Surgery for Cervical Cancer

The most appropriate type of surgery for cervical cancer depends on its stage.

The following types of surgery are used to treat early-stage cervical cancer:

• Conization - The doctor removes a cone-shaped piece of tissue using a surgical scalpel (cold knife cone biopsy) or laser. Conization can also be done by passing an electrical current through a wire loop (loop electrosurgical excision procedure, or LEEP). Conization lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. A cone biopsy is rarely used as the only treatment, except in women with early (Stage IA) cancer who might want to have children.
• Cryosurgery (also known as cryotherapy) - The doctor uses a metal probe cooled with liquid nitrogen to kill the abnormal cells by freezing them. Cryosurgery is used to treat preinvasive cervical cancer (found only the surface of the cervix), such as carcinoma in situ, but not for invasive cancer (cancer that has spread from the lining of the cervix to tissue deeper in the cervix or to other parts of the body).
• Laser surgery - The surgeon directs a focused laser beam (a narrow beam of intense light) through the vagina to vaporize (burn off) abnormal cells or to remove a small piece of tissue for study. Laser surgery is used to treat preinvasive cervical cancer but not invasive cancer.
• Simple hysterectomy - The surgeon removes the uterus (womb) and cervix but not the structures next to the uterus (parametria and uterosacral ligaments) or pelvic lymph nodes (bean-shaped structures that help fight infections). The uterus is removed through a surgical incision in the front of the abdomen or through the vagina. The ovaries (pair of female reproductive organs that produce eggs and hormones) and fallopian tubes (two hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization) are usually left in place unless they are affected by some other disease or the patient is at least 45 to 50 years old. When both ovaries and fallopian tubes are removed during the hysterectomy, this process is known as bilateral salpingo-oophorectomy. A simple hysterectomy is done to treat stage IA cervical cancers and some stage 0 cancers (carcinoma in situ).

If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, a method of examining the inside of the abdomen and pelvis through a tube inserted into a very small surgical incision, the operation is called a total laparoscopic hysterectomy.

• Radical trachelectomy - The surgeon removes the cervix and the upper part of the vagina and places a "purse-string" stitch that acts as an artificial internal opening of the cervix inside the uterine cavity. The surgeon also removes the nearby lymph nodes. The operation is done either through the vagina or the abdomen. Trachelectomy is a new way to cure some early-stage cervical cancers while removing as little normal tissue as possible. This procedure may allow some young women with early-stage (Stage IA2 and IB) cancer that can’t be treated with conization to keep their ability to have children.

The following procedures are usually used for more advanced cervical cancers:

• Radical hysterectomy and pelvic lymph node dissection - Like a simple hysterectomy, this operation removes the entire uterus. But unlike simple hysterectomy, the tissues next to the uterus (parametria and uterosacral ligaments), the upper part (about 1 inch) of the vagina next to the cervix, and lymph nodes from the pelvis are also removed. The ovaries and fallopian tubes are not removed unless some other medical reason to do so exists. The removal of both ovaries and fallopian tubes during the hysterectomy is known as bilateral salpingo-oophorectomy. 

This surgery is usually done through an abdominal incision. But another approach, called laparoscopic-assisted radical vaginal hysterectomy, is done through the vagina. In this procedure, the surgeon uses laparoscopy, a method of examining the inside of the abdomen and pelvis through a tube inserted into a very small surgical incision. The surgeon can remove lymph nodes through the tube without making a large cut in the abdomen. The surgeon can also use the laparoscope to remove the uterus, ovaries, and fallopian tubes through a vaginal incision, so that an abdominal incision is not needed.

• Pelvic exenteration - In addition to removing the entire uterus, cervix, and pelvic lymph nodes (as in radical hysterectomy), the surgeon removes the vagina, ovaries, lower colon, rectum, and bladder. The surgeon creates artificial openings (stomas) to allow urine and stool to flow from the body to collection bags. Plastic surgery may be necessary to make an artificial vagina after this operation, which is used to treat recurrent cervical cancer.

This content has been reviewed and approved by Myo Thant, MD.