When a woman has surgery for cervical cancer, the doctor will try to remove the tumor and not leave any cancer cells behind. A gynecologic oncologist is the most appropriate doctor to determine whether a tumor can be safely removed. Surgical treatment of cervical cancer depends on many things. Precancerous changes are treated differently than invasive cancer. Precancerous changes are also called dysplasia or carcinoma in situ. These types of changes are only in the surface layers of the cervix. They have not invaded deeper tissues. Invasive cancer has reached beyond the surface of the cervix.
Treatment for precancerous changes may depend on how severe the lesion is and any previous treatments you have had. Certain well-defined, low-grade lesions require no surgical therapy and can be observed for changes. In other cases, if you have a low-grade lesion, you may need a very simple treatment such as cryotherapy, laser therapy, or conization. Hysterectomy is another option. However, there are very few reasons to perform this surgery for precancerous lesions. Here is a list of the most common types of surgery for precancerous changes:
Cryosurgery. This procedure freezes and kills the abnormal cells on the cervix. The surgeon places a thin piece of metal that has been cooled with liquid nitrogen against the cervix to cause frostbite. This freezing kills the abnormal cells on the cervix. This procedure is done in the doctor’s office. Anesthesia is usually not necessary.
Laser therapy. This type of surgery uses a narrow beam of light to create heat. The heat vaporizes and destroys the lesions. You may have this procedure in your doctor’s office, usually without anesthesia.
Conization. This is considered a type of biopsy. Your doctor can do this simple procedure in his or her office while you’re under local anesthetic (the part of your cervix that is being treated is numbed). 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. A pathologist examines the cells under a microscope to make sure there is no cancer. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).
Hysterectomy. This is a major surgical procedure. A doctor removes the whole uterus and the cervix through the abdomen or the vagina. This surgery requires regional anesthesia (an epidural) or general anesthesia so you’re asleep. You stay at least overnight in the hospital. It is sometimes used for women who have had more than one treatment and no longer have enough tissue to perform a LEEP.
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 surgical procedures used for precancerous lesions. The type used depends on the stage of the cancer as well as your desire to have children. Here is a list of the most common types of surgery for invasive cervical cancer and when doctors typically perform them. Before surgery, discuss your options carefully with your doctor.
Conization (or LEEP). This is a type of biopsy. Your doctor may use this procedure instead of a hysterectomy to treat a stage IA1 cancer if you want to have a baby later. He or she can do this simple 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. A pathologist examines the cells under a microscope. In many cases, women are cured after 1 procedure. However, 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 (vaginal or abdominal). This is the standard treatment for stage IA1 invasive cancers. 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 usually recover faster when the hysterectomy is done through the vagina. However, vaginal hysterectomies may be hard to do in obese women or when other gynecologic disorders such as ovarian tumors are present. Laparoscopic or robot-assisted surgery also usually leads to faster recovery. The ovaries and fallopian tubes do not need to be removed to cure cervical cancer. Discuss the removal of your ovaries and tubes with your surgeon before the operation.
Radical abdominal hysterectomy. This type of surgery can be used to treat stage IA2, IB1, IB2, and IIA cancers. During surgery, a doctor removes your uterus, cervix, the upper part of your vagina, and the tissue that holds your uterus in place. The surgeon removes the lymph nodes in the pelvic area to test them for disease spread. The doctor can remove all the structures through an incision in your abdomen and may be able to use minimally invasive techniques. The doctor can remove all the structures through your abdomen. This surgery requires general anesthesia. You are asleep during the procedure. You may spend several days in the hospital. It is not necessary to remove your ovaries in a radical hysterectomy. This is important for younger women. By keeping your ovaries, you will not enter menopause suddenly. Only a gynecologic oncologist should perform this type of surgery.
Radical trachelectomy. This procedure is less common. It is an alternative 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 and upper portion of the cervix are then reattached to the remaining vagina. For certain patients, this procedure is as likely as a radical hysterectomy to cure cervical cancer. The procedure is complicated. It should only be performed by a gynecologic oncologist who has experience with this technique. After this surgery, there is an increased risk of infertility and pregnancy-related complications, so you may need special fertility and pregnancy care.
The side effects you have depend mostly on the type of surgery you have.
If you had cryosurgery or laser therapy, you may have some minor pain and feel a little tired. You may also have a vaginal discharge.
If you had conization or LEEP, you may have the following side effects:
Discomfort in the operated area
Vaginal bleeding, cramps, or watery discharge
Increased risk for infertility due to narrowing of the cervical canal
If you had a hysterectomy, it will take you up to 6 weeks to feel better. You will no longer have periods. You may also experience a lot of different emotions about not being able to have children anymore. You may experience these side effects:
Pain in the operated area
Trouble urinating or having a bowel movement
Risk of blood clots
Risk of infections, such as pneumonia
If you had 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:
Most of these side effects go away after a little while. Irregular bleeding may persist. 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.