radical trachelectomy combined with a laparoscopic pelvic lymphadenectomy might preserve Zinga’s fertility and enable her to get pregnant in the future. An MRI subsequently confirmed that she met all of the qualifications for this innovative and rare procedure.

Jennifer Zinga and family

“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.”

Unfortunately, few cervical cancer patients qualify 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.

“We still knew there was the possibility I might not be able to get pregnant or carry a baby to term, but we were willing to take our chances,” Zinga said.

Jennifer Zinga and her youngest son, Rocco, with Dr. Ernst Lengyel
Zinga and her youngest son, Rocco, visit Dr. Lengyel

Surgical Expertise from Abroad

Lengyel performed the procedure in June 2012 at the University of Chicago Medicine, and Zinga was discharged from the hospital three days later with no complications.

“This surgery is a wonderful opportunity to save young women like Jennifer 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,” said Lengyel.

In 2010, he spent a couple of 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.

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 12-year-old and 9-month-old during my surgery and recovery. “

Jennifer Zinga and her youngest son, Rocco

'Our Family Is Now Complete'

One year after the 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 out her 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.”

Jennifer Zinga and her youngest son, Rocco

Zinga had a scare at 32 weeks and was admitted to the hospital with contractions. 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 any time in a neonatal intensive care unit. “We were lucky to have another healthy son,” Zinga said. “We know Dr. Lengyel is the only reason we have Rocco, our miracle baby. Along with our 14-year-old, Giovani, and our three-year-old, 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.”

December 2014

Imagine magazine winter 2015 cover

This story ran in the Winter 2015 issue of Imagine, a quarterly magazine published by the University of Chicago Medicine.
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