• Surgical Procedures for Cervical Cancer

    The type of surgery used will depend on the stage of the cancer. Surgical procedures may be done to:

    Treating Precancerous Lesions

    Determining the treatment for precancerous lesions depends on various factors, including:
    • Whether the lesion is low or high grade
    • Whether you want to have children in the future
    • Your age and general health
    • The preference of you and your doctor
    A low-grade lesion may not need further treatment if the affected area was removed during biopsy. But you will 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 the abnormal cells. 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—that freezes the area. The procedure usually takes about 15 minutes.
    Afterwards, you may have cramping and some bleeding, which may last several days and later a very watery discharge as the frozen area thaws and sheds the dead cells.
    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 which heats and kills the abnormal cells. 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.
    Hysterectomy
    A hysterectomy is surgical removal of the uterus, including the cervix. Sometimes the fallopian tubes and ovaries are removed as well. The doctor may choose to remove lymph nodes near the uterus to determine whether the cancer has spread.
    Description of the Procedure:
    There are three different methods:
    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. The cuts are all closed with stitches, which will likely leave small scars.
    With each procedure, a vaginal "packing" dressing is placed in the vagina. This will be removed after a day or two.
    Vaginal hysterectomy and laparoscopically-assisted vaginal hysterectomy (LAVH) can be performed if the stage os the cancer is very low. Abdominal hysterectomy permits careful removal of more tissue. IThis procedure is used when the stage is relatively higher.
    Robotic Surgery
    In addition to standard surgical techniques, your physician may choose to do surgery with the assistance of a robotic device. The surgical procedures are the same as standard surgery, but the robotic device can give greater dexterity and limit the size and type of incision necessary to perform the procedure, reducing complications and decreasing recovery time. Not every patient is suited for robotic surgery. Ask your physician if this option is available in your area and whether you are an appropriate candidate.

    References

    American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .

    American College of Obstetric and Gynecologists website. Available at: website. Available at: http://www.cancer.org/docroot/home/index.asp .

    American Medical Association website. Available at: http://www.ama-assn.org/ .

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

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