Surgery for cervical cancer

The surgical removal of a cervical tumor is a demanding procedure. Depending on the stage of the cancer, we may be able to preserve the uterus. The tumor will be removed together with some of the surrounding tissue, the margins, which will be examined to see whether it is indeed free of cancer cells.

If the tumor is still in an early stage, it is possible to preserve the uterus through a procedure called exconization. If the tumor has developed to a later stage, we will need to perform a Wertheim-Meigs operation. This means that the uterus will be removed, together with the top part of the vagina, a large amount of the surrounding supportive tissue, and the pelvic lymph nodes. If the tumor is still small, the surgery will be a robot-assisted keyhole (laparoscopic) procedure

Efficacy

The tumor will be removed during the surgery, together with some additional tissue at the margins, which will be analyzed for the presence of remaining cancer cells. If there is reason to believe that there are still cancer cells in your body, you will receive radiation therapy or a combination of radiation therapy and chemotherapy. If no cancer cells were found in the tumor margins, you will not need any more treatment, although we will invite you to the hospital for regular follow-up screenings for five years following your surgery.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

It is important to tell your anesthesiologist which type of medication and which dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General and local anesthesia

Before your surgery, you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side effects

You may experience problems detecting bladder fullness after your surgery. This can occur if the nerves that are responsible for this “fullness” signal were damaged during the operation. Remember to go to the bathroom at regular intervals. This inconvenience is usually temporary: the feeling will return after some time.

Cervical cancer treatment will affect your fertility: your uterus may be removed, or your fertility may be affected by radiation therapy or chemotherapy. Women without a uterus will no longer menstruate. The radiation delivered to the ovaries will prevent the production of certain hormones, which will cause early menopause. You may experience hot flashes, increased perspiration, and trouble regulating your body temperature.

After the procedure

It may take months before you will be able to continue your day-to-day activities. Please make sure to get plenty of rest during your recovery.

If we detected cancer cells in the tumor margins, you may require radiotherapy after surgery.

Fertility preservation

Treatment for cervical cancer may negatively affect your fertility levels, which is why the Netherlands Cancer Institute, in collaboration with the Amsterdam UMC, location AMC and the LUMC, offers the option for fertility preservation. Treatment can induce early menopause. Your practicing physician will discuss your options in preventing or treating menopausal symptoms with you.