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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.
Precancerous cells of the cervix may be treated differently than invasive cancer. Precancerous 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.
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. This freezes and kills the abnormal cells on the cervix. This procedure is 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 while you’re under local anesthetic. This means that 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 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 general anesthesia so you’re asleep. You stay 1 or more nights in the hospital. It is sometimes used for women who have had more than one treatment and still have abnormal cervical cells.
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 extent (stage) of the cancer as well as your desire to have children. The most common types of surgery for invasive cervical cancer include:
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 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. A pathologist examines the cells under a microscope to make sure no cancer cells are found around the edges of the cone. 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. This is the standard treatment for stage IA1 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 leads to faster recovery. The ovaries and fallopian tubes don’t need to be removed to cure cervical cancer. Talk about the removal of your ovaries and tubes with your surgeon before the surgery. Removing ovaries causes menopause and long-term side effects.
Radical abdominal hysterectomy. This type of surgery can be used to treat stage IA2, IB1, IB2, and IIA cancer. 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 tissues through an incision in your abdomen. He or she may be able to use minimally invasive techniques, like laparoscopic surgery. This is a surgery where these 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. It’s not needed to remove your ovaries in a radical hysterectomy. This is important for younger women. Removing ovaries causes menopause and long-term side effects.
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. 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.
Your healthcare team will talk with you 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, 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.
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
For conization or LEEP, you may have side effects such as:
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
Trouble urinating or having a bowel movement
Risk of blood clots
Risk of infections, such as pneumonia
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:
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.
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.
Let your healthcare provider know right away if you have any of these problems after surgery:
Redness, swelling, or fluid leaking from the incision
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.