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Surgery for cervical cancer
Most women with cervical cancer will 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 menopausemenopauseThe time in a woman’s life when her ovaries stop producing estrogen and she has not had a menstrual period for 12 months. Most women start menopause between 45 and 55 years of age. and whether or not you want to become pregnant.
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 or after other treatments
- reduce pain or ease symptoms (called palliative treatment)
- check lymph nodes for cancer
- try to prevent or manage side effects of radiation therapy
The following are the types of surgery most commonly used to treat cervical cancer. You may also have other treatments before or after surgery.
|Surgeries for cervical cancer|
A cone biopsy may be used to treat stage IA1 cervical cancer in women who want to become pregnant. A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal.
There are 3 ways to do a cone biopsy:
- Loop electrosurgical excision procedure (LEEP) uses a thin wire loop heated by an electrical current to remove the cervical tissue.
- Cold-knife excision uses a surgical scalpel to remove the cervical tissue.
- Laser excision uses a laser (an intense, narrow, hot beam of light) to remove the cervical tissue.
Find out more about cone biopsy.
A radical trachelectomy removes the cervix, upper part of the vagina, some of the structures and tissues near the cervix (parametrium) and the lymph nodes in the pelvis. It is sometimes done instead of a hysterectomy. It may be an option for younger women with early stage cervical cancer who may want to become pregnant.
Find out more about radical trachelectomy.
A hysterectomy removes the uterus. The 2 types of hysterectomies that may be done to treat cervical cancer are:
- Total hysterectomy removes the cervix and uterus.
- Radical hysterectomy removes the cervix, uterus, upper part of the vagina and 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 when a women has a hysterectomy. This surgery is called a bilateral salpingo-oophorectomy. It usually isn’t done in women who have not reached menopause.
A hysterectomy may be done through the abdomen (called abdominal hysterectomy). Less often, hysterectomy may be done through the vagina (called vaginal hysterectomy). Some doctors may also do a hysterectomy by laparoscopic or robotic surgery. Laparoscopic and robotic surgery uses a thin, tube-like instrument with a light and lens (called a laparoscope) to look at organs inside the body. The laparoscope and surgical tools are passed through small incisions (cuts) in the abdomen to remove tissue.
Find out more about hysterectomy.
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. Lymph nodes may or may not be removed at the same time as a cone biopsy or total hysterectomy.
The pelvic lymph nodes and the para-aortic lymph nodes may be checked or removed during surgery for cervical cancer.
The pelvic lymph nodes are in the pelvis. They are called regional lymph nodes because they are close to the cervix. 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. The surgeon will check the para-aortic lymph nodes for cancer if the cervical tumour is large or if cancer is found in the pelvic lymph nodes.
Learn more about lymph node dissection.
Sentinel lymph node biopsy (SLNB) is the removal of the sentinel node to see if it contains cancer. The sentinel lymph node is the first lymph node in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes. There may be more than one sentinel node, depending on the drainage route of the lymph vessels around the tumour.
SLNB may be offered to women with stage I cervical cancer. A doctor may do SLNB to try to avoid doing a pelvic lymph node dissection (PLND), which removes more lymph nodes from the pelvis. If the sentinel lymph node contains cancer, the surgeon will then do PLND, in most cases. Your healthcare team will discuss your options with you to decide the best treatment based on your personal needs.
Learn more about sentinel lymph node biopsy.
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.
This surgery is sometimes used to treat cervical cancer that recurs, or comes back, within the pelvis (called local recurrence) after it is has been treated with radiation therapy. Find out more about pelvic exenteration.
In some cases, the doctor may suggest ovarian transposition before having radiation therapy for women who haven’t reached menopause. This surgery moves the ovaries higher up inside the abdomen away from the pelvis. Moving the ovaries helps to protect them from damage from radiation, which can cause early menopause.
Questions to ask about surgery
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Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.