Women suffering from cervical cancer will undergo some kind of surgery and they can be categorized as per their functions like:
- Diagnosis of cervical cancer
- Determination of the cancer spread
- Treat cancer, especially the ones in the early stage.
Some surgeries work by destroying cervical cancer by targeting the tissue with cold or with a laser rather than removing it.
Cryosurgery: In this kind, a cold metal probe is placed directly on the cervix to have the cancer cells killed with freezing temperatures. In a doctor’s office or clinic, this can be done. After the surgery, the patient may find brown discharge from the vagina for some weeks.
Laser surgery: In this case, a laser beam is focused through the vagina with the aim of burning or vaporizing the abnormal cells for the removal of a small piece of tissue for the study. This is done under local anesthesia so patients do not get to feel anything.
Conization: from the cervix, a cone-shaped tissue is removed with the help of a laser knife or a cold knife cone biopsy. At times the thin wire is also heated with the help of electricity ( this is the loop electrosurgical, LEEP or LLETZ procedure). The removed tissue will be thoroughly examined under a microscope to check for cancer or pre-cancer cells in the outer edges of the tissue. If some cancer is still found to be left behind, then further treatment is required.
Simple (total) hysterectomy: In this surgery, the uterus and cervix are removed but the structures beside uterus like the uterosacral ligaments and parametria are not touched. The vagina and pelvic lymph nodes are kept as it is and the ovaries and fallopian tubes are also in place until unless there is a reason to remove them as well. There are different kinds of hysterectomy and below we have discussed their types.
Abdominal hysterectomy: Here the uterus gets removed surgically through an incision made in front of the abdomen
Vaginal hysterectomy: In this kind, the uterus is removed via the vagina.
Laparoscopic hysterectomy: A thin tube having a tiny video camera attached to the end of the laparoscope is inserted into one or more very small surgical incisions to view the interiors of the pelvis and abdomen. This is also referred to as keyhole surgery. Through the tube, the small instruments can be controlled so that the surgeon can make cuts and through the tube gets to remove the tissues without having to make a large cut in the abdomen.
Laparoscopic-assisted vaginal hysterectomy: The ovaries, uterus and the fallopian tubes get removed via an incision made in the vagina with a laparoscope inserted for the surgeon’s ease.
Robotic-assisted surgery: with the help of special tools laparoscopy is done. The tools are attached to robotic arms that are controlled by the doctor for helping in doing precise surgery.
General or epidural anesthesia is used for all the above procedures. The hospital stay does not stretch for more than 2 to 3 days followed by a recovery period of 2 to 3 weeks thereafter. A hospital stay of 5 days is common in case of abdominal hysterectomy and the recovery period can stretch for 4 to 6 weeks.
Side effects expected: Any kind of hysterectomy comes with the result of infertility or inability to give birth to children. Certain complications like wound infection, bleeding or damage to urinary or intestinal systems can be rare. However, hysterectomy does not bring about any change in the ability of a woman to enjoy sexual pleasures and orgasm remains unaffected. The area around the clitoris and the vaginal lining remains intact and as sensitive as it was before.
Radical hysterectomy: In this kind of operation, uterus along with the tissues associated with it are removed which are the uterosacral ligaments and parametria and almost 1 inch of the upper region of the vagina and cervix. Again the ovaries and fallopian tubes are not touched. This is brought about with an incision made in the abdomen and some of the pelvic lymph nodes are removed and hence it is also called node dissection. This kind of surgery can also be done using a laparoscopy which can reduce pain and the stay time in hospital is also reduced.
In laparoscopic-assisted radical vaginal hysterectomy is performed through the abdomen and the lymph nodes get removed. This is called the laparoscopically assisted radical hysterectomy with lymphadenectomy.
Robot-assisted laparoscopic is similarly done where the surgeon controls the surgery with the help of robotic arms. In this case, less blood loss is involved and a shorter stay in hospital but it is not clear if long term benefits are better.
Possible side effects include infertility since the uterus is removed. A catheter may be required for emptying the contents of the bladder since some of the nerves of the bladder get removed. There can be excessive bleeding or damage to the intestinal and urinary system, but these are rare. Apart from this all other sexual desires and feelings remain intact and women can safely have sexual intercourse with their partner.
Trachelectomy: In this procedure, women do not need to lose their ability to give birth. Through the abdomen or through the vagina the operation is done with the help of laparoscopy. The cervix and the upper part of the vagina get removed but the body of the uterus remains as it is. Something called a purse-string stitch is placed which acts as an artificial opening of the cervix which is inside the uterine cavity.
Through another incision, the nearby lymph nodes are also removed with laparoscopy and that is also done through vagina and abdomen. After this surgery, the women are able to carry out the pregnancy til the last term and is able to deliver the baby through a cesarean section but may always be in the higher risk zone.
Pelvic exenteration: This surgery is specifically helpful for treating recurrent cervical cancer. Most of the same organs and tissues are removed as in a radical hysterectomy along with pelvic node dissection. Some parts of the bladder, rectum, vagina, and colon can also be removed depending on the extent of the spread of cancer. If the bladder gets removed then one would require a new way to store and eliminate urine. Usually, a small segment of intestine is used for the functioning of the new bladder. This new bladder is connected with the abdominal wall and the urine gets drained periodically. Urine may also get drained in a small plastic bag attached to the front of the abdomen.
If the rectum and some parts of the colon get removed, then the removal of fecal matter has to be arranged in a different way. The remaining intestine is attached to the abdominal wall so that fecal matters can pass through a colostomy into a small plastic bag worn on the front of the abdomen. In certain cases, cancerous parts of the colon just next to the cervix gets removed and the colon gets reconnected so that no bags or external appliances are needed.
If the vagina gets removed, then a new one can be created out of the skin or intestinal tissue or muscle and skin called myocutaneous grafts.
Recovery from this kind of surgery can take almost 6 months and in some cases, they can even take 2 years to feel normal. Yet women can get back to happy and productive lives with some amount of discipline, practice, and determination and can lead a good conjugal life after some time.
Pelvic lymph node dissection: the pea-sized collection of immune system tissue gets affected when cancer starts spreading from the cervix onwards. So some of these lymph nodes may be removed to check for cancer spread. Removal of lymph nodes can lead to fluid drainage troubles in the leg and can bring about severe swelling in the leg or a condition called lymphedema.
Para-aortic lymph node sampling: if cancer gets detected in any of the pelvic lymph nodes while having the surgery then some of the lymph nodes along the aorta artery may be removed. This is called para-aortic lymph node sampling. If the spread is found then radiation therapy will be recommended with or without chemotherapy. Even with an imaginary test like MRI or PET/CT scan, one can check for the spread with the help of an imaging test. Lymph nodes that are found to be bigger than usual will be required to be biopsied.