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 menopause 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
• reduce pain or ease symptoms (called palliative surgery)
• try to prevent or manage side effects of radiation therapy

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

A cone biopsy is also called conization. A cone biopsy may be used to treat stage 1A1 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.

Find out more about a cone biopsy.

A radical trachelectomy removes the cervix, the 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 want to become pregnant.

Find out more about a radical trachelectomy.

A hysterectomy removes the uterus. The following are types of hysterectomies that 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 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 woman has a hysterectomy. This surgery is called a bilateral salpingo-oophorectomy. It usually isn’t done in women who have not reached menopause.

Find out more about a 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 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. Cancer cells will most likely spread to these lymph nodes first.

An SLNB may be offered to women with stage 1 cervical cancer and may be done to avoid doing a full PLND. If the sentinel lymph node contains cancer cells, a PLND can be offered. Your healthcare team will discuss your options with you to decide the best treatment based on your personal needs.

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

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 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.

An ovarian transposition is surgery to move the ovaries higher up in the abdomen, away from the pelvis. Sometimes an ovarian transposition is done before radiation therapy for women who haven’t reached menopause. Moving the ovaries helps to protect them from damage from radiation, which can cause early menopause.

Side effects can happen with any type of treatment for cervical cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery, your overall health and the effects of other treatments such as radiation therapy (tissue treated with radiation may not heal well after surgery).

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, vaginal narrowing and vaginal dryness

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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.