This page discusses the use of surgery for the treatment of cervical cancer. For a thorough review of surgical procedures to treat cancer, please see the surgery treatment monograph .

Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues. The type of surgery used will depend on the stage of the cancer. Surgical procedures may be done to:

Treating Precancerous Lesions

The appropriate treatment for precancerous lesions depends on various factors, including:

  • Whether the lesion is low or high grade
    • A low-grade lesion may not need further treatment if the affected area was removed during biopsy
  • If you want to have children in the future
  • Your age and general health
  • The preference of you and your doctor

The treatments for precancerous lesions are very effective and rarely require further surgical follow up. You will, however, still need to have regular pelvic exams and Pap tests. When a precancerous lesion requires treatment, you may have the following options:

Cryosurgery

This procedure removes abnormal cell growth by freezing it. It can be done in a doctor’s office. The doctor inserts a speculum into your vagina and applies a gas—nitrous oxide or carbon dioxide—which freezes the area. The procedure usually takes about 15 minutes.

Afterwards, you may have cramping and some bleeding, which may last several days.

Cauterization

This procedure removes abnormal cell growth with a hot instrument, an electrical current, or a caustic substance. It can be done in the doctor’s office. The doctor inserts a speculum into your vagina and applies the instrument or substance, which “burns” off the abnormal cell area. This procedure usually takes about 15 minutes.

Afterwards, you may have cramping and some bleeding, which may last several days.

Laser Surgery

This procedure removes abnormal cell growth with an intense, narrow beam of light. It can be done in the doctor’s office. The doctor inserts a speculum into your vagina and uses the laser to remove the abnormal cell area. This procedure usually takes about 30 minutes.

Afterwards, you may have cramping and some bleeding, which may last several days.

Special Note

For all the procedures listed above, you should refrain from sex, douching, and tampons for several weeks after the procedure.

When to Contact Your Doctor

You should contact your doctor if you experience the following symptoms:

  • Heavy, clotted bleeding
  • Fever or chills
  • Intense pain

Treating Cervical Cancer

If the cancer is only on the surface of the cervix, the doctor will attempt to destroy the cancerous cells using one of the methods listed above for treating precancerous lesions. If the tumor has spread into deeper layers of the cervix, but has not spread beyond the cervix, the doctor may perform surgery to remove the tumor but leave the uterus and ovaries.

In other cases, you may need to have a hysterectomy. A simple hysterectomy, performed in the treatment of very early stage or Stage IA cervical cancer, can be performed by a gynecologist. Any more advanced disease (Stage IB or greater) should be surgically addressed by a qualified gynecologic oncologist.

Hysterectomy

A simple hysterectomy is surgical removal of the uterus, including the cervix. A radical hysterectomy removes the entire uterus, the tissue next to the uterus, the upper part of the vagina, and lymph nodes from the pelvis. If there is medical reason to do so, the fallopian tubes and ovaries are removed as well. Lymph nodes near the uterus are removed to determine if the cancer has spread.

Description of the Hysterectomy Procedure

A hysterectomy can take about one to three hours. Your hospital stay may range from one to five days. Complete recovery can take four to eight weeks. With each procedure, a vaginal "packing" dressing is placed in the vagina. This will be removed after a day or two.

There are three methods of hysterectomy:

Abdominal Hysterectomy:

A cut is made in the lower abdomen to expose the tissues and blood vessels that surround the uterus and cervix. These tissues are cut and the blood vessels are tied off to remove the uterus. Stitches are placed in these deep structures, which will eventually dissolve and do not need to be removed. The uterus is removed from the top of the vagina and the vagina is closed to prevent infection and to keep the intestines from dropping downward.

Vaginal Hysterectomy:

The vagina is stretched and kept open by special instruments; no external incision is made. The doctor does, however, make an internal incision at the top of the vagina around the cervix. The uterus and cervix are cut free from their supporting ligaments and surrounding tissue, and connecting blood vessels are tied off. The uterus and cervix are removed through the vagina, which is then closed to prevent infection and to keep the intestines from dropping downward.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH):

A laparoscope is inserted through a small cut near the navel. This small, telescope-like device, about the width of a pencil, with a light on one end and a magnifying lens on the other, helps the doctor see the pelvic organs. The abdomen is inflated with a harmless gas (carbon dioxide) to improve your doctor's visibility and provide room to work. Images from the laparoscope are viewed on a special monitor.

Other small (1/4 to 1/2 inch wide) cuts are made in the abdomen, through which the doctor inserts instruments to help move organs and remove the uterus. A cut is also made where the uterus joins the vagina. The bladder and rectum are gently pushed off the uterus, which is removed through the cut made in the vagina. The vagina is closed to prevent infection and to keep the intestines from dropping downward. All the cuts are closed with stitches, which will likely leave small scars.

Effectiveness of Hysterectomy for the Treatment of Cervical Cancer

Hysterectomy is used primarily for Stages IA, IB, and IIA. If used in Stage IA, cure rates exceed 95%. For Stage IB, radical hysterectomy can result in cure rates of 85% to 90%. For Stage IIA, radical hysterectomy can result in cure rates of 75% to 80%

Possible Complications

A hysterectomy does not change your physical ability to feel sexual pleasure, but your emotional ability may be affected. It is not uncommon for a woman to feel "less feminine" or "less sexual" because of a hysterectomy. Talk with your doctor if you are feeling this way. Ask for a referral to a mental health professional. Talking about it will help you get through it. You may want your partner to go with you as well.

Other possible complications include:

  • Thrombophlebitis (blood clots in the veins or lungs)
  • Infection, at the wound site or deep inside the abdomen or pelvis
  • Vaginal and/or internal bleeding
  • Bowel obstruction
  • Injury to the intestines, bladder, or urinary tract
  • Persistent pain
  • Anesthesia-related problems, such as breathing trouble, reactions to the drugs, and poor pain relief
  • Fatigue
  • Weight gain
  • Depression
  • Nausea and vomiting (usually mild)
  • Fistula formation, which occurs when a hole forms between the bladder, intestines, and vagina
  • Urinary incontinence
  • Bleeding, which may require blood transfusions
  • For LAVH only - temporary shoulder pain due to the carbon dioxide gas used for the laparoscopy

Postoperative Care

Postoperative care includes the following:

  • The first night after the surgery, you may be asked to sit up in bed and walk a short distance.
  • The next morning, if there is no evidence of complications and you are able to drink fluids on your own, the IC and catheter in your bladder will be removed.
  • To promote healing, eat a balanced diet rich in fresh fruits and vegetables. Depending on how much blood loss occurred during surgery, you may require a daily iron supplement.
  • Try to avoid constipation. Eat high-fiber foods, drink plenty of water, and if necessary, use stool softeners.
  • Shower instead of taking a bath for at least the first two weeks after your surgery.
  • Keep your incision sites clean and dry.
  • Do not douche or put anything in your vagina, such as a tampon, until your doctor tells you otherwise.
  • Return to your normal activities gradually; most normal activities, including sex, can be resumed in about six weeks.
  • Take daily walks as tolerated.
  • Avoid heavy lifting for four to six weeks.
  • If you have a subtotal hysterectomy, and therefore still have your cervix, you will still need pap smears on a regular basis to check for cervical abnormalities.
  • Ask your practitioner when and how to perform Kegel exercises . These exercises can strengthen the muscles of the pelvic floor and prevent/improve urinary incontinence, as well as enhance sexual pleasure.