Although cancer rates have dropped in recent years across many age groups, they are rising in young women 1%–2% annually. Meaningfully restoring health for these patients isn’t just a matter of optimizing their cancer outcomes, says Johns Hopkins gynecological oncology surgeon Rebecca Stone — it often means helping them achieve their dreams of starting a family by becoming pregnant. However, these dreams can become derailed by the damage induced by radiation, a common part of many cancer treatment protocols.

For decades, Johns Hopkins and many other hospitals have offered a surgical procedure known as ovarian transposition to preserve fertility and ovarian hormone production. This procedure involves surgically moving the ovaries out of the radiation field in order to reduce their radiation exposure to a fraction of what the organs would receive if they stayed in their natural position in the pelvis. Although the uterus is less vulnerable to damage than the ovaries, it can also lose function after radiation exposure.

Until recently, there was no way to protect the uterus when young women required pelvic radiation. But in 2022, Johns Hopkins performed its first uterine transposition procedure, offering patients a new option that could save their ability to become pregnant.

“Fertility preservation is a very important part of cancer care, and we are proud to add uterine transposition to our armamentarium of tools to help young female cancer patients in survivorship,” Stone says.

The procedure shares significant overlap with ovarian transposition, she explains. In both surgeries, the organs are moved out of the pelvis to the abdomen, away from the planned radiation beam. For uterine transposition, Stone and her colleagues carefully detach the uterus and cervix from the vagina, akin to a standard hysterectomy. But rather than remove the uterus, the surgeons preserve its blood supply and attach it to the upper anterior abdominal wall.

Once patients are finished with their cancer therapy, they undergo a second surgery to restore the uterus in its normal anatomic location. If the procedure goes as planned, blood flow remains constant to the uterine tissue, which remains pink and healthy, and patients soon restart their periods after the uterus is repositioned.

Uterine transposition is offered at just a handful of centers in the U.S., Stone says, and most exclude women with any uterine abnormalities. These include fibroids, benign tumors that affect about 80% of women over the course of their lifetime and are more prevalent in Black women. 

Although she and her colleagues determine eligibility for uterine transposition on a case-by-case basis, Stone explains, fibroids alone won’t disqualify a candidate from this procedure at Johns Hopkins — in fact, the first patient to undergo uterine transposition here had a myomatous uterus. That patient has now completed her cancer care, with all indications that her uterus has remained healthy and functional, Stone says.

“Cancer takes so much from people, and my goal as a doctor is not just to take care of someone’s cancer, it’s to take care of someone as a human being,” she says. “By offering uterine preservation as an option at Johns Hopkins, we’re not only helping patients survive their cancer, we’re helping them achieve their future hopes and dreams of having a family.”

Click here to learn more about fertility preservation options for cancer patients.