What to know about treating cervical cancer with surgery

Cervical cancer is a type of cancer that begins in the cells of the cervix, the lower part of the uterus in the female reproductive system. Cervical cancers often start in squamous cells, the thin, flat cells that cover the outer part of the cervix. Cervical cancers can also develop in glandular cells, which produce a thick, slippery fluid called mucous and are found at the opening of the cervix. Most cervical cancers begin in the transformation zone, the area of the cervix where these types of cells overlap.

Treatment for cervical cancer

Each case of cervical cancer is unique and requires an individualized approach tailored to specific features of the cancer and your personal situation. While your healthcare provider (HCP) will be your best source of information about your treatment options, it helps to have a basic understanding of the different treatment options and how they work.

Surgery is used for both the staging and treatment of cervical cancer. As with any cancer treatment, there are important factors a person with cervical cancer and their healthcare team will consider when deciding to treat with surgery and choosing the type of surgery:

• The type of cancer, the area of the cervix where the cancer is located, and the size and shape of the tumor
• The stage of the cancer, whether the cancer is growing into nearby blood vessels or lymph nodes, and if the cancer has spread to other parts of the body
• If this is the first time a person is being treated for cancer, or if this is a recurrence of a previous cancer.
• If the person diagnosed with cervical cancer is pregnant
• The person’s age, overall health, and medical history
• If maintaining fertility (the ability to reproduce and have children) is a treatment goal

Surgeries that treat cervical cancer

Surgery is often the first-line treatment for cervical cancer, especially in the early stages of the disease where the cancer has not spread. If surgery is a treatment option, the type of surgery used will depend on whether or not the person being treated wants to maintain fertility. Surgical procedures can include:

Cone biopsy

Also called conization, this is the surgical removal of the transformation zone. It can be used to diagnose cervical cancer and also as a treatment for early-stage cancers. This treatment option may be chosen if the person being treated wishes to maintain fertility.

Trachelectomy

This procedure removes the cervix and upper part of the vagina, but not the uterus. It can be used in some early-stage cervical cancers. This procedure can help the person being treated maintain fertility after treatment.

Hysterectomy

This is a surgical procedure to remove female reproductive organs. When treating cervical cancer, this can be a simple hysterectomy (which removes the uterus and cervix) or a radical hysterectomy (which includes the removal of the uterus, cervix, part of the vagina, as well as surrounding tissues). This may be chosen as a treatment option if maintaining fertility is not a treatment goal.

Keep in mind that these are basic descriptions of procedures that can be approached in different ways and can vary from one person to the next. Any time you are discussing surgery with your HCP, ask for detailed information. Ask questions if there is anything you don’t fully understand, or that you are unsure about.

Surgery to remove lymph nodes

Lymph nodes are small clusters of cells that are located along the lymph vessels in areas throughout the body. Lymph nodes contain white blood cells that are part of the immune system and filter out unwanted substances. A lymph node is roughly the size of a pea.

Cervical cancer can spread to nearby lymph nodes as well as lymph nodes in other areas of the body. During staging, surgery may be used to check if cancer has spread into lymph nodes. Surgery may also be used to remove any lymph nodes that have become cancerous.

Surgery and other treatment options

Surgery may be used in combination with other treatment options, including:

• Radiation therapy
• Chemotherapy, when drugs kill and the stop the growth of cancer cells
• Targeted therapy, which targets specific molecules on cancer cells to stop their growth and spread
• Immunotherapy, or drugs that help the immune system defend against cancer

Each of these treatment options has the potential to cause side effects and affect fertility. These are topics to be discussed with your HCP before starting treatment. If you have questions about treatment for cervical cancer and insurance coverage, speak with your HCP.

While cervical cancer is a different experience for everyone, everyone with cervical cancer should take an active role in treatment decisions. Ask questions, advocate for your treatment goals and your quality of life, and keep learning.