Surgery for cervical cancer

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 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.

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. This is usually done 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, and 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 of CancerHelp UK.

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 about a week. 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 a premature menopause. If your ovaries do have to be removed, you may need to take HRT to prevent menopausal symptoms and the effects of the menopause on your bones and other body organs.

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 so that the surgeon can see inside the body. You recover more quickly after keyhole surgery than with open surgery. You usually only stay in hospital afterwards for 2 or 3 days, instead of about a week.