The cervix is the lower part of the uterus. It keeps a baby inside the uterus during pregnancy until labor when it stretches to allow the baby to pass through and be delivered.
All gynecologic cancers, including cervical cancer, are staged. Staging is a way of talking about how far a cancer has spread from where it started and helps guide our recommendations for treatment. Early cervical cancers (Stage I or II) are treated with surgery.
Before surgery, we will perform a few other tests. These may include:
- Blood tests to determine anemia and check kidney and liver function
- Chest x-ray
- CT scan of abdomen and pelvis and possibly chest
- Colonoscopy (depending on age and symptoms)
- Consultation with urologist for possible cystoscopy (depending on age and symptoms)
- Consultation with primary care physician or specialist to determine your risk for surgery (depending on age and your medical history and symptoms)
You will also have a teaching visit with one of our nurses to tell you what to expect, how to prepare for surgery and recovery, and to answer any questions you may have. The day before surgery, we ask you to clean out your intestines (called a "bowel prep"). This helps your surgeon to safely move the intestines out of the way during surgery or operate on them if needed.
The suggested treatment for early cervical cancer is a radical hysterectomy (removal of uterus, cervix and some of the surrounding tissue) which is very different from a regular hysterectomy.
The ureters (the tubes that carry urine from the kidney to the bladder) are very close to the cervix as they enter the bladder. In a regular hysterectomy, the surgeon stays very close to the cervix to protect the ureter, but actually leaves a small part of the cervix in place. In a patient with cervical cancer, the surgeon must remove the entire cervix and some surrounding tissue.
During a radical hysterectomy, we find the ureters and move them out of the way. With the ureters safely out of the way, we can safely remove the entire cervix and surrounding tissue and a small part of the vagina. The radical hysterectomy is the first part of the surgical treatment for cervical cancer. To prevent serious post-operative complications, we leave a foley catheter in the bladder for 7 days.
In addition to the radical hysterectomy, we remove the pelvic lymph nodes. Lymph nodes are found throughout the body as part of the filtration system. They catch cancer cells that break off from the original tumor. Finding cancer cells in the lymph nodes tells us that the cancer has begun to spread. For patients with cervical cancer, we check lymph nodes deep in the pelvis near the large blood vessels that come from the heart.
In some cases, we may remove additional suspicious nodes from one level up (called para-aortic lymph nodes). The need for removing these nodes is determined during surgery.
When surgery is over, the pathologist looks at all of the tissue we removed to see where there is cancer. This tells us the stage of your cancer and whether you have risk factors for the cancer to spread or return so that we can recommend other treatment, like radiation or chemotherapy, if it is needed.