Surgery for cervical cancer
Surgery is the main treatment for stage 1 cervical cancer. It is also sometimes used to treat small stage 2A cancers.
There are different types of operation to remove cervical cancer. These are:
- cone biopsy
The type of operation you have will depend on several factors, including:
- the stage of the cancer
- the size of the cancer
- whether you have gone through the menopause
- whether you wish to have children in future.
Whatever type of operation you have, the aim is to remove all of the cancer. The surgeon will remove the cancer and a margin of healthy tissue around it. Depending on the type of operation you have, they may also remove other tissue. After the operation, the surgeon will send all the tissue to a laboratory to be looked at under a microscope.
You may need further treatment to reduce the risk of cervical cancer coming back if cancer cells are found in:
- tiny blood vessels or lymph vessels inside the tumour
- lymph nodes
- tissue around the tumour.
Your surgeon will usually discuss these results with you at your first follow-up appointment after the operation.
A cone biopsy is a small operation to remove a cone-shaped piece of tissue from the cervix. This operation is often used to treat the earliest stage of cervical cancer (stage 1A1).
This operation is usually done under general anaesthetic and you may need to stay overnight in hospital. Afterwards, you may have a small pack of gauze (like a tampon) in the vagina to prevent bleeding. You may also have a tube to drain urine from the bladder while the gauze pack is in place. The gauze pack and tube are usually removed within 24 hours. Then you can go home.
A hysterectomy is an operation to remove the womb. It is the standard treatment for early-stage cervical cancer. If you have had the menopause, the surgeon will usually also remove your fallopian tubes and ovaries.
After a hysterectomy, you will no longer be able to become pregnant. It may be very difficult to hear that your cancer treatment will mean you can no longer have children.
If you are told you need to have a hysterectomy, you can ask your hospital doctor to refer you to a fertility specialist before your surgery. They will be able to talk with you about possible options for fertility. Women who are interested in surrogacy (another woman carrying a child in her womb for you) may want to store eggs or embryos (fertilised eggs).
This operation is a type of fertility-sparing surgery. It may be an option for some women who want to have children in future and who have early-stage cervical cancer.
The surgeon removes your cervix and the upper part of your vagina. They usually also remove the supporting tissues around your cervix. This is called a radical trachelectomy.
Lymph nodes in your pelvis are also removed. The surgeon usually does this through small cuts in your abdomen. This is called laparoscopic surgery. It may be done a few days before or at the same time as the trachelectomy.
Your womb is left in place so that it is possible for you to become pregnant in future. The surgeon will usually put a stitch at the bottom of the womb after removing the cervix. This helps to keep the womb closed during pregnancy.
After a trachelectomy, there is a higher chance of miscarrying during pregnancy. If you become pregnant, you will be referred to a local specialist maternity service for closer monitoring. The baby will need to be delivered by caesarean section. Your surgeon will explain more about this.
A trachelectomy is very specialised surgery and is not carried out in all cancer hospitals. If it is an option for you, you may need to be referred to another hospital to discuss the benefits and possible risks with a surgeon who specialises in this operation.
A hysterectomy or trachelectomy can be done in different ways:
- Abdominal surgery – the surgeon makes one cut (incision) in the tummy (abdomen). Afterwards, you have a wound that goes across your tummy close to the bikini line or that goes down from the tummy button to the bikini line.
- Laparoscopic surgery – the surgeon operates through small cuts in the tummy. They use small surgical instruments and a thin telescope with a video camera on the end (laparoscope). The laparoscope lets the surgeon see inside the body.
- Vaginal surgery – the surgeon operates through a cut at the top of the vagina. The surgeon may combine this with laparoscopic surgery.
- Robotic surgery – this is like laparoscopic surgery, but the laparoscope and instruments are attached to robotic arms. The surgeon controls the robotic arms, which can move very delicately, steadily and precisely.
Your surgeon will talk with you about the type of surgery you will have.
Below is a sample of the sources used in our cervical cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Marth C, et al. on behalf of the ESMO Guidelines Committee. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2017. 28(s4): iv72-iv83. Available at www.annalsofoncology.org/article/S0923-7534(19)42148-0/pdf
National Institute for Health and Care Excellence (NICE). Menopause. Quality standard (QS143). 2017. Available at www.nice.org.uk/guidance/qs143
Farthing AJ and Ghaem-Maghami S on behalf of the Royal College of Obstetricians and Gynaecologists (RCOG). Fertility Sparing Treatments in Gynaecological Cancers. 2013. Available at www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_35.pdf
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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