Surgery for Larger Cancers

The following surgical procedures may be used for larger cervical cancer lesions (usually up to 4 to 5 centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.

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Trachealectomy: This procedure removes the cervix and surrounding tissue but not the uterus. It is used for women who have a larger cancer but wish to preserve the ability to have children. A woman who becomes pregnant after a trachealectomy will have to have stitches placed in the cervix (a procedure called cerclage) to carry the pregnancy. Trachealectomies are only done at specialized hospitals. The procedure may include removal of lymph nodes. Depending on a woman's age and the size of the tumor, she may also have a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). A woman cannot get pregnant with her own eggs after a bilateral salpingo-oophorectomy.

In some cases, these procedures can be done without open surgery, with the help of a small telescope called a laparoscope. The laparoscope is inserted through small incisions in the abdomen so the surgeon can see the area around the uterus. At the same time, surgical instruments can be inserted through another incision. Laparoscopy allows the surgeon to inspect the abdominal cavity for spread of cervical cancer and scar tissue without making a large incision.Laparoscopy may allow a woman to avoid more invasive open surgery that uses larger incisions. Compared with open surgery, it leaves smaller scars, is often less risky, and usually requires a shorter recovery period.

Radical hysterectomy: The surgeon removes the cervix, uterus, part of the vagina, and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes. Hospital stay is usually from one to two days for postsurgery care. Some women may stay in the hospital up to four days. More and more radical hysterectomies are being done laparoscopically by gynecologic oncologists. You should discuss your surgical options with your doctor.

Side effects from surgery vary depending on the procedure. Some women have excessive bleeding, infection, or damage to the urinary and intestinal systems. Most of the risks are very small and temporary. Complete recovery usually takes four to eight weeks. Activity after surgery can be gradually increased, but you should avoid heavy lifting for the first two weeks. After a few weeks, you may begin to do light chores and some driving, and return to work if your job is not too physically demanding. By the sixth week you should be able to take tub baths and resume sexual activities.