Surgery for cervical cancer
Surgery for cervical cancer should be carried out in a specialist cancer centre by a gynaecological oncologist or a gynaecologist with a special interest in cancer.
The type of surgery you have will depends on the size of the cancer and whether it has spread beyond the cervix.
If the cancer cells have spread only slightly beyond the surface of the cervix, it may be possible to treat this by removing a cone-shaped piece of tissue from the cervix. This is called a cone biopsy.
Often an operation called a hysterectomy is needed to treat cancer of the cervix.
Two different types of hysterectomy are used to treat cervical cancer. The type you have will depend on the stage of your cancer:
A total hysterectomy involves removing the womb and cervix, and occasionally the fallopian tubes and ovaries. A total hysterectomy is only suitable for women with very early-stage cervical cancer (stage 1A1).
A radical hysterectomy is the removal of the womb, cervix, tissue around the cervix (parametrium), fallopian tubes, pelvic lymph nodes and upper part of the vagina, and sometimes the ovaries. Most cancers of the cervix are treated with a radical hysterectomy. Sometimes some of the abdominal lymph nodes may be removed in addition to the pelvic lymph nodes during a radical hysterectomy.
Where possible, the ovaries are not taken out in young women with cancer of the cervix. This is because removal of the ovaries brings on an early menopause. If you need to have your ovaries removed, your healthcare team will discuss this with you before your surgery. They will also be able to tell you about treatments to help you cope with menopausal symptoms.
A hysterectomy can be carried out in different ways. The most common way is through a cut (incision) in the abdomen, known as an abdominal hysterectomy. However, for some women it may be possible to have a laparoscopic hysterectomy or keyhole surgery. During keyhole surgery, your doctor makes small cuts (incisions) in your abdomen. Small surgical instruments and a laparoscope (a telescope with a camera on the end) are inserted through these. The womb, cervix and ovaries (if needed) are then removed through the vagina or through a small cut in the abdomen. If you’re having keyhole surgery the doctors will explain in more detail how your operation will be carried out.
After a hysterectomy you will no longer have a womb, so even if you’re of child-bearing age you will be unable to become pregnant. Being told that your cancer treatment will mean you can no longer have children can be very difficult. If you’re told you need to have a hysterectomy, you can ask your hospital doctor to refer you to a fertility specialist to discuss your fertility options. Your options may include embryo (fertilised egg) storage and surrogacy, which is when another woman carries a child in her womb for you. Fertility treatments such as embryo-storage need to be carried out before surgery, so it’s important that you ask your hospital team to refer you before your hysterectomy.
For some women it may be possible to have an operation known as a radical trachelectomy, where the womb (uterus) is left in place so it’s still possible to have a baby.
This type of operation is only suitable for women with very early-stage cancer of the cervix.
A radical trachelectomy involves removal of the cervix, the tissues next to the cervix and the upper part of the vagina. The lymph nodes in the pelvis are also removed, usually through tiny cuts in the abdomen (called keyhole or laparoscopic surgery). The womb is left in place and a stitch is placed at the bottom of the womb during the surgery.
This helps to keep the womb closed during pregnancy.
There is a higher chance of miscarriage after this procedure, and if you become pregnant the baby would need to be delivered by caesarean section.
This type of surgery 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.