Cervical Cancer Overview

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Treating Cervical Cancer TOPICS

Surgery for pre-cancers and cancers of the cervix

There are several kinds of surgery for cervical cancer. Some take out the uterus (called a hysterectomy), others do not. This list covers the most common types of surgery for cancer of the cervix.

Cryosurgery

A metal probe cooled with liquid nitrogen is put in the vagina and on the cervix. This kills the abnormal cells by freezing them. Cryosurgery is used to treat pre-cancers of the cervix (stage 0), but it is not used for invasive cancer.

Laser surgery

A laser beam is used to burn off cells or to remove a small piece of tissue for study. Laser surgery is only used to treat pre-cancers of the cervix (stage 0). It is not used for 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 (sometimes called LEEP or LEETZ procedure).This approach can be used to find or to treat early stage (0 or I) cancer. It is seldom used as the only treatment except for women with early cancer who might want to have children. After the biopsy, the tissue removed (the cone) is checked under the microscope. If the outer edges (margins) of the cone contain cancer or pre-cancer cells, more treatment will be needed to make sure that all of the cancer is removed.

Hysterectomy

In a hysterectomy, the uterus and cervix are removed. The ovaries and fallopian tubes or pelvic lymph nodes may be taken out during the same operation, but this isn't a part of every hysterectomy.

Types of hysterectomies differ in terms of how much tissue is removed.

For a simple hysterectomy, only the cervix and uterus are removed. This is sometimes also called a total hysterectomy. The vagina and the tissue next to the uterus are left intact. The uterus can be taken out through either a cut (incision) in the front of the belly (abdomen) or through the vagina. Laparoscopy can be used with either of these methods. A laparoscope is a long, thin tube with a small camera on the end. It is put into the belly through small cuts in the skin to let the surgeon see inside and use small tools to remove organs. Because the cuts are small the patient may recover faster.

Hysterectomy is used to treat some very early stage I cervical cancers. It is also used for some stage 0 cancers if cancer cells were found at the edges of the cone biopsy. General or epidural (regional) anesthesia is used for this operation. The time it takes to recover and the length of hospital stay vary depending on how the surgery was done.

Radical hysterectomy: For this operation the surgeon removes more than just the uterus. The tissues next to the uterus and the upper part of the vagina next to the cervix are removed. This type of hysterectomy is most often done through a cut (incision) in the front of the belly (abdomen) and less often through the vagina. This surgery, along with a pelvic lymph node dissection (see below), are the usual treatment for stages I and, less often, some stage II cervical cancers, especially in young women. Laparoscopy can also be used to do a radical hysterectomy through the abdomen. Lymph nodes are removed as well.

Side effects of hysterectomy

After these surgeries, a woman cannot become pregnant, but she can still feel pleasure in sex. A woman does not need a cervix or uterus to reach orgasm. If the cancer has caused pain or bleeding, though, the operation could actually improve a woman's sex life by stopping these symptoms. Our document, Sexuality for the Woman With Cancer has more about these issues. If the ovaries are removed along with the uterus, the woman will go through menopause (change of life) if she hasn't already done so. This can lead to problems like hot flashes, night sweats, vaginal dryness, and mood changes.

In a radical hysterectomy, some of the nerves to the bladder are removed, and so afterward many women have problems emptying their bladder.

Trachelectomy

A procedure called a radical trachelectomy lets certain young women with early stage cervical cancer be treated without losing their ability to have children. This method takes out the cervix and the upper part of the vagina but leaves the body of the uterus behind. The doctor puts in a "purse-string" stitch to act as an opening of the cervix inside the uterus. The nearby lymph nodes are also removed. The operation is done either through the vagina or the belly (abdomen).

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

Pelvic exenteration

In this operation, besides taking out all the organs and tissues as in a radical hysterectomy, the bladder, vagina, rectum, and part of the colon may also be removed. What is taken out depends on where the cancer is. The goal is to remove all of the cancer. This operation is most often used when the cancer has come back after earlier treatment and has spread in the pelvis.

If the bladder is removed, a new way to store and pass urine is needed. A short piece of the intestine might be used to make a new bladder. Urine can be drained through a small opening on the belly called a urostomy. Either a small tube (called a catheter) is placed into the opening or the urine might drain into a small plastic bag that covers the opening and is worn on the front of the stomach. More information about urostomies can be found in our document called Urostomy: A Guide.

If the rectum and part of the colon are removed, a new way to pass solid waste (stool) is needed. This is done with a colostomy, an opening on the belly (abdomen) through which the stool can pass (more information about colostomies can be found in our document, Colostomy: A Guide). Or the surgeon might be able to reconnect the colon so that no bags outside of the body are needed.

If the vagina is removed, a new one can be made out of skin or other tissue.

It can take a long time, 6 months or even more, to recover from this surgery. Some say it takes a year or 2 to really adjust. But women who have had this surgery can lead happy and productive lives. With practice and patience, they can also have sexual desire, pleasure, and orgasm. See our document, Sexuality for the Woman With Cancer to learn more about these issues.

Ask your doctor to explain the details of the surgery he or she recommends. You'll want to know how long you will be in the hospital, how long it could take you to recover, how the surgery will change the way your body works, and what side effects you can expect to have.

Pelvic lymph node dissection

Sometimes some lymph nodes from the pelvis are removed to see if they contain cancer cells. This is known as a lymph node dissection or lymph node sampling. It can be done during a hysterectomy or trachelectomy. Taking out lymph nodes can lead to fluid drainage problems in the leg. This can cause severe swelling in the leg (lymphedema).


Last Medical Review: 04/24/2013
Last Revised: 01/31/2014