Cervical Cancer

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Treating Cervical Cancer TOPICS

Surgery for cervical cancer

Cryosurgery

A metal probe cooled with liquid nitrogen is placed directly on the cervix. This kills the abnormal cells by freezing them. This can be done in a doctor’s office or clinic. After cryosurgery, you may have a lot of watery brown discharge for a few weeks.

Cryosurgery is used to treat carcinoma in situ of the cervix (stage 0), but not invasive cancer.

Laser surgery

A focused laser beam, directed through the vagina, is used to vaporize (burn off) abnormal cells or to remove a small piece of tissue for study. This can be done in a doctor’s office or clinic and is done under local anesthesia (numbing medicine).

Laser surgery is used to treat carcinoma in situ of the cervix (stage 0). It is not used to treat invasive cancer.

Conization

A cone-shaped piece of tissue is removed from the cervix. This is done using a surgical or laser knife (cold knife cone biopsy) or using a thin wire heated by electricity (the loop electrosurgical, LEEP or LEETZ procedure). (See the section, "How are cervical cancers and pre-cancers diagnosed?" for more information.) After the procedure, the tissue removed (the cone) is examined under the microscope. If the margins (outer edges) of the cone contain cancer (or pre-cancer) cells (called positive margins), some cancer (or pre-cancer) may have been left behind, so further treatment is needed.

A cone biopsy may be used to diagnose the cancer before additional treatment with surgery or radiation. It can also be used as the only treatment in women with early (stage IA1) cancer who want to preserve their ability to have children (fertility).

Hysterectomy

This is surgery to remove the uterus (both the body of the uterus and the cervix) but not the structures next to the uterus (parametria and uterosacral ligaments). The vagina and pelvic lymph nodes are not removed. The ovaries and fallopian tubes are usually left in place unless there is another reason to remove them.

When the uterus is removed through a surgical incision in the front of the abdomen, it is called an abdominal hysterectomy. When the uterus is removed through the vagina, it is called a vaginal hysterectomy. When the uterus is removed using laparoscopy, it is called a laparoscopic hysterectomy. Laparoscopy allows the inside of the abdomen and pelvis to be seen through a thin tube with a camera at the end (the laparoscope) that is inserted into one or more very small surgical incisions. Small instruments can be controlled through the tube, so the surgeon makes cuts and removes tissue through the tubes without making a large cut in the abdomen. The laparoscope can also make it easier for the doctor to remove the uterus, ovaries, and fallopian tubes through the vaginal incision. This is called a laparoscopic assisted vaginal hysterectomy. In some cases, laparoscopy is performed with special tools to help the surgeon see better and with instruments that are controlled by the surgeon. This is called robotic-assisted surgery.

General or epidural (regional) anesthesia is used for all of these operations. The recovery time and hospital stay tends to be shorter for a laparoscopic or vaginal hysterectomy than for an abdominal hysterectomy. For a laparoscopic or vaginal hysterectomy, the hospital stay is usually 1 to 2 days followed by a 2- to 3-week recovery period. A hospital stay of 3 to 5 days is common for an abdominal hysterectomy, and complete recovery takes about 4 to 6 weeks. Any type of hysterectomy results in infertility (inability to have children). Complications are unusual but could include excessive bleeding, wound infection, or damage to the urinary or intestinal systems.

Hysterectomy is used to treat stage IA1 cervical cancers. It is also used for some stage 0 cancers (carcinoma in situ), if cancer cells were found at the edges of the cone biopsy (this is called positive margins). A hysterectomy is also used to treat some non-cancerous conditions. The most common of these is leiomyomas, a type of benign tumor commonly known as fibroids.

Sexual impact of hysterectomy: Hysterectomy does not change a woman's ability to feel sexual pleasure. A woman does not need a uterus or cervix to reach orgasm. The area around the clitoris and the lining of the vagina remain as sensitive as before after a hysterectomy. More information about managing the sexual side effects of cervical cancer treatment can be found in our document Sexuality for the Woman with Cancer.

Radical hysterectomy

For this operation, the surgeon removes the uterus along with the tissues next to the uterus (the parametria and the uterosacral ligaments) and the upper part (about 1 inch) of the vagina next to the cervix. The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so. This surgery is usually performed through an abdominal incision. Often, some pelvic lymph nodes are removed as well (this procedure, known as lymph node dissection, is discussed later in this section).

Another surgical approach is called laparoscopic-assisted radical vaginal hysterectomy. This operation combines a radical vaginal hysterectomy with a laparoscopic pelvic node dissection. Laparoscopy allows the inside of the abdomen and pelvis to be seen through a thin tube with a camera at the end (the laparoscope) that is inserted into one or more very small surgical incisions. Small instruments can be controlled through the tube, so the surgeon can make cuts and remove tissue through the tubes without making a large cut in the abdomen. The laparoscope can make it easier for the doctor to remove the uterus, ovaries, and fallopian tubes through the vaginal incision. Laparoscopy can also be used to perform a radical hysterectomy through the abdomen. Lymph nodes are removed as well. This is called laparoscopically assisted radical hysterectomy with lymphadenectomy.

Robot-assisted laparoscopic surgery is also sometimes used to perform radical hysterectomies. The advantages are lower blood loss and a shorter stay in the hospital after surgery (compared to surgery using regular incisions). However, this way of treating cervical cancer is still relatively new, and its ultimate role in treatment is still being studied.

More tissue is removed in a radical hysterectomy than in a simple one, so the hospital stay can be longer, about 5 to 7 days. Because the uterus is removed, this surgery results in infertility. Because some of the nerves to the bladder are removed, some women have problems emptying their bladder after this operation and may need a catheter for a time. Complications are unusual but could include excessive bleeding, wound infection, or damage to the urinary and intestinal systems.

A radical hysterectomy and pelvic lymph node dissection are the usual treatment for stages IA2, IB, and less commonly IIA cervical cancer, especially in young women.

Sexual impact of radical hysterectomy: Radical hysterectomy does not change a woman's ability to feel sexual pleasure. Although the vagina is shortened, the area around the clitoris and the lining of the vagina is as sensitive as before. A woman does not need a uterus or cervix to reach orgasm. When cancer has caused pain or bleeding with intercourse, the hysterectomy may actually improve a woman's sex life by stopping these symptoms. More information about managing the sexual side effects of cervical cancer treatment can be found in our document Sexuality for the Woman with Cancer.

Trachelectomy

Most women with stage IA2 and stage IB cervical cancer are treated with hysterectomy. Another procedure, known as a radical trachelectomy, allows women be treated without losing their ability to have children. This procedure removes the cervix and the upper part of the vagina but not the body of the uterus. The surgeon places a "purse-string" stitch to act as an artificial opening of the cervix inside the uterine cavity.

The nearby lymph nodes are also removed using laparoscopy which may require another incision (cut). The operation is done either through the vagina or the abdomen.

After trachelectomy, some women are able to carry a pregnancy to term and deliver a healthy baby by cesarean section. In one study, the pregnancy rate after 5 years was more than 50%, but the women who had this surgery had a higher risk of miscarriage than what is seen in normal healthy women. The risk of the cancer coming back after this procedure is low.

Pelvic exenteration

This is a more extensive operation that may be used to treat recurrent cervical cancer. In this surgery, all of the same organs and tissues are removed as in a radical hysterectomy with pelvic lymph node dissection (lymph node dissection is discussed in the next section). In addition, the bladder, vagina, rectum, and part of the colon may also be removed, depending on where the cancer has spread.

If the bladder is removed, a new way to store and eliminate urine will be needed. This usually means using a short segment of intestine to function as a new bladder. The new bladder may be connected to the abdominal wall so that urine is drained periodically when the patient places a catheter into a urostomy (a small opening). Or urine may drain continuously into a small plastic bag attached to the front of the abdomen. For more information about urostomies, see our document called Urostomy: A Guide.

If the rectum and part of the colon are removed, a new way to eliminate solid waste must be created. This is done by attaching the remaining intestine to the abdominal wall so that fecal material can pass through a colostomy (a small opening) into a small plastic bag worn on the front of the abdomen (more information about colostomies can be found in our document, Colostomy:A Guide). It may be possible to remove the cancerous part of the colon (next to the cervix) and reconnect the colon ends so that no bags or external appliances are needed.

If the vagina is removed, a new vagina can be surgically created out of skin, intestinal tissue, or muscle and skin (myocutaneous) grafts.

Sexual impact of pelvic exenteration: Recovery from total pelvic exenteration takes a long time. Most women don't begin to feel like themselves again for 6 months after surgery. Some say it takes a year or two to adjust completely.

Nevertheless, these women can lead happy and productive lives. With practice and determination, they can also have sexual desire, pleasure, and orgasms.

More information about managing the sexual side effects of cervical cancer treatment can be found in our document Sexuality for the Woman with Cancer.

Pelvic lymph node dissection

Cancer that starts in the cervix can spread to lymph nodes in the pelvis (lymph nodes are pea-sized collections of immune system tissue). To check for lymph node spread, the surgeon might remove some of these lymph nodes. This procedure is known as a lymph node dissection or lymph node sampling. It is done at the same time as a hysterectomy (or trachelectomy). Removing lymph nodes can lead to fluid drainage problems in the leg. This can cause severe swelling in the leg, a condition called lymphedema. More information about lymphedema can be found in our document, Understanding Lymphedema – For Cancers Other Than Breast Cancer.


Last Medical Review: 09/19/2014
Last Revised: 10/13/2014