Cervical Cancer: Surgery

Surgery options for cervical cancer

The type of surgery used depends on the size and stage of the cancer, as well as future pregnancy plans. Here are the most common types of surgery for cervical cancer:

• Conization. If future pregnancy is desired, this is a good option for certain early-stage cancers. It involves removing a cone-shaped piece of tissue containing cancer cells from the cervix. The removed tissue is tested to make sure no cancer is present along its edges. The goal is to remove all the cancer cells in one procedure. You’ll be monitored at follow-up visits to make sure the cancer doesn’t come back.

• Simple hysterectomy. This surgery removes the uterus and cervix. It is often recommended for certain low-risk early-stage cancers. This surgery is best for those not planning future pregnancies. Once the uterus is removed, a woman won’t be able to get pregnant.

• Radical hysterectomy. This surgery removes the uterus, cervix, part of the vagina, and some nearby tissue. Pelvic lymph nodes may also be removed and tested to see if the cancer may have spread. This surgery is often used for more advanced stages of cancer. The procedure does not involve removing the ovaries so will not cause early menopause. Once the uterus is removed, a woman won’t be able to get pregnant.

• Modified radical hysterectomy. Compared to a radical hysterectomy, the modified radical hysterectomy removes less of the vagina and less of the connective tissue around the uterus. The pelvic lymph nodes are often not removed in this surgery. This procedure is used to treat high-risk early stage cancers. Once the uterus is removed, a woman won’t be able to get pregnant.

• Radical trachelectomy. This may be an option for women who have certain high-risk, early stage cervical cancers, but may want to bear children in the future. It involves removing the cervix, a small part of the upper vagina, and nearby tissues, while keeping the uterus and ovaries intact. Lymph nodes may be removed.

There are different ways to do these procedures. Ask your surgeon how yours will be done.

Ask and learn about your surgery

So which surgery choice is best for you? To choose the right approach, you and your doctors will discuss different treatment options. Cancer and surgery can be emotional and exhausting topics to discuss. Consider bringing a family member or close friend with you to appointments for support. Write down questions you want to ask about your surgery. Here are just a few important ones:

• What type of surgery will be done?

• What type of anesthesia will be used to keep me from feeling pain?

• What will be done during surgery?

• Will my ovaries be removed? If so, is this needed?

• Will I go into menopause after surgery?

• What are the risks and possible side effects of the surgery?

• What will sex be like after surgery?

• Will I be able to get pregnant after surgery?

• Is there a specialist I can talk to about fertility preservation options before I have surgery?

• When can I return to my normal activities?

• Will the surgery leave scars? If so, what will they look like?

• What do I need to do to get ready for surgery?

Getting ready for your surgery

Before surgery, tell your healthcare team if you are taking any medicines. This is to make sure you’re not taking anything that could affect the surgery. After you've discussed all the details with the surgeon, you'll sign a consent form. By signing this, you give the surgeon permission to do the surgery. Be sure to ask any questions before you sign the consent.

You’ll also meet the anesthesiologist or nurse anesthetist. You can ask them questions about the anesthesia that will be used and how it will affect you. Let them know if you ever had difficulty with any type of anesthesia.

Common side effects after surgery

Any side effects you may experience depend mostly on the type of surgery you have. Besides any side effects mentioned previously, here are some additional ones.

For conization, you may have:

• Tiredness

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Infection

• Increased risk for fertility problems due to narrowing of the cervical canal

• Leg swelling if lymph nodes are removed

For a hysterectomy, you may have:

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Trouble passing urine or having a bowel movement

• Tiredness

• Risk of blood clots

• Risk of infections, such as pneumonia or at the incision(s)

• Dehydration

• Damage to nearby organs, like the bladder, ureters, or rectum

• Leg swelling if lymph nodes are removed

For radical trachelectomy, you may have:

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Trouble passing urine or having a bowel movement

• Tiredness

• Risk for blood clots

• Risk for infections, such as pneumonia or at the incision

• Injury to nearby organs, like the bladder, ureters, or rectum

• Leg swelling if lymph nodes are removed

• Higher risk of miscarriage

Most of these side effects go away as you heal and recover. Talk with your surgeon about how to recognize and manage problems before you go home. Most women who have had surgery get back to their normal activities within 6 weeks or so.

Recovering at home

You may get back to light activity when you go home. Stay away from strenuous activity for 6 weeks. Limits will depend on the type of surgery you had. Your surgeon will tell you what kinds of activities are safe for you while you recover. Be sure to ask your surgeon when it is safe for you to have sex.

When to contact your surgeon

Talk to your surgeon about problems you should watch for. Get in touch right away if you have any of the following:

• Any unusual bleeding or bleeding that soaks the bandage

• Redness, swelling, or fluid leaking from the incision or vagina

• Incisions that open up or the edges pull apart

• Fever of 100.4°F (38°C) or higher, or as advised by your surgeon

• Chills

• Cough, chest pain, or trouble breathing

• Redness, warmth, swelling, or pain in a leg or arm

• Trouble or pain when passing urine or changes in how your urine looks or smells

You may be given medicines, like pain pills, to take after surgery. Write down the names of your medicines. It’s helpful to know which medicines you’re taking. Check in with your healthcare team. Ask them questions, such as:

• How does this medicine work?

• What is this medicine for?

• What is my daily dose of this medicine?

• When and how often should I take this medicine?

• What side effects might this medicine cause?

Talk with your doctors about what signs to look for and when you need to call them. Know what number to call with problems or questions, even on evenings, weekends, and holidays.