Surgery for cervical cancer

For some people, surgery may be the only treatment needed. Surgery is usually recommended when the tumour is in the cervix only. The type of surgery you have will depend on how far within the cervix the cancer has spread. The illustrations on the next two pages provide more information about the main types of surgery. Your surgeon may also remove some lymph nodes during surgery.

Learn more about:

• Types of surgery
• How the surgery is done
• Surgery to remove lymph nodes
• What to expect after surgery
• Side effects of surgery
• Taking care of yourself at home

Types of surgery

Depending on how far the cancer has spread and your age, you may have one or more of the procedures listed below.

	Cone biopsy Removes a cone-shaped piece of tissue around the cancer, including a margin of healthy tissue. A cone biopsy is used to treat very early cervical cancers, particularly for young women who would like to have children. For more information see cone biopsy.
	Trachelectomy Removes part or all of the cervix, along with the upper part of the vagina. The uterus, fallopian tubes and ovaries are left in place. This is not a common procedure, but it may be used in young women with early-stage cancer who would like to have children. For more information see Fertility issues.
	Total hysterectomy Removes the uterus and cervix. This surgery can be used for early cervical cancers. The fallopian tubes are also commonly removed (see Bilateral salpingectomy). Some premenopausal women are able to keep their ovaries.
	Radical hysterectomy Removes the uterus, cervix, and soft tissue around the cervix and top of the vagina. This is the standard operation for most cervical cancers treated with surgery. The fallopian tubes are also commonly removed (see Bilateral salpingectomy). Some premenopausal women are able to keep their ovaries.
	Bilateral salpingectomy Removes both fallopian tubes. This procedure is commonly recommended for women having a hysterectomy.
	Bilateral salpingo-oophorectomy Removes both fallopian tubes and ovaries. This is considered for women having a hysterectomy when your doctor is concerned that the cancer may have spread to the ovaries, or for women approaching menopause (between the ages of 45 and 55) or who have been through menopause.

How the surgery is done

Your surgeon will talk to you about the most suitable surgery for you, as well as the risks and any possible complications (in both the short and long term).

The surgery will be performed under a general anaesthetic. Research has shown that outcomes for cervical cancer surgery are better with open surgery (laparotomy). This means that the surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made along the bikini line instead. The uterus and other organs are then removed through the cut.

Keyhole surgery (laparoscopy or robotic surgery) is not commonly recommended to treat cervical cancer.

Surgery to remove lymph nodes

You may have one of the following procedures to check if the cancer has spread from the cervix to lymph nodes in the pelvis.

Sentinel lymph node biopsy

This procedure may be used for some women with early cervical cancer and is only available in some treatment centres. It helps to identify the lymph node that the cancer is most likely to spread to first (the sentinel lymph node). While you are under anaesthetic, your surgeon will inject a dye into the cervix. The dye will flow to the sentinel lymph node and the surgeon will remove it for testing. If it contains cancer cells, the surgeon may remove the remaining nodes in the area in a procedure called a lymphadenectomy. Alternatively, your doctors may decide you need other treatments such as chemoradiation. A sentinel lymph node biopsy can help the surgeon avoid removing more lymph nodes than necessary and minimise side effects such as lymphoedema.

Lymphadenectomy (lymph node dissection)

The surgeon will remove an area of lymph nodes from the pelvic and/or abdominal areas to see if the cancer has spread beyond the cervix. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as radiation therapy.

For more on this, see our general section on Surgery.