Cryosurgery

A metal probe cooled with liquid nitrogen is placed directly on the cervix. This kills the abnormal cells by freezing them. Cryosurgery is used to treat pre-invasive cervical cancer (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. Laser surgery is used to treat pre-invasive 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 loop electrosurgical, 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 want to preserve their ability to have children (fertility). After the biopsy, the tissue removed (the cone) is examined under the microscope. If the margins (outer edges) of the cone contain cancer (or pre-cancer) cells, further treatment will be needed to make sure that all of the cancer is removed.

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 some other 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. 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) or for adenocarcinoma in situ. 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. Also removed are 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 pelvic lymph nodes (pea-sized collections of immune system tissue). 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 very small surgical incisions. Small instruments can be controlled through the tube, so the surgeon can remove lymph nodes 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.

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. 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. 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. 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 removes 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 more than 50%, but the risk of miscarriage after this surgery was higher 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 organs and tissues are removed as in a radical hysterectomy with pelvic lymph node dissection. This operation may also remove the bladder, vagina, rectum, and part of the colon, 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.

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.

Last Medical Review: 09/14/2009
Last Revised: 10/28/2009