There are different types of surgery to remove cervical cancer including:
- Cone biopsy
- Hysterectomy
- Bilateral salpingooophorectomy
- Trachelectomy
- Lymphadenectomy
The type of surgery you have will depend on several factors, including:
- The stage of the cancer
- The size of the cancer
- Whether you have gone through the menopause
- Whether you wish to have children in future
To reduce the risk of cervical recurrence you may need further treatment if cancer cells are found in:
- Lymph nodes
- Tiny blood vessels or lymph vessels inside the tumour
- Tissue around the tumour
What is cone biopsy?
A cone biopsy is another way to treat cervical intraepithelial neoplasia (CIN) by excisional surgery or conization. A cone shaped piece of tissue is taken from the cervix by the doctor. The tissue removed in the cone contains the transition zone where the cervical pre-cancers and cancers are more likely to originate. Cone biopsy is not only used for diagnosing precancers and cancers but can also be used as a treatment option as precancers and certain very early cancers can often be completely eliminated through this procedure.
The procedure can be performed in different ways:
- Using a laser beam (laser conization)
- Using a surgical blade (cold knife cone biopsy)
- Using a thin wire heated by electricity (the loop electrosurgical excision procedure, LEEP or LEETZ procedure).
What is simple hysterectomy?
The uterus is removed by a simple hysterectomy but not the structures adjacent to the uterus. This procedure does not remove vagina and pelvic lymph nodes. The ovaries are generally left in place, unless they are removed for any other medical reasons. Simple hysterectomy can be used to treat some cases of serious CIN or certain early forms of cervical cancer.
There are different ways a hysterectomy can be done such as:
- Abdominal hysterectomy: A surgical incision in the front of the abdomen is made to remove the uterus
- Vaginal hysterectomy: The uterus is removed through the vagina
- Laparoscopic hysterectomy: This procedure involves removing the uterus using laparoscopy. One or more very small surgical incisions are made on the abdominal wall and a thin tube is inserted with a small video camera at the end (the laparoscope) into the abdomen and pelvis to see inside. Small instruments can be operated via the tube(s), so that the surgeon can cut around the uterus without making a large abdominal cut. Later, the uterus is separated through cut in the vagina.
- Robotic-assisted surgery: In this technique, laparoscopy is conducted using special instruments attached to robotic arms which are operated by the doctor to help perform precise surgery.
What is radical hysterectomy?
In this procedure, the surgeon removes the uterus along with the tissues next to the uterus (the parametria and the uterosacral ligaments), the cervix, and the upper portion of the vagina adjacent to the cervix (about 1 inch). A large incision is made in the abdominal wall in this technique. The ovaries are not removed unless other medical reasons exist for doing this. With a radical hysterectomy more tissue is removed than in a simple hysterectomy. During this period, some lymph nodes are also removed and checked for presence of cancer.
A modified radical hysterectomy is similar to a radical hysterectomy but does not remove as much of the vagina and tissues adjacent to the uterus and lymph nodes are usually not removed.
Side effects of hysterectomy include:
- Infertility
- Infection
- Bleeding
- Damage to the urinary or intestinal systems such as the bladder or colon
What is trachelectomy?
A radical trachelectomy is a technique that allows treatment in cervical cancer women without losing their ability to have children. This surgery is performed either through the vagina or through the abdomen. The procedure is done either through the vagina or the abdomen using laparoscopy. The surgery removes the cervix and the upper part of the vagina but not the uterus. The surgeon then inserts a permanent “purse-string” stitch inside the uterine cavity to keep the uterus opening closed the way cervix normally does. Through laparoscopy, the surrounding lymph nodes are removed. Many women are able to carry pregnancy after trachelectomy, while women who have undergone this operation may be at greater risk for miscarriage.
What is bilateral salpingo-oophorectomy?
The ovaries and fallopian tubes are removed depending on how far the cancer has spread, and age through this technique. This procedure of performed at the same time as hysterectomy with the patient’s consent. The ovaries remain intact in certain women to avoid the start of early menopause. Discuss with your doctor whether this technique is suitable based on your medical condition.
What is pelvic exenteration?
This surgery is used on cervical cancer recurrence or when it spreads outside the cervix. Your surgeon will cut the lymph nodes in the cervix, uterus and surrounding area. Certain organs may also be removed such as the liver, vagina, rectum, and part of the colon depending on where the cancer has spread. The surgeon may establish new pathways to extract urine and waste from your body if you have your bladder or rectum removed.
What is cryosurgery?
Cryosurgery is a form of ablation where it positions a very cold metal probe directly on the cervix that kills the abnormal cells by freezing. This is used to treat cervical intraepithelial neoplasia (CIN). It can be done in a clinic or in a doctor’s office. You may have a watery brown discharge for several weeks after cryosurgery.
What is laser ablation?
Laser ablation aims a focussed laser beam to vaporize defective cells through the vagina. It should be performed under local anesthesia in a doctor’s office or with general anesthesia in the operating room because it can cause more pain than cryotherapy. It is also used to treat cervical intraepithelial neoplasia (CIN).
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