Cervical Cancer Surgery (Radical Hysterectomy)

Medically reviewed by Dr Manan Boob, MBBS (KEM), MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

Cervical cancer is cancer of the cervix, the narrow neck of the womb that opens into the vagina. When it is found early, the main treatment is an operation called radical hysterectomy. It removes the womb and cervix together with the tissue around them (the parametrium) and a cuff of the upper vagina, and it is almost always combined with removal of the lymph nodes in the pelvis (pelvic lymphadenectomy) so that the spread can be checked. This is a bigger operation than an ordinary hysterectomy, because the aim is to clear the tissue where early cervical cancer tends to travel.

For some very small, low-risk cancers a less extensive operation, a simple hysterectomy, is enough. Which one you need is decided by the stage and size of the cancer, not by preference.

Most cervical cancers are preventable and detectable early. If you want the background, read our guides to cervical cancer screening, the Pap and HPV test and the HPV vaccine.

Who needs it

Surgery is the right treatment when a biopsy has shown cervical cancer and the examination and scans suggest the disease is limited to the cervix, or has only just grown beyond it. Most of the women I see with this diagnosis first noticed bleeding after intercourse, bleeding between periods or after menopause, or a persistent watery or foul-smelling discharge. Some are diagnosed with no symptoms at all, on a Pap smear or HPV test.

Surgery is not the right choice once the cancer has spread further into the tissues beside the cervix, into the bladder or bowel, or to distant organs. In those situations radiotherapy with chemotherapy gives the better chance of control, and an operation would add risk without benefit. Our wider gynecologic oncology service works out the stage with you carefully, because the whole plan rests on it.

“If it is cancer, why can’t you just remove everything and be done?” I understand the urge. But the right operation depends on how far the cancer has gone. Too little surgery can leave disease behind; surgery in the wrong stage can add risk without helping. A few days spent on the right tests lets us choose correctly the first time.

How it is done

You come in fasting, and the anaesthetist puts you to sleep. A catheter is placed to drain the bladder.

The operation can be done through a lower abdominal cut (open) or through keyhole cuts, depending on what we have decided together; see the section below.

The pelvic lymph nodes are usually dealt with first. They are removed from along the large blood vessels of the pelvis, with care to protect the nerves and vessels beside them. In some centres the nodes are examined during the operation, and if they are already involved, the plan may change.

The surgeon then frees the womb, cervix and surrounding tissue. The ureters, the thin tubes that carry urine from the kidneys to the bladder, are identified and moved aside so that the tissue around the cervix can be removed without damaging them. The bladder and rectum are gently separated from the cervix. The blood supply is sealed, a cuff of the upper vagina is taken, and the whole specimen is removed. The top of the vagina is closed, a drain may be left in the pelvis, and the cuts are closed.

The tubes are removed. The ovaries are sometimes left in place in younger women with early disease, if we both agree that this is safe.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia, sometimes combined with a spinal or epidural for pain relief.

Operating time is usually three to four hours, longer if the anatomy is difficult or scarring from earlier surgery is present.

Expect a hospital stay of about four to six days after an open operation, and sometimes a little less after keyhole surgery. A catheter often stays in for several days, and some women need it longer, because the nerves that control the bladder can be slow to recover.

Recovery

Day 1. Soreness at the cut, tiredness, a catheter in place. We start sips of fluid, then light food. We get you sitting and standing early, which lowers the risk of clots in the legs.

The first week. Short walks, a drain removed when it stops draining, light spotting from the vagina. We teach you to empty your bladder fully once the catheter is out, and some women are sent home with the catheter or taught to pass it themselves for a short while.

Weeks 2 to 4. Daily routine returns step by step. Avoid heavy lifting and straining. Nothing should go into the vagina until the surgeon confirms healing, usually after about six to eight weeks.

By six weeks. Most women are back to normal routines. The final biopsy report is usually ready within one to two weeks, and we go through it with you well before this. Follow-up visits and tests continue for years after treatment; they are part of the treatment, not a sign that something is wrong.

Call us sooner for fever, heavy bleeding, spreading redness or discharge at the cut, calf pain or swelling, breathlessness, trouble passing urine, or leaking of urine from the vagina.

Keyhole or open: how the route is chosen

This is the question women ask first, and the honest answer is that it depends. Keyhole surgery gives smaller cuts, less pain and a faster return to daily life, and for many cancers of the womb it is our usual choice. For early cervical cancer, the picture is less simple. Over the past several years, the evidence on keyhole radical hysterectomy has been debated, and some studies have raised concern about the cancer outcome for certain patients compared with open surgery.

So I do not tell women that keyhole is always better here. We look at the size of the tumour, what the scans show about the lymph nodes, your general health, and the approach in which the surgeon has the most experience. Sometimes that points to keyhole surgery, sometimes to open surgery. We tell you which we recommend, and why. With cancer, clearing the disease safely comes before everything else, and then we do all we can to make recovery comfortable.

Risks and complications

Cancer surgery is major surgery, and you should hear the risks plainly.

• Bleeding during or after the operation, occasionally needing a transfusion.
• Infection at the cut, in the pelvis or in the urine.
• Bladder problems. The nerves to the bladder can be bruised, which makes emptying difficult for a few weeks, and in a few women for longer.
• Injury to the ureter, bladder or bowel, uncommon and usually noticed and repaired at the time. A ureter injury can very occasionally cause urine to leak later (a fistula) and need another procedure.
• Blood clots in the legs or lungs. We reduce this with early walking, stockings and, where needed, blood thinners.
• Lymphoedema (leg swelling) and lymphocele, a fluid collection, after the lymph nodes are removed.
• Bowel or sexual changes. Some women notice constipation or a shortened vagina, and some have changes in sensation. We discuss these openly and help.
• Early menopause if the ovaries are removed.
• Need for further treatment. If the final report shows higher-risk features, radiotherapy with or without chemotherapy is advised.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Radiotherapy with chemotherapy (chemoradiation) is the standard treatment for cancer that has spread beyond the early stage, and it is also a reasonable choice for some early cancers, especially if you are not fit for a major operation. Surgery and radiotherapy are both effective for the earliest stages, so it matters which you start with, and we talk through the trade-offs. Having both together adds side effects, which is one reason the first choice should be made carefully.

Fertility-sparing surgery. For a small number of women with a very small tumour who wish to have children, an operation that removes the cervix and surrounding tissue but keeps the womb (radical trachelectomy) may be possible. It is suitable only for carefully selected cases and needs close follow-up.

Simple hysterectomy may be enough for the smallest, lowest-risk early cancers, as noted above.

For general information on the operation itself, see our page on total laparoscopic hysterectomy.

What it costs

The figures below are all-inclusive — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations. The right operation depends on your stage, so we quote each separately.

Radical hysterectomy, laparoscopic: ₹85,000 – ₹1,35,000.

Radical hysterectomy, open: ₹80,000 – ₹1,00,000.

Simple hysterectomy, low-risk early disease: ₹75,000 – ₹1,10,000.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every report: the biopsy, Pap or HPV result, MRI or CT if done, blood tests, and a list of your medicines.
• Tell us about diabetes, high blood pressure, thyroid or heart problems, and any blood thinners. Some medicines need adjusting beforehand; please do not stop anything on your own.
• Mention any earlier abdominal or pelvic operations, as these can change the plan.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise. You may be asked to take a bowel preparation the day before.
• Leave jewellery, nail polish and contact lenses at home.
• Arrange for an attendant to stay with you and for help at home for the first few weeks, since the catheter and bladder care need support.
• Bring someone you trust to the consultation. It is hard to take everything in alone.

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If you or someone in your family has been told there is a problem with the cervix, bring the reports and let us go through them together, unhurried. The gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, will explain what the diagnosis means and which treatment is right for you. Call +91-8668954915 or get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.