Cervical cancer surgery - complete removal. Types of treatment for cervical cancer

Treatment options for cervical cancer depend on the stage of the disease and its characteristics. The cervix is ​​the lower part of this organ that protrudes into the vagina. Cancer usually develops from its thin-layered outer layer (squamous cell carcinoma). Less common is adenocarcinoma, which forms from the glandular cells of the cervical canal (cervical canal). Sometimes both types of cells are involved in tumor formation.

It has been proven that the sexually transmitted human papillomavirus (HPV) plays a leading role in the occurrence of the disease. In addition to HPV, risk factors for cervical development include:

  • sexually transmitted infections
  • weakening of the immune system,
  • smoking.

Stages of cervical cancer

  • In the treatment of cervical cancer Stage 1 Therapy is simplified by the fact that the cancer is limited to the cervix itself. The prognosis for treatment is favorable; in most patients, relapse (recurrence) of the disease is avoided.
  • At stage 2 the tumor grows into the upper part of the vagina. In the absence of metastasis in the lymph nodes, the prognosis is also favorable (stable remission, absence of signs of the disease, in up to 80% of cases over a five-year period, depending on the type of disease).
  • Cervical cancer stage 3 spreads down to the lower part of the vagina or penetrates into the side wall of the pelvic region.
  • At stage 4 metastases are detected in nearby organs - the bladder or rectum. In addition, cancer can migrate to the lungs, liver or bones. Despite the severe form of the disease and the prognosis, even at this stage there are chances to achieve positive remission.

Treatment options

The main treatments for cervical cancer include surgery and radiation therapy. Chemotherapy plays a supporting role and can be prescribed in later stages and as part of complex therapy.

Radiosurgery


Modern technologies in some cases help to avoid surgical intervention. Radiosurgery is one of the areas of radiation therapy. Main features:

  • High radiation intensity - allows you to destroy cancer cells in one session;
  • High precision of radiation focusing - minimal impact on healthy tissue;
  • It is painless and has minimal consequences.

Some of the most modern radiation therapy systems available in Russia today are: CyberKnife and TrueBeam.

Radiation therapy

Radiation therapy (RT) is part of the standard treatment for squamous cell carcinoma of the cervix and advanced adenocarcinoma. Before surgery, a course of radiation is given to reduce the size of the tumor, either alone or in combination with chemotherapy. After surgery, RT is used to destroy any remaining cancer cells.

The radiation therapist may prescribe external (external) irradiation, internal irradiation (brachytherapy), or a combination of both.

Modern external beam radiation techniques, such as intensity-modulated radiation therapy (IMRT), can deliver high doses of radiation to tumor cells while reducing radiation exposure to healthy tissue. When choosing this method, the risk of side effects and their severity are minimized.

Surgery

In the early stages of the disease (if leukoplakia or a very small tumor is detected), conization can be performed - the most gentle operation in which a small cone-shaped section of the cervix with part of the cervical canal is removed.

In more complex cases, a hysterectomy is performed - an operation during which the uterus is completely removed. Hysterectomy can lead to a complete cure and is a prevention of relapse, but after complete removal of this organ it is impossible to become pregnant.

Therefore, in some cases, when treating cervical cancer, a decision may be made to perform organ-sparing surgery - radical trachelectomy. To do this, special devices are inserted into the abdominal cavity through small incisions, with the help of which the surgeon removes the cervix and upper part of the vagina, and, if necessary, lymph nodes. The uterus is then connected directly to the lower part of the vagina. It should be understood that trachelectomy allows you to maintain hope for the possibility of pregnancy, but cannot guarantee it one hundred percent.

Hormone therapy and chemotherapy


Also, with a hormone-dependent type of disease, it is possible to use hormone therapy. Hormone dependence is determined using laboratory tests. As a rule, antiestrogens are used, which reduce the activity of female hormones; sometimes gestagens are also used in the regimen. Can be prescribed in the early stages with high hormone dependence. Chemotherapy is used primarily as an adjuvant component in the treatment of later stages of cervical cancer, to fight cancer cells that have spread outside the uterus.

Consequences and recovery after treatment for cervical cancer

After a hysterectomy, transient complications may occur, such as pelvic infection, bleeding, or blood clots in the urine or stool. Long-term consequences of the operation include the possibility of shortening and drying of the vagina, which leads to pain during sex. This side effect is easily corrected.

After a radiation therapy session, a woman may occasionally experience nausea and a feeling of fatigue.

Post-operative recovery usually takes no more than 8 weeks. In complicated cases (for example, when plastic surgery is needed to form a new vagina), recovery after treatment for cervical cancer can take several months. For quick and complete rehabilitation, it is necessary to follow the doctor’s recommendations regarding personal hygiene and lifestyle.

Modern treatment of cervical cancer involves performing organ-preserving operations. The use of this tactic allows women to have children in the future. Women aged 40-50 years with a history of human papillomavirus, genetic predisposition or hormonal disorders are especially susceptible to the disease.

Diagnosis of the disease

To clarify the diagnosis, the doctor individually selects the necessary research methods for each patient:

  • blood test for tumor markers;
  • cytological examination (with Pap smear);
  • colposcopy;
  • molecular genetic testing;
  • biopsy;
  • intravaginal ultrasound diagnostics;
  • magnetic resonance imaging;
  • examination of the uterine cavity using hysterography and hysteroscopy.

To exclude the presence of metastasis, an examination of the lungs, pelvic organs and abdominal cavity is prescribed.

Surgical treatment

Preference for one or another type of surgical treatment is given taking into account the age and general condition of the patient, the result of histological examination and the degree of spread of metastases:

  • Conization of the cervix is ​​performed in the initial stages of cancer. It is used for the purpose of diagnosis and prevention of further spread of malignant cells. The tumor is excised using electrical excision or a carbon dioxide laser. During the operation, the cone-shaped area and the cervical canal of the cervix are removed. The resulting tissues are subjected to histological examination. The operation is performed under local anesthesia. The patient does not require a hospital stay. The healing process and complete rehabilitation period take about a month;
  • trachelectomy is performed at stages 1-2, when it is necessary to preserve reproductive function (the upper part of the vagina and cervix is ​​removed). The surgeon applies a special purse-string suture to recreate the opening of the cervix into the uterine cavity. Since this manipulation does not affect the body of the uterus, a woman can become pregnant using the IVF method, and then fully carry the child. Childbirth is carried out through caesarean section. Surgery to remove cervical cancer is performed using: laser excision, cryodestruction, ultrasound or radiosurgery. After trachelectomy, the patient remains under inpatient observation for another 5-7 days. The risk of relapse after this surgical procedure is small.

    Studies have found that the pregnancy rate 5 years after trachelectomy is about 50%. The only thing is that the risk of miscarriages (not carrying a pregnancy to term) is much higher compared to healthy women;

  • hysterectomy. An operation to remove cervical cancer is performed, during which the body and cervix are resected, but nearby structures (sacrouterine ligaments and tissue of the periuterine space) are preserved. The vagina and pelvic lymph nodes are not excised. The fallopian tubes and ovaries are also retained unless for some reason the surgeon is forced to remove them;
  • radical hysterectomy - removal of cancer of the cervix, uterus itself, fallopian tubes, ovaries and regional lymph nodes is performed using methods: vaginal, laparoscopic or abdominal. To preserve natural hormonal levels, in some cases the ovaries are not removed. The hospital stay takes 5-7 days. Recovery from a radical hysterectomy usually takes 6 to 8 weeks. It is clear that this surgical procedure leads to infertility, since the uterus is removed.

The main way to combat various malignant neoplasms is surgical excision of the lesion. This also applies to cervical cancer. In most cases, such tactics allow saving a woman’s life, although at such a cost as the loss of reproductive functions. Surgery for cervical cancer, as a rule, involves removing not only the organ itself, but also nearby lymph nodes, which makes it possible to stop further spread of the tumor as much as possible.

What are the indications for surgery

The decision on the need for surgical intervention in the cervical area is made individually by a specialist. As a rule, this is preceded by a comprehensive examination of the woman and differential diagnosis. The information obtained allows us to distinguish benign from malignant neoplasms.

Main indications for cervical removal:

  • early stage of the oncological process - surgery for cervical cancer can greatly increase the chances of recovery and improve the survival prognosis;
  • if the cancer focus is localized only in the area of ​​the cervix of the organ, on the surface, and the woman subsequently plans to become a mother, it is quite possible to perform the most organ-preserving operation - trachelectomy;
  • certain forms of cervical hypertrophy - a similar condition is provoked by various pathological processes, for example, prolapse of the uterus, malfunction of the cervical canal, chronic inflammatory processes of the mucous membrane, fibroids localized in the cervical area;
  • severe endocervicitis, with recurrence of cervical polyps;
  • consequences of cervical ruptures during difficult childbirth or late abortions - against the background of eversion of the cervix into the vaginal cavity, ulcerations are formed that can become malignant;
  • congenital or acquired deformities of the cervix;
  • leuko- and erythroplakia that are not amenable to conservative therapy.

As can be seen from the above, there are many indications for surgical intervention in addition to cervical cancer. However, most of these reasons imply the prevention of the formation of a focus of atypia in the organ.

Types of interventions performed for cancer in situ

In a situation where a woman has received a questionable result of a cytological smear or when diagnosing an early stage of tumor formation in the cervical area, a specialist, in order to prevent further progression of the pathology, makes a decision on conization.

The procedure involves the removal of a malignant lesion. In this case, the removed portion of the cervix and cervical canal resembles a cone, which is where the name of the procedure comes from. The resulting biomaterial must be carefully examined in the laboratory - to identify the presence of atypical cells, or, when cancer is confirmed, to assess the depth of its penetration. Therefore, conization is both a diagnostic procedure and a therapeutic one.

In many ways it resembles the conization of the cervix described above, but loop electroconization has its own characteristics. Instead of a scalpel, the specialist uses a wide metal loop through which an electric current is passed during the manipulations. Coagulation of tissues upon contact with a loop heated to maximum temperature has a cutting effect. This allows you to safely and almost painlessly remove the area of ​​malignancy.

Minimally invasive treatment methods

For the formation of a tumor lesion within the boundaries of the epithelial cell membrane, as well as for precancerous changes in the cervical mucosa, the latest minimally invasive treatment methods are currently successfully used. They consist in the local application of various physical factors that can destroy atypical cells.

For example, one of such successful methods, based on liquid nitrogen, which freezes and completely destroys a limited area of ​​the epithelium in the area of ​​malignancy of the cervix - cryodestruction. After complete removal of the superficial form of the cancer focus, the need for surgical intervention no longer arises. The duration of the rehabilitation period is minimal.

In addition to this technique, you can resort to laser surgery. Its essence comes down to the targeted effect of a medical laser, which causes coagulation of tissues affected by atypia.

Such minimally invasive methods of getting rid of cervical cancer in most cases do not affect a woman’s reproductive ability - she may well become a mother after some time. In addition, cryodestruction and laser surgery do not increase the risk of cervical insufficiency during pregnancy.

Treatment tactics for progressive forms of cervical tumors

Worsening the situation - the movement of cancer cells into neighboring tissues and organs, most often the pelvic lymph nodes, requires more radical measures from oncological surgeons. Treatment tactics must be comprehensive, in which, in addition to excision of the primary and secondary lesions, radiation and chemotherapy are also used.

Surgical interventions used for metastasis of atypical elements from the cervical area will be of the following types:

  1. Removal of the uterus through vaginal access, without making incisions in the abdominal cavity - vaginal gasterectomy.
  2. Removal of not only the uterus itself and its cervix, but also the appendages and nearby lymph nodes is a radical hystrectomy.
  3. Modified hysterectomy differs from the radical technique described above in less extensive intervention. Appendages or lymph nodes may remain intact - at the discretion of the specialist, who makes a decision individually in each case.
  4. Bilateral removal of the uterine appendages - bilateral salpingo-oophorectomy, is carried out both by an open technique and using laparoscopic techniques.

The achievements of modern medicine make it possible to save the lives of women using the above methods of surgical intervention in situations previously considered inoperable. However, even a radical hysterectomy, when in addition to the uterus, the appendages and lymph nodes are also examined, necessarily requires exposure to chemotherapy, as well as biological and targeted medications. Such tactics greatly improve the survival prognosis.

Consequences of surgical treatment

In each case of diagnosing cervical cancer, specialists choose the most optimal surgical option - the most organ-preserving one. However, with metastasis of secondary foci, it may be necessary to remove not only the cervix, but also the entire organ, as well as lymph nodes, part of the bladder, intestines, and vagina.

In the second stage of a malignant neoplasm, only the uterine part of the tumor must be removed; they try to preserve the ovaries so that a hormonal imbalance does not occur in the woman.

A successful option is recognized if the cancerous lesion is detected in situ, when the atypia has not yet had time to go beyond the epithelial layer. In this case, it is only possible to perform conization - removal of part of the cervix, but the reproductive function is preserved. Sexual relations after excision of cervical cancer are possible if the vagina was preserved or it was restored using intimate plastic surgery.

In the early postoperative period, possible complications should include:

  • inflammatory lesions in the area of ​​intervention;
  • vaginal bleeding of varying intensity and duration;
  • infection of the urethra, bladder;
  • thromboembolism, which poses a threat not only of ischemia in any organ, but also of death.

In the late postoperative period, a woman may experience discomfort and pain in the perineal area of ​​the vagina and ovaries. In addition, there is itching and numbness in the suture area, periodic bleeding.
In any case, you shouldn’t lose optimism - at the moment, cervical cancer is not a death sentence at all.

Women who have undergone surgery for gynecological tumors lead a very active sex life, think about pregnancy and become mothers.

What are the prognosis after surgery?

Surgical excision of the primary tumor that has formed in the area of ​​the cervix, at stages 1–2 of its appearance, has a favorable prognosis. Recovery of patients reaches 85–90%. In this case, the ovaries and vagina are rarely removed, so the hormonal levels are practically not affected - the woman feels complete.

Sometimes they get by with just removing the cervix. The situation is considered a great success, since in the future it is even possible to carry a pregnancy.

With the most negative prognosis, when metastasis is diagnosed not only to neighboring tissues and organs, but also to distant parts of the body, you should not give up - after surgical removal of everything possible, specialists then carry out long-term rehabilitation, cosmetic and plastic restoration. Of course, it is impossible to return to your former health, but life will continue, albeit with restrictions.

If the patient presents late, when metastases from the primary site have managed to affect many organs, the prognosis is the most unfavorable.

All measures are palliative in nature - to maximally improve the quality of life of a cancer patient and relieve pain. In many ways, everything depends on the woman herself - her mood for recovery, goals in life, financial security and, of course, the support of relatives and friends.

A malignant process in the cervix is ​​called cervical cancer. If glandular tissue is affected, the disease is histologically classified as adenocarcinoma, otherwise as squamous cell carcinoma.

Stage 1 cervical cancer is classified in accordance with the rules of the international TNM system, which can be used to determine the spread of the tumor, the presence or absence of distant metastases, and metastases in the lymphatic system.

In this system, stage 1 of cervical cancer is designated as T1, where T (tumor) is an indicator of the extent of the primary tumor. This means that the malignant process exclusively affects the cervix. The body of the uterus is not affected. But stage 1 also has its own classification:

  1. The tumor process affects the cervix - T1.
  2. Tumor penetration into tissue can be detected microscopically - T1a:
  • Tumor growth into the stroma (the basis of the organ, consisting of connective tissue in which blood and lymphatic vessels pass) to a depth of up to 3 mm and up to 7 mm on the surface - T1a1;
  • Tumor growth into the stroma up to 5 mm deep and up to 7 mm on the surface – T1a2.
  1. The tumor can be detected visually during a physical examination, or microscopically, but the size will exceed T1a and its subtypes - T1b:
  • Visually detectable lesion up to 4 mm in size – T1b1;
  • Visually detectable lesion larger than 4 mm – T1b

There is another classification of cervical cancer stages according to FIGO:

  • Stage I, corresponding to T1 according to TNM;
  • Stage IA divided into I.A.1 and I.A.2 and is equivalent to stages T1a1 and T1a2 according to TNM;
  • Stage I.B. divided into I.B.1 and I.B.2 and is equivalent to stages T1b1 and T1b2 according to TNM;

Despite the fact that the TNM classifier is better known, in diagnosis the tumor is initially described by FIGO. Russian specialists often use letters of the Russian alphabet. It looks like this: A1, B1 etc.

The initial stage of cervical cancer includes the so-called cancer in situ (stage 0). Unlike stage 1, malignant cells have not yet invaded (have not grown) into the underlying tissue. Tumor cells proliferate, but at the same time die, which prevents the tumor from growing.

With adequate and timely treatment, the prognosis for stage 1 cervical cancer is favorable. According to statistics, the five-year survival rate of patients with this pathology exceeds 90%.

Treatment of stage 1 cervical cancer can be carried out in several ways, including a combination of them. The choice of one or another treatment method or their combination depends on the histological type of tumor (squamous cell carcinoma or adenocarcinoma), its stage, the presence of concomitant pathologies in the patient, etc.

Important! If you are diagnosed with cervical cancer at any stage, it is very important to consult a specialist in a timely manner. You should not look for treatment methods on forums and other resources. Treatment of cancer requires a systematic approach and should take place in a hospital setting under the supervision of a doctor. Traditional medicine is powerless.

There are several types of surgeries for excision of cervical tumors. These include:

  • Amputation of the cervix;
  • Knife conization;
  • Radical trachelectomy;
  • Pelvic exenteration;
  • Various types of hysterectomy.

In the case of treatment of stage 1 cervical cancer (T1a and T1b), hysterectomy is predominantly used, and in some cases radical trachelectomy.

Trachelectomy is the complete or partial removal of the cervix, part of the vagina, groups of iliac and lymph nodes, as well as some groups of ligaments. The advantage of such an operation will be the preservation of the woman’s reproductive function.

A hysterectomy is an operation to remove the uterus. Several types of such manipulation are classified. When treating stage 1 cervical cancer, types I, II and III are used (there are 4 in total).

  • Type I – Performed for stage T1a1 and cancer in situ. Involves removal of the uterus and a small part of the vagina (up to 1 cm);
  • Type II – Performed for stages T1a1, T1a2, T1b This type involves radical hysterectomy. The uterus and a small part of the vagina (up to 2 cm) are completely removed along with the ureters;
  • Type III – Performed at stage T1b. It involves the removal of paravaginal and paracervical tissue, part of the vagina, uterus and uterosacral ligaments.

In the treatment of stage 1 cervical cancer, such therapy is predominantly used as an auxiliary therapy. Used in cases where there are contraindications to combined radiation therapy or when the patient does not tolerate it well. In this case, the tumor must be reduced to allow surgical treatment. For this purpose, special schemes for the administration of cytostatics have been developed. Typically, the patient undergoes 3 courses of polychemotherapy; if the tumor responds positively to the cytostatic drug (it decreases), excision of the tumor is possible.

Radiation therapy

This treatment method can be carried out alone or in combination with chemotherapy and surgery. There are several types of radiation therapy:

  • External beam radiation therapy - with this method, the radiation source (usually a linear accelerator) does not come into contact with the tumor;
  • Intracavitary radiation therapy – the radiation source is in direct contact with the tumor;
  • Combined radiation therapy – combines both of the above methods.

Radiation therapy can stabilize the oncological process, improve the patient’s quality of life, reducing the severity of symptoms, and also lead to a complete recovery.

It has a number of contraindications: fibroids, adhesions, endometritis, some diseases of the genitourinary organs.

When treating cervical cancer at stages defined as T1a1 and T1a2, hysterectomy is usually used in combination with radiation therapy (external + contact).

When treating stage T1b1, hysterectomy is used in combination with external beam radiation or chemotherapy. It is possible to use exclusively combined radiation therapy.

Stage T1b2 is usually treated with chemotherapy and radiation therapy. In some cases, it is possible to use hysterectomy in combination with radiation therapy.

After complete cure of the disease, the risk of relapse cannot be excluded. It may occur after six months (or more). Indicates the incurability of the malignant process. The tumor can be located both in the cervix and in any other organ in the form of metastases. Decisions about treatment methods are made individually. Usually they combine all possible methods. Polychemotherapy is prescribed to improve the patient’s quality of life (palliative therapy).

Etiology and pathogenesis

Scientists have identified several factors that increase the risk of cervical cancer. Among them: smoking, early sexual activity and frequent changes of sexual partners. But the most likely cause of the disease is human papillomavirus types 16 and 18, which is sexually transmitted. Up to 75% of cases of malignant process in the cervix are associated with this virus.

During normal functioning of the body's immune system, the human papilloma virus is destroyed. But if it is suppressed, then the virus instantly develops, takes on a chronic form and has a negative effect on the epithelial layer of the cervix.

Clinical manifestations

In the early stages of the malignant process, cervical cancer practically does not manifest itself at all, which makes diagnosis much more difficult. Therefore, it is very important to undergo regular gynecological examinations. In the presence of an oncological process in the body, there are common somatic manifestations in the form of general weakness, increased sweating at night, weight loss and persistent low-grade fever. When taking a general blood test, leukocytosis (increased white blood cells), possibly slight anemia and an increased erythrocyte sedimentation rate (ESR) will be observed.

Symptoms such as: bleeding, spotting and other discharge, pain in the pelvic area, difficulty urinating, etc. are characteristic of stages 3-4 of cervical cancer; at stage 1 they appear extremely rarely.

An integrated approach must be taken to the diagnosis of cervical cancer.

Physical examination

Involves a general examination of the woman. Palpation of peripheral lymph nodes and abdominal cavity. Examination of the cervix in a chair using mirrors and bimanually. A rectal examination is required.

Laboratory diagnostics

First of all, the gynecologist takes smears from the cervical canal and human papilloma. Next, biochemical and general clinical tests of blood and urine are required. Blood serum, tests for tumor markers.

Non-invasive diagnostic methods

The main methods of non-invasive diagnostics include ultrasound of the pelvic organs and internal organs. Tomographic examination (MRI, PET). Positron emission tomography will help determine the presence of metastases in organs and tissues. If necessary, additional methods can be used: cystoscopy, sigmoidoscopy, colonoscopy, etc.

Invasive diagnostic methods

These methods include taking a biopsy for an accurate diagnosis, determining the stage, tumor proliferation. In some cases (presence of metastases), diagnostic laparoscopy may be necessary.

If stage 1 cervical cancer is suspected, when making a diagnosis it must be differentiated (distinguished) from sexually transmitted diseases. Sometimes with syphilis, the surface of the cervix becomes covered with small ulcers, which may resemble a malignant process. Next, it should be distinguished from ectopia, papillomas, and other similar diseases of the cervix. From sexually transmitted infections and from uterine cancer that has spread to the cervical canal and vagina.

Preventive measures in the fight against cervical cancer included human papillomavirus, which are successfully used in developed countries. At the same time, positive statistics have already been determined to reduce the incidence of cervical cancer and (dysplasia). It is recommended that girls and boys aged approximately 9-13 years be vaccinated before sexual activity. Vaccination is also recommended for women under 45 years of age.

Video: Early stage cervical cancer surgery

Video: Treatment of dysplasia and cervical cancer in situ

Surgery for uterine cancer is a surgical method of removing a tumor.

In some cases, complete removal of the organ is necessary, which allows saving the patient’s life, albeit at the cost of loss of reproductive functions. The operation is accompanied by the removal of the uterine cervix and regional lymph nodes, which stops the process of development of the cancerous tumor.

Carrying out the operation depending on the type and stage

The uterus is a hollow organ, the anatomy of which is distinguished by the body (convex upper part) and the cervix (narrowed canal, thanks to which contact with the environment and the vagina occurs).

In the middle, the uterus is lined with endometrium, a type of epithelium. With an excess amount of estrogens and a number of other factors, the endometrium can grow and after a certain time undergo a malignant transformation. The mucous membrane of the cervix also has the possibility of degeneration. In some cases (about 20%), the malignant process does not affect the epithelium.

Similar degenerations occur after menopause, but in recent years there has been a trend towards an increase in the development of tumors among women of reproductive age. Removing a uterine tumor separately from the organ is not possible. The cancerous formation is excised along with all its surrounding tissues.

Oncology of the cervix is ​​distinguished separately. This fact is associated with the high incidence of the disease. Treatment depends on the extent of the process.

Based on this, the types of cancer are distinguished:

  • Pre-invasive (limited to epithelium);
  • Microinvasive (the neoplasm is able to penetrate the mucous membrane, the tumor size is up to one centimeter in diameter);
  • Invasive (the malignant process spreads to surrounding tissues).

Intervention depending on the stages:

    • 1st stage. This stage allows organ-preserving operations.
    • 2nd stage. Preserving the organ is possible, but involves great risks. At this stage, there is a possibility of the tumor penetrating into the lymph nodes and blood vessels, therefore, metastases are formed. The risk of preserving the uterus is quite high, so total removal is usually used. Such surgical treatment gives a high remission rate. Up to one hundred percent of women can live five years or more after undergoing surgery, as well as appropriate courses of radiation and chemotherapy.
    • For invasive cancer, treatment is carried out in a combined way - excision of the cervix (in later stages, together with the uterus, appendages and lymph nodes) in combination with radiotherapy. Survival over the next five years depends on the prevalence of the tumor, the presence of metastases and is about 40-80%.
  • Endometrial cancer quite often develops together with cervical cancer. His treatment is removal of the uterus. The exception is the first stage, when the tumor has not yet spread beyond the body of the organ. In this case, it is possible to perform a subtotal hysterectomy (partial removal). In all other cases, for endometrial cancer (body of the uterus), complete amputation is performed, the exception being general contraindications to surgical intervention from other organ systems (disorders of the circulatory and cardiovascular systems). Surgical treatment should be carried out in combination with radio and hormonal therapy.
  • Uterine sarcoma is a rare nonepithelial malignant tumor. The disease is characterized by severe course and treatment. In the first stages, combination therapy is carried out. And the affected organ must be amputated. In the final stages, large-scale irradiation is carried out followed by removal of the organ. The surgical intervention strategy depends on the aggressiveness of the tumor. Some types involve not only the removal of the uterus, ovaries and appendages, but also parts of the vagina. This treatment tactic is called Wertheim's operation. The prognosis, unfortunately, is less favorable than with other forms of oncology.

Preparation for surgery

After the specialist has made a decision about the need for surgical intervention, he is obliged to discuss with the patient all the consequences that entail. The volume of excision and the use of organ-preserving operations can be influenced by the following factors: the desire of the patient or her spouse to have children, the state of health and age of the patient.

After discussions, a date for the operation is set. Before this date, the patient must undergo a series of examinations and pass the necessary tests. All this will help the attending physician to clarify the diagnosis and determine the presence or absence of contraindications for surgical treatment. During this period, the patient is prescribed sedatives and sedatives to relieve psycho-emotional stress.

A few days before the expected date of the operation, the specialist, having studied the patient’s tests, announces the final verdict on the method of performing the operation and its volume. Anesthesia is selected taking into account the wishes of the patient.

There are two types of anesthesia for surgery: general anesthesia, which is administered through the use of an intratracheal tube, or epidural (painkillers are delivered by an injection into the spine).

The patient must sign a document consenting to the operation, as well as give permission for a more extensive intervention, if necessary.

Types of surgery

Removal of the uterus for cancerous formations in the body of the organ is the only method of surgical treatment. Produced as follows:

  • amputation of the entire body of the uterus;
  • amputation of the entire uterus (extirpation);
  • removal of the uterus, fallopian tubes, appendages and/or ovaries;
  • carrying out the Wertheim operation. This method is traumatic; it involves the removal of not only the uterus with appendages, surrounding tissue and lymph nodes, but also the upper third of the vagina.

The removal operation may depend on the access method:

  • abdominal (abdominal), carried out by making an incision in the abdominal wall;
  • laparoscopic – carried out by punctures in the abdomen and/or side;
  • vaginal.

Surgery for cervical cancer is performed:

  1. Complete removal of the organ.
  2. Conization (carried out by excision of the area of ​​degenerated tissue).

Abdominal cavity hysterectomy


The specialist makes an incision in the lower abdomen - horizontal or vertical. Next, an inspection of the internal organs is carried out, paying attention to the uterus and appendages.

After fixation, the organ is removed from the abdominal cavity. The fallopian tubes, vessels and ligaments are clamped using clamps and intersected between them.

Before applying stitches, a specialist must examine the condition of the internal organs.

Vaginal hysterectomy

This operation is indicated mainly for women who have given birth, because their vagina is sufficiently dilated, allowing all manipulations to be carried out freely. With this intervention, total removal (of the body of the uterus and cervix) is usually performed. Surgery for cervical cancer is contraindicated in case of any complications that require revision of the abdominal cavity (for example, suspected ovarian cancer). For a large uterus, abdominal surgery is recommended.

Laparoscopic hysterectomy

The intervention can only be laparoscopic, when the organ itself is removed through punctures, or combined with vaginal access. In the second case, the uterus is removed through a natural opening, and the vessels and ligaments are removed through punctures in the abdominal area. The operation is monitored through a video camera lowered into the abdominal cavity.

Removal of the cervix

When one cervix is ​​affected, the transvaginal method is used. The surgeon removes the organ by making a cone-shaped or wedge-shaped incision. And the stitches are applied in a sequential order with excision to avoid excessive blood loss.

Conization of the cervix

It is an organ-preserving operation that allows you to remove the affected epithelium while preserving the mucous membrane. The operation is performed using a loop, rather than a scalpel, through which an electric current is passed. Vaginal access is appropriate. The more tissue removed, the less chance of recurrence. Therefore, during surgery, the healthy part of the epithelium is also captured.

Postoperative period

Most women may experience symptoms in the first two months such as aching pain, numbness, itching around the scar and bloody vaginal discharge. This symptomatology is not a cause for concern.

Relapse of oncology is possible in the presence of unremoved metastases of the tumor or in the dispersion of malignant cells during the operation itself. But thanks to modern diagnostic and treatment methods, the risk of such developments is minimized.