Pre-cancer vs. cancer

Pre-cancer cells of the cervix are not treated the same as invasive cancer. Pre-cancer cells are also called dysplasia or carcinoma in situ. These types of changes are only in the surface layers of the cervix. They have not grown into deeper tissues. Invasive cancer has grown through the surface of the cervix. Both can be treated with surgery. But different types of surgery are used.

Surgery for pre-cancer

Treatment for pre-cancer depends on the size of the area of changed cells and any other treatments you may have had. Some surface cell changes may be treated without major surgery. These treatments may include cryosurgery, laser therapy, or conization. Removing the uterus (hysterectomy) is another option, but it's seldom needed to treat pre-cancer.

The most common types of surgery for cervical pre-cancers include:

Cryosurgery

A very cold, metal probe is touched to the part of your cervix with the changed cells. This freezes and kills the pre-cancer cells on the cervix. Cryosurgery may be done in your healthcare provider's office or clinic.

Laser surgery

This type of surgery uses a narrow beam of light to create heat. The heat vaporizes (burns off) and destroys the abnormal cells. You may have this procedure in your healthcare provider's office or in an operating room.

Conization

This is a type of biopsy and treatment. It can be done in your healthcare provider's office. You'll be given a local anesthesia. This means drugs will be used to make part of your cervix numb. A laser, knife, or an electric wire is then used to remove the changed cells in a cone-shaped piece of tissue taken from the outer part of the cervix. The removed tissue is sent to a lab and tested to make sure there are no cancer cells in it. When the electric wire is used, this procedure is also known as loop electrosurgical excision procedure (LEEP).

Simple hysterectomy

This is a major surgery. A doctor removes your uterus and cervix through a cut (incision) made in your belly (abdomen) or through your vagina. A hysterectomy can also be done as a laparoscopic or robot-assisted surgery. This usually has a faster recovery because a few small cuts are made instead of 1 big cut. This surgery uses regional anesthesia (epidural or spinal) to make you numb below the waist. Or you might be given general anesthesia so you’re asleep and don't feel pain. You stay in the hospital for a night or so after surgery. Hysterectomy might be used for women who've had more than one treatment and still have pre-cancer cervical cells. 

Surgery for invasive cervical cancer

Invasive cancer means the cancer has spread beyond the surface of the cervix into the deeper layers. Women with invasive cancer may be treated with some of the same types of surgery used for pre-cancer. The type used depends on the size and stage (extent) of the cancer and on whether you want to have children. The most common types of surgery for invasive cervical cancer include:

Conization or LEEP

Your healthcare provider may use this procedure instead of a hysterectomy to treat a stage IA cancer if you want to get pregnant in the future. It can be done in the office under local anesthetic. A laser, knife, or an electric wire is used to remove a cone-shaped piece of tissue from the outer part of the cervix that contains the cancer. The tissue is sent to a lab and tested to make sure no cancer cells are near the edges (margins) of the cone. Sometimes all the cancer cells are removed in one procedure. Still, when using this treatment, there's a small chance that the cancer will come back. It's important to keep all follow-up appointments to watch for signs that the cancer is back

Simple hysterectomy

This is the standard treatment for stage IA1 invasive cancer in women who don’t want to get pregnant in the future. Your whole uterus and cervix are removed through your abdomen or vagina. Anesthesia is needed. Regional anesthesia makes you numb so you don't feel the surgery. General anesthesia means you are given drugs that make you sleep and not feel pain while surgery is done. You stay at least 1 night in the hospital. Women often recover faster when the hysterectomy is done through the vagina. Laparoscopic or robot-assisted surgery also tends to have a faster recovery. This is when the surgery is done through a few small cuts instead of 1 big cut. The ovaries and fallopian tubes don’t need to be removed to cure cervical cancer. Talk about this with your surgeon before the surgery. Removing your ovaries causes menopause.

Radical hysterectomy

This type of surgery can be used to treat stage IA2, IB1, IB2, and sometimes small IIA cancers. Your uterus, cervix, the upper part of your vagina, and the tissue that holds your uterus in place are removed. The lymph nodes in the pelvic area might also be taken out to test them for cancer. This surgery is often done through an incision in your abdomen. Laparoscopic or robotic surgery may be used, too. But studies have shown that there's a higher chance of the cancer coming back when the surgery is done this way. Your ovaries don't need to be removed in a radical hysterectomy. This is important for younger women. Removing ovaries causes menopause.

Radical trachelectomy

This surgery is less often used. It's an option that may be used if you are young and want to get pregnant in the future. Your cervix, pelvic lymph nodes, the upper part of your vagina, and nearby tissues are removed. Your uterus is then reattached to the remaining vagina. A band is put around the bottom of your uterus to work like the cervix would. For some women, this procedure is as likely as a radical hysterectomy to cure cervical cancer. But this surgery is complex. It should only be done by a gynecologic oncologist who has experience doing it. After this surgery, there's an increased risk of infertility and pregnancy-related complications. For a future pregnancy, you may need fertility treatments and high-risk pregnancy care, and you will need to deliver by cesarean section.

Getting ready for your surgery

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask about:

• What type of surgery will be done

• What will be done during surgery (what organs will be removed)

• If you'll go into menopause after surgery (if your ovaries will be removed)

• The risks and possible side effects of the surgery

• What you can expect sex to be like after surgery 

• If you will be able to get pregnant after surgery

• When you can return to your normal activities

• If the surgery will leave scars and what they will look like

• What you should do to get ready for surgery

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. Also tell them if you use marijuana, tobacco, alcohol, or street drugs. This is to make sure you’re not taking anything that could affect the surgery. After you've discussed all the details with the surgeon, you'll sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist or nurse anesthetist and can ask questions about the anesthesia that will be used and how it will affect you. Just before your surgery, this specialist will give you the anesthesia so that you fall asleep and/or don’t feel pain.

Common side effects after surgery

The side effects you have depend mostly on the type of surgery you have.

For cryosurgery or laser therapy, you may have:

• Pain

• Tiredness

• Vaginal bleeding or watery discharge

• Cramps that might seem like those you get with your period

For conization or LEEP, you may have side effects such as:

• Tiredness

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Increased risk for fertility problems due to narrowing of the cervical canal

For a hysterectomy, it will take you up to 6 weeks to feel better. You'll no longer have periods. You may have a lot of emotions about not being able to get pregnant in the future. You may have side effects such as:

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Trouble passing urine or having a bowel movement

• Tiredness

• Risk of blood clots

• Risk of infections, such as pneumonia or at the incision(s)

• Dehydration

• Damage to nearby organs, like the bladder, ureters, or rectum

• Leg swelling (called lymphedema) if lymph nodes are removed

For a radical trachelectomy, you may have an increased risk for infertility. If you do become pregnant, you may have a higher risk for miscarriage, pregnancy loss, and pre-term delivery. Right after surgery, you may have these side effects:

• Pain

• Vaginal bleeding, cramps, or watery discharge

• Trouble passing urine or having a bowel movement

• Tiredness

• Risk for blood clots

• Risk for infections, such as pneumonia or at the incision

• Injury to nearby organs, like the bladder, ureters, or rectum

Most of these side effects go away as you heal and recover. Irregular bleeding may continue. Your healthcare provider or nurse can help you learn how to cope with these problems. For instance, you can control pain with medicine. Before you go home, talk with your healthcare provider about how to recognize and manage problems. Most women who have had surgery get back to their normal activities within 6 weeks or so. Your provider will tell you when it's OK to have sex.

Recovering at home

When you get home, you may get back to light activity. Avoid strenuous activity for 6 weeks. Limits will depend on the type of surgery you had. Your healthcare team will tell you what kinds of activities are safe for you while you recover.

When to call your healthcare provider

Talk to your healthcare provider about problems you should watch for. Call right away if you have any of the following:

• Any unusual bleeding or bleeding that soaks the bandage

• Redness, swelling, or fluid leaking from the incision or vagina

• Incision opens up or the edges pull apart

• Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

• Chills

• Cough, chest pain, or trouble breathing

• Redness, warmth, swelling, or pain in a leg or arm

• Trouble or pain when passing urine or changes in how your urine looks or smells

You may be given medicines, like pain pills, to take after surgery. It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work, what they're for, what dose you should take, when you should take them, and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when you need to call them. Know what number to call with problems or questions, even on evenings and weekends.