Cervical Cancer Surgery

When surgery is possible

Surgery is the main treatment for early tumors without lymph node involvement. The extent depends on the stage:

• microinvasive cancer — conization with clear margins or simple hysterectomy is usually enough; the extent is refined by lymphovascular invasion, and the lymph nodes are assessed when needed;
• a tumor up to 4 cm confined to the cervix — radical hysterectomy with assessment of the pelvic lymph nodes; for small low-risk tumors the extent can be reduced;
• a tumor smaller than 2 cm in a woman planning pregnancy — a fertility-sparing operation after confirming that the lymph nodes are not involved and selection by histological type and other criteria.

The stage and spread are assessed with pelvic MRI and, for locally advanced tumors or suspected nodal involvement, with PET-CT. The disease itself, its causes and tests are described on the page “Cervical Cancer”.

When chemoradiotherapy replaces surgery

For tumors of 4 cm or more, extension into the parametrium (the tissue around the cervix) or lymph node involvement, the standard is chemoradiotherapy: external beam radiation with chemotherapy and intracavitary brachytherapy. This is not a “worse option” but the main treatment for exactly these tumors.

If involved lymph nodes are found during surgery, the radical hysterectomy is usually not completed, and the patient is referred for chemoradiotherapy. In distant metastases treatment is systemic. For a central pelvic recurrence after radiation, pelvic exenteration — removal of the pelvic organs together with the tumor — is possible in selected patients.

If you have been offered surgery for a large tumor or radiation for a small one, it makes sense to get a surgeon’s second opinion before treatment starts.

Types of cervical cancer surgery

How radical hysterectomy is performed

The uterus with the cervix, the parametria, the upper third of the vagina and the pelvic lymph nodes are removed; often the sentinel lymph nodes are found and examined first. In young patients with squamous cell carcinoma the ovaries are usually preserved. When it is oncologically safe, the nerves that control the bladder are preserved during surgery.

Unlike many other tumors, the standard approach here is open. The large randomized LACC trial and subsequent data showed that recurrences occur more often after laparoscopic radical hysterectomy. A minimally invasive approach can be discussed only for tumors smaller than 2 cm with clear margins after conization, in an experienced specialized center that meets ESGO quality criteria, if the patient agrees after a detailed discussion of the evidence and the risks.

Hospital stay, recovery and follow-up

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. After radical hysterectomy the bladder may temporarily empty less well — a catheter is left for several days and residual urine is checked. The length of the hospital stay depends on the extent of surgery.

If the histology shows risk factors — involved lymph nodes, parametrium or margins — chemoradiotherapy is usually given after surgery; with a combination of other factors (tumor size, lymphovascular invasion, depth of invasion) radiotherapy is considered.

For the first 2 years check-ups take place every 3–6 months, then less often up to 5 years; tests are ordered according to symptoms and stage. After fertility-sparing surgery follow-up is more intensive: cytology, HPV testing and MRI on the schedule set by the doctor.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• urinary problems — the bladder may temporarily empty less well; when it is oncologically safe, the nerves are preserved to reduce this risk;
• leg swelling after removal of the lymph nodes — which is why lymphedema prevention matters;
• bleeding during or after surgery;
• infection and general surgical complications, including thrombosis.

Combining radical surgery with radiation adds complications, so it is avoided by design and the choice of method is made before surgery. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of surgery, whether the sentinel lymph nodes are examined, the number of days in the hospital and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• the histopathology report of the biopsy or conization with tumor size, depth of invasion and margin status;
• tissue blocks and slides — for review in another laboratory;
• pelvic MRI discs, PET-CT or CT with the reports;
• cytology and HPV test results, the colposcopy report;
• summaries of previous treatment, if there was any.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.