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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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Your gynaecologist will discuss your surgery| with you. The type of surgery depends on the size of the cancer and whether it has spread beyond the cervix. Before any operation it’s important to make sure that you have discussed it fully with your gynaecologist.
According to NHS guidelines, any surgery for cervical cancer should be carried out in specialist cancer centres by a gynaecological oncologist or a gynaecologist with a specialist interest in cancer.
If the cancer cells have spread only slightly beyond the surface cells of the cervix it may be possible to treat this with a cone biopsy |.
Sometimes an operation called a radical trachelectomy may be possible. With this type of operation the womb is left in place so it’s still possible to have a baby after cancer treatment. This is known as fertility preserving surgery. Often it’s necessary to treat cancer of the cervix by an operation known as a hysterectomy| .
Two different types of hysterectomy are used to treat cancer of the cervix. The type you have will depend on the stage of your cancer:
A hysterectomy is usually carried out through an incision in the abdomen but it may also be done laprascopically (keyhole surgery) using a small telescope and several very small incisions in the abdomen.
For more detail see our hysterectomy| information.
Sometimes, surgery will also include removal of some of the abdominal lymph nodes in addition to the pelvic lymph nodes.
Where possible the ovaries are not taken out in young women with cancer of the cervix as this brings on an early menopause. If it’s necessary to remove the ovaries, the symptoms of the menopause can often be prevented by giving hormone replacement therapy (HRT) as tablets, skin patches or creams. Your doctor will be able to discuss this with you in detail.
After your operation (hysterectomy or trachelectomy) you’ll be encouraged to start moving about as soon as possible. This is an essential part of your recovery and, even if you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. You’ll be seen by a physiotherapist who can help you to do the exercises.
When you get back to the ward you’ll have a drip (an intravenous infusion of fluid) going into a vein in your arm until you’re able to eat and drink normally. You may also have drainage tubes from the wound to drain off any excess fluid. The drip and drains are taken out within a few days. Usually a small tube (catheter) is put into your bladder to drain your urine into a collecting bag. You may have vaginal bleeding and discharge for a few days after the surgery.
After your operation you may need to take regular painkilling drugs, which are very effective. If you still have pain| , it’s important to let the nurses know as soon as possible, so that your painkillers can be changed until you find a type and dose that is effective. In many hospitals, epidural pain relief is used during and for a short time after the operation. This means that a thin tube is inserted into the epidural space (an area around the spinal cord) through which pain relieving medicine can be given.
A local anaesthetic is used to numb the area around the lower back where the epidural goes in. Your doctor can tell you more about this method of pain relief.
Most women are ready to go home about 6–8 days after their operation. This may be sooner if you’ve had laparoscopic (keyhole) surgery. If you think you might have problems when you go home, for example if you live alone or have several flights of stairs to climb, let your nurse or social worker know when you are admitted to the hospital, so that help can be arranged.
Sometimes after an operation it can take a while for bladder function to return to normal. In this situation, you may need to go home with a urinary catheter in place, just for a short time until your bladder starts working normally again. If you need a catheter, arrangements can be made for a district nurse to visit you at home to check how things are. If you have any problems you should contact your doctor as soon as possible.
Before you leave hospital you’ll be given an appointment to attend an outpatient clinic for your post-operative check up. This will be a good time to discuss any problems you may have after your operation. But remember, you can usually ring your hospital doctor, specialist nurse or ward nurse at any time if you have any problems.
You’ll be able to go back to your usual sex life, but your doctor will probably advise you not to have sex for at least six weeks after your operation, to allow the wound to heal properly. Many women need more time before they are ready to resume a sexual relationship. This is an important part of your recovery so don’t be afraid to discuss it with your doctor, specialist nurse or one of our cancer support specialists| . Being able to resume a sexual relationship is likely to take more time if you’ve had surgery and radiotherapy as well.
After a hysterectomy you’ll no longer have your monthly periods or be able to become pregnant.
You may find our information on sexuality and cancer| helpful.
After a hysterectomy it’s important to avoid strenuous physical activity or heavy lifting for about two months. Your physiotherapist or nurse will give you advice about this. Some women also find it uncomfortable to drive for a few weeks after their operation and it’s probably a good idea to wait a few weeks before you start driving again. Some insurance companies have guidelines about this and it may be helpful to contact your own company.
Some women take longer than others to recover from their operation. If you find you are having problems, it may be helpful to talk to someone who is not directly associated with your illness. Our cancer support specialists| are always happy to talk with you and they may be able to put you in touch with a counsellor or a support group in your area, so you can discuss your experiences with other women who are in a similar situation.
Most women will have no long-term complications after surgery for cancer of the cervix. However some women, in particular those who’ve had both surgery and radiotherapy or chemotherapy are more likely to develop long-term complications of surgery.
Rarely women may have bladder or bowel problems after a hysterectomy, because of damage to the nerves that control them during the surgery. To avoid these problems, surgeons try to not damage the nerves during surgery; this is known as nerve-sparing or nerve-preserving surgery.
If the lymph nodes have been removed there is a risk of developing swelling (lymphoedema| ) in one or both legs. This is a build up of lymph fluid that can’t drain away normally because the glands have been removed. It’s more likely to happen if you’ve had radiotherapy to the pelvic area as well as surgery. If you develop any problems after your surgery, let your surgeon or nurse know so that you can get the right kind of help.
For some women with very early cancer of the cervix, it may be possible to have a radical trachelectomy. In this type of surgery the cervix, the tissues next to the cervix and the upper part of the vagina are removed, but the rest of the womb is left in place. The lymph nodes in the pelvis are also removed, usually through tiny cuts in the abdomen (called keyhole [or laparoscopic] surgery).
As the womb is not removed, a trachelectomy means that it may still be possible for a woman to have children. At the time of surgery a stitch is placed at the bottom of the womb (uterus); this keeps it closed during pregnancy. There is a higher chance of miscarriage after this procedure, and the baby will need to be delivered by caesarean section.
Trachelectomy is only suitable for women with early stage cancer of the cervix.
This type of surgery isn’t common and is only done in a few hospitals in the UK. You may need to ask your gynaecologist to refer you to a specialist hospital if you would like to discuss the possibility of having a radical trachelectomy. It’s important that your doctor fully explains to you the benefits and possible risks of this type of operation.
If your cancer comes back in the pelvic area after the initial treatment, it may be possible to have an operation called a pelvic exenteration. This is a major operation and involves removing some or all of the structures in the pelvis, including the womb, cervix, vagina, fallopian tubes and ovaries, bladder and the lower end of the large bowel (rectum).
This type of operation is only carried out when cancer has come back (recurred) and there are no other treatments available. It’s only suitable for a small number of women and various investigations and scans will be needed to see if it’s possible.
The surgery is divided into two stages:
The operation involves creating two openings (stomas) on the abdominal wall if both the bladder and rectum have been removed. This means you will need two stoma bags: one to collect bowel motions and one for urine. These stomas are known as a colostomy and a urostomy.
Sometimes, if only part of the rectum is removed during surgery, it may be possible for the bowel to be reconnected to the rectum at a later stage. Often, the rectum can be reconnected during the operation, but as a precaution a stoma for the bowel is made and this is then reversed some months later. In this case the bowel stoma will only be temporary.
Occasionally if the bladder is removed it may be possible to have a new bladder created from part of the bowel. This new bladder only requires a small stoma and you don’t need to wear a bag over it. Urine is drained by putting a catheter into the stoma several times a day. You can be taught how to do this yourself. This type of surgery is complicated and only suitable for a small number of people. Your doctor will be able to discuss with you whether it is suitable for you.
Before the operation you will see a nurse who specialises in the care of people with stomas (a stoma nurse). The nurse will explain all about stomas and how to look after them and can answer any questions you may have. The stoma nurse will also visit you after the operation to give you practical help and emotional support.
The operation also involves making (reconstructing) a new vagina. Unfortunately because scar tissue easily forms, this often results in the new vagina being less flexible and shorter.
A pelvic exenteration is a very big operation, and many women find that recovery can be difficult, both physically and emotionally. It’s important that you understand exactly how the operation may affect you so it’s really important to talk to your surgeon or specialist nurse. You may need to have a few consultations with them to do this. They can support you in deciding whether pelvic exenteration is right for you.
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