In modern medicine, doctors perform the following two main operations to treat invasive cervical cancer:
- Hysterectomy (simple or radical)
- Trachelectomy.
Depending on the patient’s condition and her desire to become pregnant and have a child, doctors decide on the method of removing the cancerous tumor. The choice of technique is also influenced by the aggressiveness of the cancer and the degree of its spread throughout the body.
Simple hysterectomy
In a simple hysterectomy, the doctor removes the uterus (both the uterine body and the cervix) but not the structures adjacent to the organ (the parametrium and uterosacral ligaments). The vagina and pelvic lymph nodes are not removed. The ovaries are usually retained unless there is another reason to remove them.
Such treatment in Israel is most often carried out laparoscopically or with the help of a robotic assistant. This minimizes trauma to surrounding tissues. As a rule, hospitalization lasts no more than 2 days.
Radical hysterectomy
During the operation, the surgeon removes the uterus along with the tissues next to it (parametrium and uterosacral ligaments), the cervix and the upper part (about 2-3 cm) of the vagina next to the organ. The ovaries are not removed unless there is another medical reason. A radical hysterectomy removes more tissue than a simple hysterectomy, so your hospital stay may be more extended. At this time, some nearby lymph nodes will be removed and checked for cancer.
This procedure is usually performed through an incision in the abdomen (open surgery). This sometimes involves removing some of the pelvic lymph nodes (lymph node dissection).
Radical hysterectomy can also be performed using laparoscopy or robotic assist. In this case, the patient takes into account the cost of treatment for cervical cancer in Israel and, together with the doctor, makes the final choice of the surgical method.
Trachelectomy
Trachelectomy surgery allows women to undergo treatment without losing their ability to have children. The intervention is carried out either through the vagina or through the abdominal cavity, sometimes using laparoscopy.
During this procedure, the doctor removes the cervix and the upper part of the vagina but not the body of the uterus itself. The surgeon then places a permanent “purse string” suture into the uterine cavity to close the opening of the organ, as the cervix normally does.
Nearby lymph nodes are also removed using a laparoscope.
After a trachelectomy, some women are able to carry their pregnancy to term and give birth to a healthy baby by cesarean section. However, women who have this surgery may have a higher risk of miscarriage.
Pelvic exenteration
This operation is performed in special cases when cervical cancer recurs. The surgeon removes all the same organs and tissues as in a radical hysterectomy with pelvic lymph node dissection. In addition, the bladder, vagina, rectum and part of the colon are also removed, depending on where the cancer has spread.
Lymph node mapping
This is a procedure in which the surgeon removes only those lymph nodes where the cancer first appeared. To do this, the doctor injects a radioactive substance or a special dye into the cervix at the beginning of the operation. Lymphatic vessels will carry these substances along the same path as cancer. The first lymph node) that receives the dye or radioactive substance will be the sentinel node. Removing only one or a few lymph nodes reduces the risk of side effects from surgery, such as leg swelling (lymphedema).
Sentinel lymph node mapping may be considered in some cases for the treatment of stage I cervical cancer. It is best used for tumors smaller than 2 cm.
