Surgery for cervical cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Most people with cervical cancer have surgery. The type of surgery you have depends mainly on the size of the tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age, overall health, if you have reached menopause and whether or not you want to become pregnant in the future.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible (called debulking) before other treatments
• reduce pain or ease symptoms (called palliative surgery)
• treat cancer that comes back after other treatments (called salvage surgery)

The following types of surgery are used to treat cervical cancer. You may also have other treatments before or after surgery.

Cryosurgery destroys cancer cells by freezing them. Doctors apply an extremely cold liquid or gas to the tissues of the cervix through a metal tube called a cryoprobe. The area is allowed to thaw and then is frozen again. The freeze-thaw cycle may need to be repeated a few times.

Cryosurgery is sometimes used to treat precancerous conditions of the cervix. You may have cryosurgery to treat low-grade or moderate-grade cervical intraepithelial neoplasia (CIN) where the abnormal cells are located on the surface of the cervix (called exocervical lesions) and do not extend into the endocervical canal.

Find out more about cryosurgery.

A cone biopsy (also called conization) removes a cone-shaped piece of tissue from the cervix. The piece is made up of tissue from the outer part of the cervix closest to the vagina and part of the endocervical canal. A cone biopsy is often done using a thin wire heated by electricity (called a loop electrosurgical excision procedure, or LEEP).

A cone biopsy may be used to treat stage 1A cervical cancer in people who want to become pregnant in the future.

Find out more about a LEEP.

Laser surgery uses a powerful, narrow beam of light (called a laser beam) to destroy cancer cells.

Laser surgery for cervical cancer is also called laser ablation. It is sometimes used to treat precancerous conditions of the cervix, such as high-grade CIN. Laser ablation may be done instead of a cone biopsy.

Find out more about laser surgery.

A radical trachelectomy removes the cervix, the upper part of the vagina, some of the structures and tissues near the cervix (called the parametrium), and the lymph nodes in the pelvis. It is sometimes done instead of a hysterectomy. It may be an option for younger people with early-stage cervical cancer who want to become pregnant in the future.

Find out more about a radical trachelectomy.

A hysterectomy removes the uterus. One of the following types of hysterectomies may be done to treat cervical cancer:

• A total hysterectomy removes the cervix and uterus.
• A radical hysterectomy removes the cervix, uterus, upper part of the vagina and the parametrium. Lymph nodes in the pelvis near the cervix are often removed during a radical hysterectomy. Surgery to remove these lymph nodes is called a pelvic lymph node dissection (PLND).

Sometimes both ovaries and fallopian tubes are also removed during a hysterectomy. This surgery is called a bilateral salpingo-oophorectomy. It is usually done only in people who have already reached menopause.

Find out more about a hysterectomy.

A pelvic exenteration is surgery to remove the cervix, uterus, vagina, ovaries, fallopian tubes and nearby lymph nodes. The bladder, rectum or both may also be removed. In some cases, the vulva is also removed. A pelvic exenteration is sometimes used to treat cervical cancer that comes back (recurs) within the pelvis if there are no signs of cancer anywhere else in the body.

Find out more about a pelvic exenteration.

Surgery to remove lymph nodes is called a lymph node dissection. It is often done at the same time as a radical trachelectomy or radical hysterectomy to check the lymph nodes for cancer cells. Lymph nodes may or may not be removed at the same time as a cone biopsy or total hysterectomy.

• The pelvic lymph nodes are in the pelvis. They are the first group of lymph nodes that cervical cancer may spread to. The operation to remove them is called a pelvic lymph node dissection (PLND).
• The para-aortic lymph nodes are at the back of the abdomen around the lower part of the aorta (the large artery that carries blood away from the heart). When cervical cancer spreads to lymph nodes outside of the pelvis, it most often spreads to the para-aortic lymph nodes.

Learn more about a lymph node dissection.

A sentinel lymph node biopsy (SLNB) removes the sentinel lymph node to see if it contains cancer cells. The sentinel lymph node is the first in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. If cervical cancer spreads, it will most likely spread to these lymph nodes first.

Learn more about a sentinel lymph node biopsy (SLNB).

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for cervical cancer may cause these side effects:

• bleeding
• vaginal discharge
• bladder problems including urinary incontinence
• bowel problems including constipation
• infection
• lymphedema in the legs or pelvis
• fertility problems
• treatment-induced menopause
• bowel obstruction
• sexual problems including painful intercourse

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.