In the early stages of cervical cancer, surgery is usually the preferred primary treatment approach. Not all women are candidates for all surgical procedures.
Surgery procedures by stage are:
- Loop Electrosurgical Excision Procedure (LEEP) and Laser Surgery. Used for pre-invasive cancer including cervical intrapethelial neoplasia (CIN) and stage 0.
- Conization. Used for treating pre-invasive cancer (CIN and stage 0) and invasive cancer stage IA1.
- Cryosurgery. Used for stage 0.
- Total (Simple) Hysterecomy. Used for stage 0, stage IA1.
- Radical Hysterectomy. Used for stage IA2, stage IB1 and 1B2, stage IIA.
- Radical Trachelectomy. Used for select women with stage IA2, stage IB1.
Loop Electrosurgical Excision Procedure
Loop electrosurgical excision procedure (LEEP), also called large loop excision of the transformation zone (LLETZ), uses a high frequency electrical current to cut away diseased tissue.
- A local anesthetic is applied to the cervix, and a wire loop is inserted into the vagina.
- A button-sized slice of tissue is removed from the cervix for examination.
- A deeper slice is used to evaluate the endocervical canal.
The procedure is done in one office visit. Extensive and deep sections of damaged tissue can be effectively removed in this visit. Disease can be cured in one treatment. When used for dysplasia, it appears to be as effective as more invasive procedures.
Laser surgery for cervical cancer uses a laser beam, in place of a knife, to burn off abnormal cells or to remove pieces tissue for biopsy. The laser beam is directed through the vagina.
Conization is a surgical procedure that removes a cone-shaped piece of tissue from the cervix. Conization uses either a heated wire, like LEEP, or it may involve a scalpel or laser (in which case the procedure is sometimes called “cone knife cone biopsy”). The surgery is performed under general anesthesia in an operating room. With conization, the ability to become pregnant can be preserved in most cases.
A hysterectomy attempts to eliminate the cancerous tissue by removing the uterus. In women of childbearing age, the ovaries can usually be left intact. Although a woman who has a hysterectomy but retains her ovaries cannot bear children, she will not go into premature menopause.
Women with cervical cancer usually have either a total (simple) hysterectomy or a radical hysterectomy.
Total Hysterectomy. A total (also called simple) hysterectomy involves the removal of the uterus and the cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. Lymph nodes in the pelvis are not usually removed. The uterus may be removed through an open abdominal incision or vaginally. There are various ways to perform vaginal hysterectomy, including laparoscopically. A simple hysterectomy is usually performed to treat stage IA1 cervical cancer. [For more information on hysterectomy procedures, see In-Depth Report #73: Uterine fibroids and hysterectomy.]Click the icon to see an illustrated series detailing a hysterectomy.
Radical Hysterectomy. A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the pelvic lymph nodes (a procedure called lymphadenectomy). The fallopian tubes and ovaries are not usually removed, (a procedure called bilateral-salpingo-oopherectomy) unless there are other medical reasons for doing so. Radical hysterectomy is used to treat cervical cancers in stages IA2, IB1, and IB2.
Pelvic Exenteration. If the cancerous tumor recurs within the pelvis after primary treatment, the patient may need a more extreme procedure called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. (In such cases, plastic surgery may be needed afterward to recreate an artificial vagina.)
Recovery. Hospital stays for simple hysterectomy range from 1 - 2 days for vaginal hysterectomy to 3 - 5 days for abdominal hysterectomy. Total recovery time is generally 2 - 3 weeks for vaginal hysterectomy and 4 - 6 weeks for abdominal hysterectomy. Radical hysterectomy generally requires a 5 - 7 hospital stay and about a 6-week recovery period.
Side Effects. Side effects include difficulty emptying the bladder or bowels and a painful lower abdomen (if an abdominal incision was used). Normal activity, including intercourse, can be resumed in about 4 - 8 weeks. The effects of hysterectomy on sexuality vary among women. Some women note a change in their orgasmic response because they no longer experience uterine contractions.
Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in natural menopause. The patient should discuss the benefits and risks of hormone replacement therapy with her doctor.
[For more information on hysterectomy, see In-Depth Report #73: Uterine fibroids and hysterectomy.]
For some women with stage IA2 and stage 1B cancer, radical trachelectomy may be a fertility-sparing alternative to hysterectomy. Radical trachelectomy involves removing the cervix, surrounding lymph nodes, and upper part of the vagina. The uterus is then reattached to the remaining vagina.
Radical trachelectomy was first introduced in 1995 and is a relatively new, and complex, procedure. Surgeons must be highly trained to perform it, and doctors must be selective about choosing women who are appropriate potential candidates. Patients must meet strict criteria in terms of lesion size and lymph node involvement.
Radical trachelectomy does pose a high risk for miscarriage during future pregnancy, but about half of women who have had this procedure have been able to carry a baby to term. The baby is delivered by cesarean section.