Surgery for cervical cancer

Surgery is the main treatment for early-stage cervical cancer. The aim is to remove all of the cancer. There are different types of surgery:

  • cone biopsy – a small cone-shaped piece of tissue is removed from the cervix
  • hysterectomy – an operation to remove the womb (uterus) and sometimes the fallopian tubes and ovaries
  • trachelectomy – an operation to remove the cervix.

The type of surgery you have will depend on:

  • the size of your cancer and whether it has spread
  • whether you have gone through the menopause
  • whether you wish to have children in future.

After surgery, all the tissue that has been removed is sent to a laboratory to be looked at under a microscope.

You may need further treatment to reduce the risk of the cancer coming back if cancer cells are found in:

  • tiny blood vessels or lymph vessels inside the tumour
  • lymph nodes
  • tissue around the tumour.

Types of surgery

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
  • hysterectomy
  • trachelectomy.

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 the 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.


Cone biopsy

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).


Hysterectomy

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. Being told that your cancer treatment will mean you can no longer have children can be very difficult. 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 discuss possible options for fertility with you. 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).


Types of hysterectomy

There are two types of hysterectomy that may be done. The type you have will depend on the stage of the cancer.

Simple hysterectomy (also called total hysterectomy)

The surgeon removes your womb and cervix. They may also remove your pelvic lymph nodes. This operation may be done for very early-stage cancers that cannot be seen without a microscope (stage 1A).

Radical hysterectomy

The surgeon removes the upper part of your vagina, your cervix, your womb, the supporting tissue around your womb and cervix (parametrium), and your pelvic lymph nodes.


Trachelectomy

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 (see below). 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.


How the operation is done

A hysterectomy or trachelectomy can be done in different ways:

  • Abdominal surgery – the surgeon makes one large 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.
  • Vaginal surgery – the surgeon operates through a cut at the top of the vagina. The surgeon may combine this with laparoscopic surgery (see below).
  • 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.
  • 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.

Back to Surgery for cervical cancer

Follow-up care after surgery

After surgery you have an appointment with your surgeon to check on your recovery and discuss the results of your operation.