Cryosurgery: A metal probe cooled with liquid nitrogen is inserted in the vagina and placed on the cervix . This kills the abnormal cells by freezing them. Cryosurgery is used to treat preinvasive cervical cancer (stage 0), but not for treating 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. Laser surgery is used to treat preinvasive cervical cancer (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 LEEP or LEETZ procedure). (See the section, "Can Cervical Cancer Be Prevented?" for more information.) 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 might want to have children. After the biopsy, the tissue removed (the “cone”) is examined under the microscope. If the margins (outer edges) of the cone contain cancer cells, another treatment (like surgery) is needed to make sure that all of the cancer is removed.

Simple hysterectomy: This is surgery to remove the uterus (both the body of the uterus and the cervix). The structures next to the uterus (parametria and uterosacral ligaments) are not removed. The vagina remains entirely intact, and pelvic lymph nodes are not removed. The ovaries and fallopian tubes are usually left in place unless there is some other reason to remove them.

If 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. General or epidural (regional) anesthesia is used for either operation. The recovery time and hospital stay tends to be shorter for a vaginal hysterectomy than for an abdominal hysterectomy. For a vaginal hysterectomy, the hospital stay is usually 1 to 2 days followed by a 2- to 3-week recovery period. For an abdominal hysterectomy, a hospital stay of 3 to 5 days is common, 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.

A simple hysterectomy is used to treat stage IA1 cervical cancers. The operation is also used for some stage 0 cancers (carcinoma in situ), if there are cancer cells 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.

Radical hysterectomy and pelvic lymph node dissection: For this operation the surgeon removes more than just the uterus. The tissues next to the uterus (parametria and uterosacral ligaments), the upper part (about 1 inch) of the vagina next to the cervix, and some lymph nodes (bean-shaped collections of immune system tissue) from the pelvis are also removed. 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.

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 tube inserted into a very small surgical incision. Small instruments can be controlled through the tube, so the surgeon can remove lymph nodes through the tube 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.

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. The surgery results in infertility. 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 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 remains as sensitive as before. A woman does not need a uterus or cervix to reach orgasm.

Some women feel less feminine after a hysterectomy. They may view themselves as "an empty shell." Such thoughts do not enhance sexual pleasure. However, when cancer has caused pain or bleeding with intercourse, the hysterectomy may actually improve a woman's sex life by stopping these symptoms.

Trachelectomy: Most women with stage IA2 and stage IB are treated with hysterectomy. Another procedure, known as a radical trachelectomy, allows some of these young women to be treated without losing their ability to have children. This procedure involves removing the cervix and the upper part of the vagina and placing a "purse-string" stitch to act as an artificial internal opening of the cervix (the opening of the cervix inside the uterine cavity). The nearby lymph nodes are also removed using laparoscopy. 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 over 50%, but the risk of miscarriage after this surgery is higher than is seen 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 organs and tissues as in a radical hysterectomy with pelvic lymph node dissection are removed, plus this operation may also remove the bladder, vagina, rectum, and part of the colon. This operation is used to treat recurrent cervical cancer.

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.

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. It may be possible to remove the involved colon (next to the cervix) and reconnect the colon 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 myocutaneous (muscle and skin) grafts.

Sexual impact of pelvic exenteration: Recovery from total pelvic exenteration takes a long time. Most women don't begin to feel like their normal selves 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.