Surgery to remove the womb is quite a big operation, and may be necessary to make sure that all the cancer has gone. Doctors usually offer a hysterectomy to women with stage 1 or 2A cervical cancer.
You have the operation while you are asleep (under general anaesthetic).
Before your operation
Your doctor (gynaecological oncologist) will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have.
Having a general anaesthetic means that you won’t be able to eat or drink for a number of hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your doctor or nurse will give you instructions about this.
During the operation, your doctor will remove:
- your womb (including the cervix)
- 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). Some women with very early cervical cancer (stage 1A), may have just the cervix and womb removed (a simple hysterectomy).
If you haven’t been through the menopause (pre menopausal), your doctor will generally leave the ovaries. Removing them would put you into an early (premature) menopause. In this case, you might need to take hormone replacement therapy (HRT) to prevent menopausal symptoms and the effects of the menopause on your bones and other body organs.
If you have been through the menopause, your doctor will usually remove the ovaries as well.
Removing lymph nodes
During the operation your doctor will remove the lymph nodes in your pelvis. The lymph nodes are part of the lymphatic system. If cancer cells break away from a tumour, the first place they can travel to is the nearest lymph nodes. So your doctor removes them and checks for cancer cells.
There are different ways your doctor can do a hysterectomy and lymph node removal. Many women have keyhole surgery. This is also called minimal access or laparoscopic surgery. Instead of one large wound site on your tummy (abdomen) you have several smaller wounds, each usually less than a centimetre long.
Your doctor usually makes up to 5 small cuts through your skin in your lower abdomen. They put small surgical instruments and a laparoscope through these to carry out the operation. A laparoscope is like a narrow telescope that lights and magnifies the inside of your body. Your doctor can see the images on a TV screen.
In some specialist hospitals, the doctor may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery.
The doctor sits at a control unit a few feet away from the patient. The doctor controls the movement of a set of robotic surgical equipment, guided by a video camera. This gives them a 3D view, which they can magnify a number of times. This helps them carry out difficult operations using very precise movements.
The photo below is an example of robotic surgery. You can see the doctor sitting at the control unit on the right of the picture.
Your doctor sends the tissue that they remove, including the lymph nodes, to the laboratory. This is to check that they have removed all of the cancer in the cervix, and to see if there are any cancer cells in the lymph nodes.
Your specialist will offer you more treatment if there is a risk that cancer cells have been left behind, or if there is any sign that the cancer has spread. Treatment is usually with chemotherapy and radiotherapy (chemoradiotherapy).
You will be in hospital for between 1 and 3 days. And recovering at home afterwards for at least another month or so.
There are risks with any type of surgery, but most women don’t have problems after a hysterectomy. Your doctor makes sure the benefits of having the surgery outweigh any possible risks.
You have follow up appointments to check your recovery and sort out any problems. Your gynaecological oncologist may give you the results of the surgery during your first follow up appointment. Or some hospitals may phone you with the results.
You can contact your GP or your specialist nurse if you have any problems between appointments.