In an unprecedented case, a woman with gynecological cancer moves her uterus and becomes pregnant

Santa Catarina hairdresser Angélica Hodecker was recently married and was just 30 years old when she received the diagnosis that knocked her off her feet: she had cervical cancer the third most common malignant tumor among women, behind only breast and colorectal tumors, according to the National Cancer Institute (Inca). Young and still without children, she wanted to be a mother and found herself faced with the need to make urgent decisions, which could change her dream of motherhood.

The first proposed treatment was quite radical for a woman who wanted to get pregnant at some point: removing the uterus, tubes and ovaries to eliminate any chance of the cancer progressing. With that, the dream of being pregnant would come to an end. “The disease had only affected the cervix, why was it necessary to remove everything?” asked the hairdresser.

Angélica sought out a second specialist and came up with another treatment alternative for her case: undergoing conization, a type of surgery that removes only the diseased part of the cervix, thus preserving the other organs of the reproductive system. From then on, the doctor would assess whether or not a more aggressive intervention was necessary.

She underwent the procedure, but the results indicated that surgery alone was not enough to eliminate the tumor — it would be necessary to undergo chemotherapy and pelvic radiotherapy. As a result, she would become infertile.

In this case, fertility preservation could be done by freezing eggs, but a future pregnancy would have to be done in a surrogate belly, as the uterus that receives radiotherapy loses the elasticity of its muscle fibers and its functional part, the endometrium. , begins to heal. In this way, the organ is unable to maintain a pregnancy.

“My alternative was to stop cancer treatment to try to get pregnant as quickly as possible. And, after pregnancy, I would resume treatment against the disease”, he says. “I dismissed that hypothesis outright. I wanted to be a mother, but it was impossible to stop treatment to try to get pregnant. What if the cancer progressed during this period?”

It was during this phase of uncertainty that Angélica sought a third opinion. The alternative presented was to have a trachelectomy (a procedure that removes the cervix, but not the body of the uterus) and a lymphadectomy (removal of the lymph nodes in the pelvis).

The problem is that, even after this surgery, she would have to undergo cycles of radiotherapy and chemotherapy and, consequently, would be infertile. It was then that she discovered a technique that was still experimental, but very promising: making a uterine transposition surgery that is, temporarily relocating the uterus, with the aim of preserving the organ for a future pregnancy.

The unprecedented proposal

The technique was developed in 2015 by oncological surgeon Reitan Ribeiro, from Curitiba, and consists of transfer the reproductive organs (uterus, tubes and ovaries) repositioning them on the upper part of the woman’s abdomen, between the liver and the navel. The idea is to keep them intact and away from the effects of radiation during cancer treatment. At the end of the chemotherapy and radiotherapy cycles, a new surgery returns the organs to their original position.

The proposal was to do something absolutely unprecedented. At that time, in 2021, another five uterine transposition surgeries for gynecological cancer had already been carried out in Brazil, but none of them involved a patient with cervical cancer – Angélica’s case would be the first in the world’s scientific literature. To date, around 20 women have had this surgery in Brazil.

“We are in a time of transition. We started from the concept of surgery, which was initially carried out experimentally, but we are finding that it is a feasible, low-cost and low-complexity surgical alternative for preserving fertility in these women”, explains the gynecologist specialized in robotic surgery and cancer. gynecologist Renato Moretti, from Hospital Israelita Albert Einstein, one of the few centers capable of performing uterine transposition in Brazil.

“I didn’t have any comparisons, I didn’t have anyone to tell me if it would work or not. There was a successful case, which resulted in pregnancy, but it was a liposarcoma [câncer raro, nas células de gordura]. My husband and I think a lot, but we don’t [não conseguir engravidar] we already had it. A single session of pelvic radiotherapy would affect my fertility, so we decided to try”, recalls Angélica, who was Moretti’s patient during this process.

But not all women with gynecological cancer are eligible for surgery. THE technique is only indicated for those who have the potential to become pregnant later desire to become pregnant and that the oncological disease does not affect the uterus. “It is also important to highlight that uterine transposition is immediately applicable after multidisciplinary discussion, with the minimum delay in radiotherapy that the patient needs to treat the cancer”, emphasizes Moretti.

According to the specialist, around 20% to 30% of patients who discover cervical cancer in the early stages will have to undergo pelvic radiotherapy. In the more advanced stages, everyone needs this treatment. “In short, radiotherapy is part of cancer treatment in at least 80% of women, because the reality in Brazil is to make the diagnosis at more advanced stages”, he observes.

Angélica and her husband agreed to try uterine transposition, but they were prepared for the worst. If the technique did not work as expected, they would freeze eggs and sperm for a future supportive belly or they could opt for parenthood via adoption. “We were a little hesitant, because it was research and, if it didn’t work out, we would go back to square one. But we had to try.”

Within a week, Angélica was in the operating room. The surgery was considered a success and, in less than 10 days, the hairdresser was already in the hospital to begin radiotherapy cycles. He underwent all the treatment (25 radiotherapy sessions daily and six chemotherapy sessions once a week) and, in March 2021, he replaced his organs.

The surprise of spontaneous pregnancy

After the surgery, Angélica began to undergo periodic monitoring every three months to make sure that the cancer was eliminated. “Everything was going very well. My uterus was intact, vascularized, I was ovulating normally, but my menstruation was blocked by contraceptives. During this period, the doctor allowed us to suspend the use of contraceptives and we talked about the possibility of pregnancy”, he says.

But there was one more detail. Due to the treatment, Angélica’s cervical canal was narrowed. It would be necessary to undergo a procedure to open this region and, perhaps, a natural pregnancy would be more difficult to occur. Moretti spoke with the couple about the possibility of in vitro fertilization (IVF).

“I was newly married, I wanted to be a mother, but not necessarily at that moment. But when they say to a woman ‘either you have a baby now, or perhaps you will have difficulty getting pregnant in the future’, the clock ticks. So we started the idea of ​​pregnancy right after cancer treatment”, he says.

The proposal was to try to get pregnant naturally within a year. If it didn’t work, the couple would move on to assisted reproduction. It wasn’t necessary. Five months later, Angélica became pregnant without any auxiliary treatment. “When my period was late and the first pharmacy test came back positive, I was in disbelief. I cried sitting on the bathroom floor. I repeated the strip test three times, took another digital scan and even took a blood test to make sure it was true”, he recalls.

She sent the photo of the pharmacy exam to Moretti and asked: “I’m pregnant, what now?” And he replied: “Now let’s start prenatal care.” And that’s how the monitoring of the unprecedented pregnancy began, but considered high risk because she didn’t have a cervix.

Everything went normally. Isabel – affectionately called Bebel – was born on Christmas Eve, on December 24, 2022, healthy, weighing 2.2 kg and measuring 43 cm. This birth was so important to scientific literature that a case report was published in August 2024 in the Journal of Surgical Oncology.

Angélica’s story opens the door for other women with gynecological cancer to undergo the procedure to preserve fertility. “It was magical. I don’t want to romanticize motherhood, but I came to think that I wouldn’t be able to experience that one day”, says Bebel’s mother.

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This content was originally published in In an unprecedented case, a woman with gynecological cancer moves her uterus and becomes pregnant on the CNN Brasil website.

Source: CNN Brasil