Surgery for cervical cancer

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 (the stage| ). 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 cancer of the cervix should be carried out in specialist cancer centres by a gynaecological oncologist or a gynaecologist with a specialist interest in cancer. 

Types of surgery

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. It’s only possible for women with early stage cervical cancer, and it’s only done in a few hospitals in the UK.

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 of hysterectomy that you have will depend on the stage of your cancer:

• A simple hysterectomy involves removal of the womb and cervix and occasionally the fallopian tubes and ovaries. If you are going to have your fallopian tubes and ovaries removed, your doctors will discuss this with you before your surgery.
• A radical hysterectomy is the removal of the womb, cervix, tissue around the cervix (parametrium), fallopian tubes, pelvic lymph nodes, the upper part of the vagina, and sometimes the fallopian tubes and ovaries.

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.

Sometimes surgery will also include removal of some of the lymph nodes in abdomen and pelvis.

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, hormone replacement therapy (HRT), given as tablets, skin patches or creams, can often prevent the symptoms of the menopause. Your doctor will be able to discuss this with you in detail.

If after the initial treatment, your cancer comes back in the pelvic area, it may be possible to have an operation called a pelvic exenteration| . This is a major operation and involves removing all or most of the organs in the pelvic area. It’s only suitable for a small number of women, and various investigations and scans will be needed to see if it’s possible.