Cervical Cancer Facts

Treatment | Surgery | Chemotherapy | Radiation Therapy

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Goal of Surgery for Cervical Cancer

The goal of surgery is to remove as much cancer as possible. If the tumor is small and only in the cervix, surgery often cures the cancer. Tumors that are small and that have not spread are called early-stage cancers. Surgery is most often used for early-stage cancers.

Making the Decision to Have Surgery for Cervical Cancer

Surgery is most often used for smaller cancers that have not spread. These are known as early-stage cancers.

Before you have surgery for cervical cancer, you will see a gynecological oncologist. This is a doctor who has special training in treating cancer in a woman's reproductive organs.

When you have surgery for cervical cancer, the doctor will try to remove the tumor and not leave cancerous cells in your body. The doctor considers certain factors to evaluate the safety of surgery. The following factors tell the whether or not you can have surgery. They also help determine which type of surgery will be done.

  • How old you are
  • Your desire to become pregnant
  • Your health
  • How much the cancer has spread
  • The chance of needing radiation and chemotherapy after surgery

There are different kinds of surgery for cervical cancer. Before choosing surgery, ask your doctor the following questions:

  • What kinds of surgery can I consider?
  • Which operation do you recommend for me?
  • Will the surgery cure the cancer?
  • Will I need other treatment in addition to surgery?
  • How will I feel after surgery?
  • Where will the scars be?
  • What will they look like?
  • Will I have to do special exercises after surgery?
  • When can I get back to my normal activities?

What Happens During Surgery for Cervical Cancer?

When you have surgery for cervical cancer, the doctor will try to remove the tumor and not leave any cancer cells behind. Your surgeon is the proper doctor to decide whether a tumor can be safely removed. Surgical treatment of cervical cancer depends on many things.

Precancerous changes are also called dysplasia or carcinoma in situ. They are not treated the same as invasive cancer. These types of changes are only in the surface layers of the cervix. They have not invaded deeper tissues. Invasive cancer has reached beyond the surface.

Types of Surgery for Precancerous Changes

Treatment for precancerous changes may depend on how severe the lesion is. If you have a precancerous lesion, you may be observed closely if it is very early. Or you may need a very simple treatment such as cryotherapy, laser therapy, or conization.

Hysterectomy is another option. There are very few reasons, though, to perform this surgery for precancerous lesions. Here is a list of the most common types of surgery for precancerous changes.

  • Cryosurgery. This procedure freezes and kills the abnormal cells on the cervix. The surgeon places a thin piece of metal that has been cooled with liquid nitrogen against the cervix to cause frostbite. This freezing kills the abnormal cells on the cervix. This procedure is done in the doctor's office. Anesthesia is usually not needed.
  • Laser therapy. This type of surgery uses a narrow beam of light to create heat. The heat burns and destroys the lesions. You may have this procedure in your doctor's office, usually with a local anesthetic.
  • Conization. This is considered a type of biopsy. Your doctor can do this simple procedure in his or her office on in an operating room while you're under local anesthetic. The doctor uses a laser knife or an electric wire to remove a small cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope to make sure there is no cancer. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).
  • Simple hysterectomy. This is a major surgical procedure. A doctor removes the whole uterus through the abdomen or the vagina. This surgery requires regional anesthesia so you're sedated or general anesthesia so you're asleep. You stay at least overnight in the hospital. It is sometimes used for women who have had more than one treatment and no longer have enough tissue to perform a LEEP. Or you may have this procedure if you don't plan to have children.

Types of Surgery for Invasive Cervical Cancer

Invasive cancer means the cancer has spread beyond the surface of the cervix. Women with invasive cancer may be treated with some of the same surgical procedures used for precancerous lesions. The type used depends on the stage of the cancer. It also depends on your desire to have children. Here is a list of the most common types of surgery for invasive cervical cancer. The descriptions also tell when doctors typically perform them. Before surgery, discuss your options carefully with your doctor.

  • Conization. This is a type of biopsy. Your doctor may use this procedure to treat a stage IA1 cancer if you want to have a baby later. He or she can do this simple procedure in the office under local anesthetic. The doctor uses a laser knife or an electric wire to remove a cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope. In many cases, women are cured after one procedure. When using this treatment, though, there is a small chance that the cancer will come back. So make sure to keep all follow-up appointments with your doctor. This is more common with adenocarcinomas. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).
  • Simple hysterectomy (vaginal or abdominal). This is the standard treatment for early stage (stage IA1) invasive cancers. A doctor removes your whole uterus through your abdomen or vagina. This surgery requires regional or general anesthesia. You are sedated or asleep. You stay at least one night in the hospital. Women get better faster when the hysterectomy is done through the vagina. Vaginal hysterectomies, though, may be hard to do if you are obese. They may also be hard when there are other gynecologic disorders. For example if you have ovarian tumors a vaginal hysterectomy may not be the right surgery. The ovaries and fallopian tubes do not need to be removed to cure cervical cancer. Discuss risks and benefits of the removal of your ovaries and tubes with your surgeon before the operation.
  • Radical abdominal hysterectomy. This type of surgery is used to treat larger tumors generally confined to the cervix (stage IA2, IB1, IB2, and IIA cancers). During surgery, a doctor removes your uterus, the upper part of your vagina, and the tissue that holds your uterus in place. The surgeon also takes out the lymph nodes in the pelvic area. The doctor can remove all the structures through your abdomen. This surgery requires regional or general anesthesia. You are sedated or asleep. You spend several days in the hospital. It is not necessary to remove your ovaries in a radical hysterectomy. This is important for younger women. By keeping your ovaries, you will not enter sudden menopause. This surgery may be able to be performed in a minimally-invasive way with a laparoscope. Talk to your surgeon.
  • Radical trachelectomy. This procedure is still considered investigational. It is, though, becoming more widely used by gynecologic oncologists. The doctor removes your cervix, pelvic lymph nodes, and upper part of your vagina. Doctors use this surgery for women with early cervical cancers who want to have children.

What to Expect After Surgery for Cervical Cancer

Surgery causes temporary pain. Patients are usually sore for a few days after an operation. Pain can be controlled with medicine. You should talk about pain relief with your doctor or nurse.

Surgery for cervical cancer may cause pain in the lower abdomen. You might have vaginal bleeding, cramps, or watery discharge for a little while. You may also have problems urinating or having a bowel movement. These usually go away within a few days.

After surgery, you may feel tired or weak for a while. The time it takes to recover from surgery is different for each person. It may also depend upon the type of surgery you have.

Your sexuality may also be affected by surgery. This may especially be the case if you have a hysterectomy. You may be sad because you can no longer have children. It is important for your partner and doctors to understand this and discuss it before surgery.

These are common side effects after these procedures.

  • LEEP. This is also called conization. The side effects of LEEP usually include bleeding and sometimes narrowing of the cervix. Narrowing of the cervix is called cervical stenosis. This may increase your chance of having a baby preterm in the future. Most women are able to return to full activity a day or so after completing a LEEP. Cancer coming back is called a recurrence. Because the cancer may come back, it is important to continue to get a Pap test and exam regularly after a LEEP.
  • Hysterectomy. If you have this surgery, you will have to stay in the hospital for one or more days. A radical hysterectomy requires the longest hospital stay. It takes several weeks to recover after any type of hysterectomy. After surgery, you will no longer have menstrual periods. You also will not be able to have children. You may have trouble feeling sexual pleasure if nerves are damaged. You may have a catheter in your bladder for a number of days after your surgery. You should talk to your doctor about this option.
  • Radical trachelectomy. If you have this procedure, you can try to have children. There is an increased risk of miscarriage. Not all cervical cancer patients are eligible to have this type of surgery.

Make sure you keep all your follow-up appointments. After any surgery, you should still get regular Pap tests, exams, and imaging tests as recommended by your doctor. That way you can make sure the cancer hasn't come back.

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