Surgery is recommended for women who have small tumours confined to the cervix and where there is no evidence of lymph node spread. The actual extent of the cancer in the cervix will determine the type of surgery that is required.
If your tumour is very small, a cone biopsy may be the only treatment you need.
Other types of surgery include:
- hysterectomy (simple or radical)
- lymph node dissection
- bilateral salpingo-oophorectomy
- ovarian transposition or relocation
- pelvic exenteration.
One type of surgery which may be offered to you, if you still wish to have children and your cancer is small enough, is a radical trachelectomy. This involves removing the cervix and adjacent pelvic tissues, while preserving the upper part of the uterus (called the body of the uterus or womb).
The side effects of a radical trachelectomy are similar to those of a hysterectomy (see ‘Hysterectomy’, below), but you will still have periods (menstruate) after the surgery.
A hysterectomy is the surgical removal of the uterus. In cervical cancer, the cervix is also removed (total hysterectomy). There are two main types. Both are usually performed under a general anaesthetic.
The uterus and cervix are removed. If your operation is performed through an abdominal incision (cut in the tummy) you will usually spend four to five days in hospital. If your surgery is performed laparoscopically (keyhole surgery), you will only be in hospital for one to two days.
The uterus and about two centimetres of the upper vagina and the soft tissues around the cervix are removed. This surgery may affect your bowel or bladder function. You may have to spend about a week in hospital. In some treatment centres you may be offered a laparoscopic (keyhole) approach to your operation. In this case you will only be in hospital for two to three days, but you may still have some effect on your bowel and bladder function.
When you wake up from a hysterectomy, you will have several tubes in place. An intravenous drip will give you fluid and medication. There may also be one or two tubes in your abdomen to drain fluid from the operation site and a small plastic tube (catheter) in your bladder to drain urine. These tubes will be removed three to five days after the operation.
As with all major operations, you will have some pain or discomfort. You will be given pain relief medication through an intravenous drip or an epidural (an injection of drugs into the spine). Let your doctor or nurse know when you feel uncomfortable – don’t wait until the pain becomes severe.
Your doctors, nurses and physiotherapist will show you how to move your legs to prevent blood clots and help lymph fluid drain. As soon as you are able, you should get out of bed and walk around.
You can go home after any stitches or clips are taken out. Most women feel better within six weeks but recovery may take longer for women who have had a radical hysterectomy.
The following tips may help:
- Rest: Take things easy and only do what is comfortable.
- Lifting: Avoid heavy lifting for at least three months. Ask others for help around the house.
- Driving: Avoid driving until you feel comfortable to do so and are able to put your foot down suddenly to brake. After an abdominal incision this may take a few weeks, but after laparoscopic surgery you should be able to drive in a week or so. If you are unsure, talk to your doctor.
- Sex: Avoid penetrative vaginal sexual intercourse for about six weeks after the operation to give the wound time to heal. If you have become menopausal, you may feel a lack of interest, your vagina may be dry and there may be pain on deep penetration. Taking things slowly with an informed and sympathetic partner is most important. Please feel free to discuss these issues before surgery with your doctor and after with the nurses caring for you, who will be knowledgeable about any of these areas of women’s health and wellbeing.
Lymph node dissection (pelvic lymphadenectomy)
In most cases of cervical cancer your doctor will need to surgically remove some lymph nodes in your pelvic region to see if cancer has spread beyond the cervix. This is called a lymph node dissection or a lymphadenectomy.
Lymph node dissection is usually performed at the time of the planned radical hysterectomy or radical trachelectomy.
Your surgeon may use extremely small titanium clips to seal the lymph vessels when the nodes are removed. After surgery you may develop an accumulation of fluid known as a lymphocoele (pronounced “limfoseal”) around these clipped sites. They can be seen on scans but are not cancerous and don’t usually cause any problems, though sometimes the fluid needs to be removed.
If cancer is discovered in your lymph nodes during the operation, your doctor may cease the procedure and talk to you after surgery about the need to change your treatment plan. Chemoradiation may be recommended.
If there is no cancer found in the lymph nodes, the removed tissues will be tested in a laboratory and the results reported to your treatment team about a week later. They will then let you know if any further treatment is needed.
A lymph node dissection may cause one or both of your legs to swell (lymphoedema).
Bilateral salpingo-oophorectomy is surgery to remove both ovaries and both fallopian tubes. It is not a standard part of cervical cancer surgery. The need for a bilateral salpingo-oophorectomy will depend on whether you are post-menopausal and if you have the less common sub-type of cancer named adenocarcinoma.
Ovarian transposition or relocation
Sometimes your surgeon will recommend that your ovaries are transposed (relocated) out of the pelvis at the time of surgery, just in case there is a need for radiation treatment after the surgery.
Pelvic exenteration is a rarely performed procedure. This may be offered if the cancer has spread beyond the uterus to the surrounding organs (either the bladder or rectum), or has returned in the pelvic area after radiation treatment.