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• Hysterectomy - This is an operation to remove a woman's uterus, and in some cases, the ovaries and fallopian tubes as well. It may be offered to women with earlier stage invasive cancer who do not desire future childbearing. Depending on the specific situation, the surgery may be performed as an open procedure (through an incision in the lower abdomen) or, if the cancer is small and in an early stage, laparoscopically ("minimally invasive surgery", which requires several very small incisions). There are several types of hysterectomies:

  • Complete or total hysterectomy - removes the cervix as well as the uterus (this is the most common type of hysterectomy.)
  • Partial or subtotal hysterectomy - removes the upper part of the uterus and leaves the cervix in place (not used in the case of cervical cancer).
  • Radical hysterectomy - removes the uterus, the cervix, the upper part of the vagina, lymph nodes and supporting tissues.

• Radical trachelectomy - In some very early cervical cancers, when the woman wishes to preserve fertility, it may be possible to remove most of the cervix but leave enough to preserve fertility. Radical trachelectomy involves removal all of the cancer, but spares the internal opening of the cervix which is then secured with placement of a stitch to support a pregnancy until the baby can be born by Caesarean section. Unfortunately, however, the premature delivery rate remains high. It may still be necessary to perform a hysterectomy if the cancer cells are found upon microscopic evaluation during surgery to have spread beyond the area. Because there is a small risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, your surgeon may also need to remove some lymph nodes in the area. This is usually done with a laparoscope via several small incisions in the abdomen. Hospital stays for this procedure are usually only 2-3 days. Most women recover quickly and complications are uncommon.

• Pelvic Exenteration - This is a type of surgery that involves a radical hysterectomy (removal of the cervix, uterus, fallopian tubes, ovaries) in addition to removal of the urethra, vagina, rectum, anus, and in some cases, the vulva. The procedure requires placement of a permanent colostomy, where stool empties into a bag on the left side of the abdominal wall. The bladder is reconstructed from bowel to provide a reservoir which empties into a pouch on the abdomen. Pelvic exenteration is most commonly used in cases of advanced or recurrent cervical cancer, vaginal cancer, and vulvar cancer when more conservative surgical options are not technically possible or would not be able to remove the extent of the tumor.

Complications of Surgical Treatment

• Urinary tract injury - may result in incontinence or bladder retention (the inability to fully empty the bladder).

• Lymphocysts - These are benign cystic masses that may develop in the early days to weeks following radical pelvic surgery. When lymphocysts develop many months after surgery, it is important to differentiate between the usual benign cyst and the presence of recurrent tumor. This is accomplished by surgical removal of the cyst so that it can be evaluated microscopically.