• Surgical Procedures for Cervical Cancer

    Surgery is the most common treatment for cervical cancer. The goal is to remove any abnormal tissue or tumor(s), and preserve as much of the cervix and its function as possible. It is also common to combine surgery with radiation therapy and/or chemotherapy to try to kill any cancer cells that may be left behind.
    Though CIN is not cancer, it has the potential to develop into cervical cancer. Treating it early by removing the abnormal tissue can decrease the risk of progression to cancer.
    The type of surgery depends on several factors. CIN and early stage cancer may be treated with less invasive procedures than late stage cancer. Factors that are considered include:
    • Grade of the abnormal cells. CIN is graded from 1 (low) to 3 (high) in severity. CIN 1 is normally watched and monitored, while CIN 2 and 3 require treatment. CIN 3 may also be called stage 0 cervical cancer (carcinoma in situ).
    • Stage of cancer and extent of treatment needed.
    • Whether you want to have children in the future.
    • Your age and general health.
    • The preference of you and your doctor.
    Many of these procedures can also be used for a biopsy. During a biopsy, suspicious tissue is removed so it can be examined under a microscope.

    Surgery for CIN and Early Stage Cervical Cancer

    Cryosurgery can be used to remove CIN and stage 0 cervical cancer by freezing off the abnormal cells. Nitrogen or carbon dioxide liquid is applied to a probe, which is inserted through the vagina. The substance is applied to the cervix. This procedure can be done in a doctor's office.
    Laser Surgery
    This procedure can be used to treat CIN and stage 0 cervical cancer. A laser beam is an intense, narrow beam of light which heats and kills the abnormal cells. The laser removes the abnormal cells directly on the cervix. This can be done in a doctor's office.
    Conization is the removal of a cone-shaped piece of tissue from the cervix. It can be done with a scalpel, cold knife, laser beam, or loop electrosurgery (LEEP). A LEEP procedure uses a thin wire that is heated by an electric current. Conization treats CIN or stage IA1 cervical cancer. After the tissue is removed, it is examine to see if the margins around the sample are clear of any abnormal cells. This helps determine if further treatment is needed.
    Conization preserves fertility in women who plan on having children following treatment.
    A cone biopsy is a diagnostic test to determine if cancer is present.

    Surgery for Advanced Cervical Cancer

    A hysterectomy is surgical removal of the uterus and cervix. Sometimes the fallopian tubes and ovaries are removed as well. The doctor may choose to remove pelvic lymph nodes near the uterus to determine if or where the cancer has spread. The extend of surgery depends on how much cancer is present. A hysterectomy is usually done for cervical cancer that is stage IA2 and higher.
    Hysterectomies can be done as:
    • Open—During open surgery, an incision is made in the abdomen. Doing so exposes the organs so they can be accessed by the surgeon. The uterus and cervix and removed through the abdominal incision.
    • Laparoscopic—Tubes are inserted into small incisions. Lights, a camera, and surgical instruments can be used through the tube. Images from the laparoscope are viewed on a special monitor. Healing and recovery time for laparoscopic surgery is generally faster than open surgery.
    • Robotic assisted—Robotic arms are inserted through small incisions. This allows for greater range of movement than a doctor's hand.
    In addition, a hysterectomy can be done through the vagina. During a vaginal approach, no external incision is needed. The vagina is kept open by special instruments. The uterus and cervix are then removed through the vagina. If a laparoscope is used for a vaginal hysterectomy, a pencil-thin scope is inserted next to the navel to access the uterus and cervix.
    In general, vaginal procedures can be done for lower stage cancer. Abdominal hysterectomies are done for later stages.
    Trachelectomy (or cervicectomy) is a procedure to remove the cervix in women with stages IA2 to II cancer. It may be done as a way to preserve fertility in young women who wish to have children after treatment. Like a hysterectomy, a trachelectomy can be done through the abdomen or vagina using the methods mentioned above. The amount of tissue removed around the cervix depends on the extent of the cancer.
    Trachelectomy is not considered standard treatment and is not available everywhere. In some cases, surgical staging done during this procedure turns up more cancer than originally thought. When this happens, prior understanding and consent to have a hysterectomy may be required.
    Women who become pregnant after this procedure have a significant increase in the risk of a premature birth or miscarriage. Cesarian delivery is also necessary after a trachelectomy.
    Pelvic Exteneration
    If the cancer has spread beyond the cervix into nearby organs, a more extensive procedure will be necessary. These include the vagina, urinary bladder, rectum, or lower portion of the colon. If the bladder, rectum, and/or part of the colon are removed, further surgery will be needed to store and remove wastes with a urostomy and/or colostomy. A vagina can be reconstructed from other bodily tissues.
    Pelvic Lymph Node Dissection
    Cancer can spread to the lymph nodes located in the pelvic region outside of the uterus. Once there, it can travel to other parts of the body through the lymphatic system. During surgery, some or all lymph nodes suspected of having cancer will be removed and examined under a microscope.


    Cervical cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003094-pdf.pdf. Accessed November 18, 2015.

    Cervical cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114831/Cervical-cancer. Updated April 11, 2016. Accessed October 3, 2016.

    Cervical cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/gynecology-and-obstetrics/gynecologic-tumors/cervical-cancer. Updated May 2013. Accessed November 18, 2015.

    Management of abnormal cervical cytology. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2015. Accessed November 18, 2015.

    Management of cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T902723/Management-of-abnormal-cervical-cytology. Updated June 1, 2016. Accessed October 3, 2016.

    Treatment options by stage. National Cancer Institute website. Available at: http://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq#section/%5F201. Updated June 12, 2015. Accessed November 18, 2015.

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