Cervical Cancer: Surgery

 

Surgery for cervical cancer is done to remove the tumor and not leave any cancer cells behind. A gynecologic oncologist can determine if a tumor can be safely removed with surgery.

Precancer versus cancer

Precancer cells of the cervix may be treated differently than invasive cancer. Precancer cells are also called dysplasia or carcinoma in situ. These types of changes are only in the surface layers of the cervix. They have not grown into deeper tissues. Invasive cancer has grown through the surface of the cervix. Both can be treated with surgery. The types of surgery used may be different.

Types of surgery for precancer

Treatment for precancer may depend on the size of the area of changed cells and any other treatments you have had. Some surface cell changes may need a more simple treatment. These may include cryotherapy, laser therapy, or conization. Removal of the uterus (hysterectomy) is another option, but it's not often needed to treat precancer. The most common types of surgery for precancer include:

• Cryosurgery. A very cold metal instrument is touched to the part of the cervix with the changed cells. This freezes and kills the abnormal cells on the cervix. This procedure may be done in the doctor’s office.

• Laser therapy. This type of surgery uses a narrow beam of light to create heat. The heat vaporizes and destroys the abnormal cells. You may have this procedure in your doctor’s office.

• Conization. This is a type of biopsy. Your doctor can do this procedure in his or her office. You will be given a local anesthesia. This means that the part of your cervix being treated will be numbed. The doctor uses a laser, knife, or an electric wire to remove the changed cells in a cone-shaped piece of tissue taken from the outer part of the cervix. A pathologist looks at the cells under a microscope to make sure there are no cancer cells in it. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).

• Hysterectomy. This is a major surgery. A doctor removes the whole uterus and the cervix through a cut (incision) made in the belly (abdomen) or through the vagina. This surgery uses regional anesthesia (epidural or spinal) to make you numb below the waist. Or you may have general anesthesia so you’re asleep. You stay 1 or more nights in the hospital. This is sometimes used for women who have had more than one treatment and still have abnormal cervical cells. A hysterectomy can also be done as a laparoscopic or robot-assisted surgery. This usually has a faster recovery.

Types of surgery for invasive cervical cancer

Invasive cancer means the cancer has spread beyond the surface of the cervix. Women with invasive cancer may be treated with some of the same types of surgery used for precancer. The type used depends on the size and stage (extent) of the cancer and on whether you want to have children. The most common types of surgery for invasive cervical cancer include:

• Conization or LEEP. Your doctor may use this procedure instead of a hysterectomy to treat a stage IA cancer if you want to get pregnant in the future. He or she can do this procedure in the office under local anesthetic. The doctor uses a laser, knife, or an electric wire to remove a cone-shaped piece of tissue from the outer part of the cervix that contains the cancer. A pathologist examines the cells under a microscope to make sure no cancer cells are found around the edges (margins) of the cone. In many cases, women are cured after 1 procedure. But when using this treatment there is a small chance that the cancer will come back. So make sure to keep all follow-up appointments with your doctor.

• Hysterectomy. This is the standard treatment for stage IA invasive cancer in women who don’t want to get pregnant in the future. A doctor removes your whole uterus and cervix through your abdomen or vagina. This surgery requires regional or general anesthesia. You are sedated or asleep. You stay at least 1 night in the hospital. Women often recover faster when the hysterectomy is done through the vagina. Laparoscopic or robot-assisted surgery also usually has a faster recovery. The ovaries and fallopian tubes don’t need to be removed to cure cervical cancer. Talk about removing your ovaries and tubes with your surgeon before the surgery. Removing ovaries causes menopause.

• Radical hysterectomy. This type of surgery can be used to treat stage IA2, IB1, IB2, and sometimes small IIA cancers. A doctor removes your uterus, cervix, the upper part of your vagina, and the tissue that holds your uterus in place. The surgeon usually removes the lymph nodes in the pelvic area to test them for disease spread. The doctor can remove all the tissues through an incision in your abdomen. He or she may be able to use minimally invasive techniques such as laparoscopic or robotic surgery. This is a surgery where the tools are used through smaller cuts. This surgery is done with general anesthesia. You are asleep during the procedure. You may spend several days in the hospital after surgery. The doctor does not need to remove your ovaries in a radical hysterectomy. This is important for younger women. Removing ovaries causes menopause.

• Radical trachelectomy. This procedure is less often used. It is an option that may be used to preserve fertility in young women. The doctor removes your cervix, pelvic lymph nodes, upper part of your vagina, and surrounding tissue. The uterus is then reattached to the remaining vagina. A band is put around the bottom of the uterus to work like the cervix would. For certain people, this procedure is as likely as a radical hysterectomy to cure cervical cancer. The procedure is complex. It should only be done by a gynecologic oncologist who has experience with this method. After this surgery, there is an increased risk of infertility and pregnancy-related complications. For a future pregnancy, you may need fertility treatments and high-risk pregnancy care.

Getting ready for your surgery

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask about:

• What type of surgery will be done

• What will be done during surgery

• The risks and possible side effects of the surgery

• What you can expect sex to be like after surgery 

• If you will be able to get pregnant after surgery

• When you can return to your normal activities

• If the surgery will leave scars and what they will look like

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia so that you fall asleep and don’t feel pain.

Common side effects after surgery

The side effects you have depend mostly on the type of surgery you have.

For cryosurgery or laser therapy, you may have:

• A small amount of pain

• A small amount of tiredness

• Vaginal bleeding or watery discharge

• Cramps that might seem like those you get with your period

For conization or LEEP, you may have side effects such as:

• A small amount of tiredness

• Discomfort in the treated area

• Vaginal bleeding, cramps, or watery discharge

• Increased risk for infertility due to narrowing of the cervical canal

For a hysterectomy, it will take you up to 6 weeks to feel better. You will no longer have periods. You may have a lot of emotions about not being able to get pregnant in the future. You may have side effects such as:

• Pain in the treated area

• Vaginal bleeding, cramps, or watery discharge

• Trouble urinating or having a bowel movement

• Tiredness

• Risk of blood clots

• Risk of infections, such as pneumonia

• Dehydration

For a radical trachelectomy, you may have an increased risk for infertility. If you do become pregnant, you may have a higher risk for miscarriage, pregnancy loss, and preterm delivery. Right after surgery, you may have these side effects:

• Pain in the treated area

• Vaginal bleeding, cramps, or watery discharge

• Trouble urinating or having a bowel movement

• Tiredness

• Risk of blood clots

• Risk of infections, such as pneumonia

Most of these side effects go away after a little while. Irregular bleeding may continue. Your doctor or nurse can help you learn how to cope with these problems. For example, you can control pain with medicine. Before you leave the hospital or doctor's office, talk with your doctor about how to recognize problems. Most women who have had surgery get back to their normal activities within 6 weeks. 

Recovering at home

When you get home, you may get back to light activity. You should avoid strenuous activity for 6 weeks. Limits will depend on the type of surgery you had. Your healthcare team will tell you what kinds of activities are safe for you while you recover.

When to call your healthcare provider

Let your healthcare provider know right away if you have any of these problems after surgery:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Fever

• Chills

• Chest pain or difficulty breathing

• Redness, swelling, or pain in your leg

• Trouble passing urine or pain when you do

You may be given medicines, like pain pills, to take after surgery. It's important to know which medicines you're taking. Write your medicines down. Ask your healthcare team how they work, what they're for, what dose you should take, and what side effects they might cause.
Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with problems or questions, even on evenings and weekends.