Our gynecologic surgeons use minimally invasive techniques such as robotic-assisted surgery as the standard of care for treating cervical cancer. Complex cervical cancer surgery is available through specialists at the Penn Center for Advanced Gynecologic Surgery. We will work with you to develop an individualized treatment plan that takes into consideration your reproductive needs after surgery.
Surgical options for cervical cancer
Precancer (dysplasia) or very small lesions can be treated with minor surgery that can often be done at a gynecologic practice. Larger tumors or cancer that has spread may require more extensive surgery, such as a hysterectomy or radical hysterectomy, and additional treatment options including radiation and chemotherapy.
Laser surgery for cervical cancer
Penn gynecologic oncologists may use laser surgery to treat pre-invasive forms of cervical cancer, known as cervical dysplasia. Laser surgery focuses a high-energy light beam on abnormal cervical cells and vaporizes them.
Conization (cone biopsy) for cervical cancer
Penn Medicine physicians use conization, including cold-knife cone biopsy and loop electrosurgical excision procedure (LEEP), to diagnose and treat cervical cancer and precancerous lesions of the cervix.
During the procedure, a piece of tissue is removed from the cervix using either a scalpel (cold-knife cone biopsy) or a thin wire heated with electricity (LEEP). Conization is rarely used as the sole treatment for cervical cancer, unless you want to preserve your ability to have children and the amount of cancer present in the cervix is very small.
The tissue removed during conization is checked under a microscope by a pathologist to determine whether abnormal cells are present. If the outer edges of the tissue, called margins, still show precancerous changes, additional treatment may be needed to make sure that all of the abnormal cells are removed.
Hysterectomy for cervical cancer
For some types of cervical cancer, surgeons remove the uterus and the cervix in a procedure known as a hysterectomy. Hysterectomy may be performed as an open procedure, known as an abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. If lymph node sampling is needed, this can be done through the same incision as the abdominal hysterectomy.
Removing the uterus through the vagina is called vaginal hysterectomy. This procedure is minimally invasive and sometimes done with the assistance of a laparoscope, which is a thin camera inserted into the abdomen to facilitate the procedure and allow for abdominal and pelvic lymph node biopsies, if necessary.
We consider your medical history, stage of cancer and current health condition to determine the type of surgery that’s best for you. Depending upon the extent of the cancer, we may also perform biopsies in other areas of the abdomen.
Simple hysterectomy for cervical cancer
A simple hysterectomy removes only the uterus and cervix. Removing the ovaries and fallopian tubes are not always necessary for adequate treatment of cervical cancer.
Radical hysterectomy for cervical cancer
When surgeons perform a radical hysterectomy, the entire uterus, the tissues next to the uterus (parametrium and uterosacral ligaments) and the upper part of the vagina are removed.
Usually performed abdominally, radical hysterectomy can also be performed vaginally, laparoscopically or robotically. Most patients undergoing a radical hysterectomy also have a lymph node dissection, in which lymph nodes are removed either through the abdominal incision or by laparoscopic or robotic lymph node sampling.
Pelvic exenteration
Pelvic exenteration is a radical cervical cancer surgery that removes all organs from the pelvic region. It is not commonly performed, but may be used in special cases to treat cervical cancer that has recurred. A variety of structures or organs adjacent to the cervix may be removed during the procedure, including the:
- Parametria and uterosacral ligaments
- Vagina
- Fallopian tubes and ovaries
- Bladder and rectum
During the operation, openings, or stomas, are created in the body to allow urine and stool to collect in special bags. Some patients may have a type of reconstruction that allows a continent stoma (one that does not require a bag) for urine. If the vagina is removed, an artificial vagina can be created through reconstructive surgery in which plastic surgeons use grafts of muscle and skin to reconstruct the vagina.