Cervical Cancer Surgery

Cervical Cancer Surgery

Surgery is often the first line of treatment for patients with early-stage cervical cancer.

There are a number of procedures that can be used to treat cervical cancer depending on the size and location of the cancerous tissue. Washington University gynecologic oncologists are skilled surgeons with special expertise in fertility-sparing procedures that can treat cervical cancer effectively while allowing patients to maintain the hope of becoming pregnant in the future.

Surgeries for early-stage cervical cancer

Women with early-stage cervical cancers – or, cancers limited to the cervix – typically undergo one of the following, fertility-sparing procedures.

Conization

During a conization, or cone biopsy, surgeons remove the cancer from the cervix by cutting out a segment of tissue shaped like a cone. This is often done for women who desire to get pregnant in the future and have very localized, early-stage cervical cancer. In many cases, patients can undergo conization as an outpatient procedure, and some unique cases may need sentinel lymph node biopsy too.

Many patients do not need further treatment after undergoing a conization. However, if the surgical team cannot remove all of the cancer they will recommend additional treatments.

Radical trachelectomy

 If the cancer is too extensive to be treated with a conization, but is still limited to the cervix, a trachelectomy may be an appropriate fertility sparing treatment. During this procedure, the surgeon will remove the cervix and adjacent lymph nodes and tissues. Then, the surgeon will connect the uterus to the vagina.

A radical trachelectomy can be conducted through an open incision in the abdomen or laparoscopically. Laparoscopy is a minimally invasive surgery, meaning that the surgeon makes several small incisions and uses cameras and special instruments to work inside the body.

Because a radical trachelectomy leaves the uterus in place, patients are still able to get pregnant and carry their own children. This procedure can be a good fit for women hoping to expand their family but may not be for everyone.

Radical trachelectomies are complex surgeries that are not offered at all hospitals. At Siteman, we will leverage all of our expertise and experience to make sure you receive the best care possible.

Which surgical interventions impact fertility?

 There are many surgical options for cervical cancer treatment. Fertility preservation is a consideration for some patients, for others it is less of a factor. Your physician may recommend these options if you are:

• post-menopausal,
• not wanting to become pregnant, or
• at an advanced cervical cancer stage that requires it.

Before undergoing any kind of hysterectomy, patients can ask about fertility preservation.

Total hysterectomy

During a total hysterectomy, surgeons remove the cervix, uterus and fallopian tubes, but often leave the ovaries in place. There are a number of ways to do this. Sometimes, the uterus can be taken out through the vaginal canal. If the procedure is being performed laparoscopically, then the patient will only need several small incisions. Other times, the surgeon will have to make a larger incision in the abdomen to perform the procedure safely and effectively.

Your recovery time will depend on the type of procedure your surgeon conducts. Patients who undergo laparoscopic or minimally invasive procedures typically recover more quickly than patients who undergo more traditional, open procedures. Your surgeon will choose the best approach for you, your body, and your condition.

Radical hysterectomy

A radical hysterectomy is more extensive than a total hysterectomy. In addition to the cervix, uterus and fallopian tubes, the surgeon also removes some of the surrounding tissues that touch the cervix, including the upper vagina, and pelvic lymph nodes. The ovaries may be removed as well.

Fertility preservation

Women diagnosed with cervical cancer are sometimes concerned about being able to have children in the future. Siteman offers procedures to help our patients protect their fertility if they are still of child-bearing age. We also recognize that some patients may be struggling to balance cancer treatment with their work and family obligations, and we try to assist however we can.

Having the uterus removed during a total or radical hysterectomy leaves patients unable to carry a child. While such a course of treatment may be necessary to protect a patient’s life, Washington University oncologists at Siteman also recognize that it can be devastating for women who still hope to have children.

If you are a woman with cervical cancer and facing a fertility-ending surgery or treatment, you still have options. Siteman offers a number of services and procedures that can enable patients to have a child, including egg banking and embryo banking.