Surgery for cervical cancer
This page has information about the different operations you may have if you have cancer of the neck of the womb (cervix). There is information about
Surgery for early cervical cancer
If you have surgery for early cervical cancer you will usually need to have surgery to remove your womb (hysterectomy). For some very early cervical cancers, it is possible to have a radical trachelectomy.
In this operation, your surgeon will try to remove all of the cancer, but leave the internal opening of the cervix. This is then stitched closed, leaving a small opening to allow the flow of your period to escape. The idea is that the stitch will support a pregnancy until the baby can be born by caesarean section. This operation can only be done if you have a small stage 1 cervical cancer.
Before the operation, your surgeon will not be able to promise you that trachelectomy is possible. If they find that the cancer has spread further, you may need to have a hysterectomy after all. Or you may have combined chemotherapy and radiotherapy (chemoradiation). Your surgeon may need to remove some lymph nodes from around your womb. They usually do this with a laparoscope (so it is sometimes called keyhole surgery).
Hysterectomy means removal of your womb. It is quite a big operation. You will be in hospital for about a week and recovering at home for at least another month. Sometimes a hysterectomy can be done using keyhole surgery. You recover more quickly after keyhole surgery, and only stay in hospital for 2 to 3 days.
You can view and print the quick guides for all the pages in the treating cervical cancer section.
If you have surgery for early cervical cancer you will usually need to have a hysterectomy. For a small number of women, there may be a choice of operation. For some very early cervical cancers, it is possible to remove most of the cervix, but leave enough behind so that you may be able to become pregnant and have a baby afterwards. This is called a radical trachelectomy. Surgery for early cervical cancer is covered below on this page. On the next page in this section there is information about surgery for cervical cancer that has spread beyond the cervix or has come back after treatment.
In this operation, your surgeon will try to remove all of the cancer, but leave behind the internal opening of the cervix. This is then stitched closed, leaving a small opening to allow the flow of your period to escape. The idea is that the stitch will support a growing pregnancy until the baby can be born by caesarean section. This operation can only be done if you have a small stage 1 cervical cancer. Before the operation, your surgeon will not be able to promise you that trachelectomy is possible. They can't tell for sure how far up into the cervix the cancer has grown.
The part of the cervix that is removed during the surgery is checked under a microscope, often while you are still in the operating theatre. If there are no cancer cells around the edge of the tissue that has been removed and your surgeon is sure that all the cancer has gone, you will not need to have any more tissue removed. If the lab results show that some cancer has been left behind, you will have to have more tissue taken away. Your surgeon may then have to do a hysterectomy after all. This can only be done during the same operation if you have given your consent beforehand. Some women may have combined chemotherapy and radiotherapy (chemoradiation) instead of hysterectomy.
Once all the checks have been done, your surgeon will put in the stitch that will hold your cervix closed. Because there is a small risk of cancer spread to the lymph nodes in stage 1B cancers and some stage 1A cancers, your surgeon may also need to remove some lymph nodes from around your womb. They usually do this with a laparoscope (so it is sometimes called keyhole surgery). You will have up to 5 small cuts (incisions) around your lower abdomen when you wake up. These are the openings the surgeon used to remove your lymph nodes.
The lymph nodes will be checked under a microscope to see if they contain any cancer cells. If they don't, then you will not need any further treatment. If cancer cells are found in any lymph nodes, it is a sign that some cancer cells could have escaped from your cervix and a cancer could begin to grow again. Your doctor is then likely to suggest that you have some radiotherapy to kill off any other cancer cells that may have been left behind. If you need to have radiotherapy, you will not be able to have a baby after the treatment. This can be very upsetting if you were hoping to have a family. Your medical and nursing team will do all they can to support you.
Radical trachelectomy is a smaller operation than radical hysterectomy (the traditional alternative). You will usually only have to be in hospital for 2 or 3 days. Most women recover very quickly and complications are uncommon. There is more about pregnancy after cervical cancer surgery in this section.
Surgery to remove the womb is quite a big operation, and may be necessary to make sure that all the cancer has gone. You will be in hospital for between 4 and 7 days. And recovering at home afterwards for at least another month or so. During the operation, the surgeon will remove
- Your womb
- All the tissues holding your womb in place
- The top of your vagina
- All the lymph nodes around the womb
This is called a radical hysterectomy (or Wertheim's hysterectomy).
If you have had your menopause, your doctor will talk to you about taking out your ovaries as well. They are not usually affected by the cancer, but some surgeons think it is a good idea to take them out and remove your risk of getting ovarian cancer in the future. It is important to know that you are at no higher risk of cancer of the ovary than any other woman in the general population.
If you have not had your menopause, it may be possible to leave the ovaries because removing them would put you into an early (premature) menopause. If your ovaries do have to be removed, you may need to take hormone replacement therapy (HRT) to prevent menopausal symptoms and the effects of the menopause on your bones and other body organs.
After having the lymph nodes in your pelvis removed, there is a risk of developing swelling in one or both of your legs. This is called lymphoedema. Your nurse will talk to you before your operation about what you can do to try to lower your risk of developing lymphoedema.
If you notice one or both of your legs becoming more swollen anytime after having surgery, let your nurse or doctor know. If it is caused by lymphoedema they can refer you to a lymphoedema nurse specialist. The sooner it is diagnosed, the easier it is to treat.
Increasingly, surgeons are doing hysterectomies for early cervical cancer using keyhole surgery. This is also called minimal access surgery or laparoscopic surgery. Instead of having a major wound site, you have several smaller wounds. The doctor uses these to put in small surgical instruments and a laparoscope. This is a bit like a telescope. There is an eyepiece attached to a camera so that the surgeon can see inside the body.
Some hospitals are now using robotic surgery to remove cervical cancer. This is a type of keyhole (laparoscopic) surgery. The surgeon sits at a control unit a few feet away from the patient. The surgeon controls the movement of a set of robotic surgical equipment, guided by a video camera. This gives the surgeon a 3D view, which they can magnify a number of times. This helps the surgeon carry out difficult operations using very precise movements. In the photo you can see the surgeon sitting at the control unit on the right hand side of the picture.
Keyhole surgery can take longer than traditional open surgery. But women generally recover quicker, staying in hospital for 2 or 3 days. And most women have little pain. It is normal to feel tired after major keyhole surgery and most women need at least 2 weeks of rest and plenty of sleep before returning to most normal activities. Compared to open surgery, keyhole surgery may also reduce the risk of other problems that can happen after any surgery such as wound infection, blood clots and the need for blood transfusion.
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