A hysterectomy is a common surgical treatment of early stage cancer and precancerous disease of the cervix in women. With any treatment of cancer it is important to first understand your responsibility and your medical team’s role as well as explore treatment options and get a second opinion(s) before you begin treatment. Since the side effects of surgery can be significant, talk to your doctor prior to treatment so that you understand the specific type of surgery you will undergo and the expected side effects. The type of hysterectomy used to remove the cervical cancer depends on the extent of the cancer. A radical hysterectomy removes the entire uterus, including the cervix with the cancer and an area of normal tissue through a low abdominal incision. This area of normal tissue also includes a portion of the upper vagina, and may result in vaginal shortening after the operation. A modified radical hysterectomy is similar to a radical hysterectomy but less invasive. A less extensive operation, called a simple hysterectomy, is used when the cancer is not invasive (precancerous, stage 0) or in the earliest stage of invasion (stage IA). A simple hysterectomy removes a smaller rim of normal tissue, and spares most of the length of the vagina. With both types of surgery, the ovaries and Fallopian tubes can be removed as well, and this is known as a bilateral salpingo-oophorectomy. The decision to perform a bilateral salpingo-oophorectomy depends on your age and whether the ovaries are still functioning.
A radical hysterectomy is most effective if the exploration during surgery shows that the cancer has not spread beyond the cervix. However, some patients will have cancer that has spread outside the cervix into the lymph nodes in the pelvis. Before performing a hysterectomy, the doctor will sometimes perform a pelvic lymph node dissection. Pelvic lymph node dissection involves the removal of lymph nodes to determine the presence or absence of cancerous cells. If the lymph nodes contain cancer, usually the surgeon will not proceed with a radical hysterectomy. Instead, another form of treatment, usually radiation therapy and chemotherapy, is generally recommended.
Despite undergoing surgical removal of cervical cancer, some patients may experience recurrence of their cancer. Cancer recurrence occurs more commonly with bulky stage IB or stage II cervical cancer. It is important to realize that some patients with cervical cancer already have small amounts of cancer that have spread outside the cervix and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. Undetectable areas of cancer outside the cervix are referred to as micrometastases. The presence of these micrometastases causes recurrence following the initial treatment. External beam radiation therapy with or without implant radiation and chemotherapy are often recommended to cleanse the body of micrometastases in order to improve the cure rate achieved with surgical removal of the cancer.
Surgery on top of living with a diagnosis of cancer can be both an emotionally and physically draining experience. Understanding associated surgical risks, short-term side effects and long-term side effects, as well as asking your doctor pertinent questions before surgery, will give you the tools to mange and cope after your surgery.
Any form of hysterectomy is major surgery with associated surgical risks. Hemorrhage, blood clots, surgical wound complications or allergic reaction to anesthesia are surgical risks that should be discussed with your doctor. In-hospital death occurs after radical hysterectomy in less than 1% of cases.
Normal and expected temporary effects of surgery for the treatment of cervical cancer may include pain, nausea, fatigue and anxiety. Urinary tract infection after the surgery is also common. Additional temporary side effects may include difficulty urinating or having a bowel movement. Since the bladder may be pushed and pulled due to all of the dissection around it, a temporary catheter (tube in the bladder to drain the urine) is usually required to give the bladder time to heal. With a simple hysterectomy, disturbance to the bladder is minimal making urinary complications rare. However, approximately one-third of women undergoing a radical hysterectomy may experience temporary bladder difficulties which may last a few weeks after surgery. Although most women return to normal bladder functioning, a very small percentage may require more permanent self-catheterization. Depending on the type of hysterectomy, your age and general health, recovery from short-term side effects may take 6 to 8 weeks.
In addition to rare bladder dysfunction, injury to the rectum and lower leg lymphedema are also potential long-term side effects of a hysterectomy. In a few cases, injury to the rectum or tubes that drain the kidneys (ureters) or bladder can occur. This may be in the form of a “fistula” or abnormal connection to the vagina. This is a chronic problem that may require surgery to repair the opening. Lower leg lymphedema (swelling) as a result of lymph node dissection may also occur in some cases. Elastic stockings or support hose as well as preventing infection and injury to the leg, can help minimize lymphedema.
Long-term sexual complications due to the removal of the uppermost part of the vagina are reportedly minor. In a few cases, patients indicate some loss of sensation and lubrication, as well as intercourse difficulty due to vaginal shortening. The emotional impact of the surgery may also affect libido in some patients.
The physical loss of reproductive organs has significant long-term physical and emotional side effects and should be discussed with your doctor before surgery. Some patients may want to investigate having their eggs harvested for possible surrogacy before surgery. Once the uterus is removed, women no longer menstruate and can no longer have children. Furthermore, if the ovaries are removed in a woman of child-bearing age, menopause will be induced. Some of the side effects of early menopause include hot flashes, irritability, vaginal dryness, sweats and nervousness. Hormone replacement therapy may be used to help control some of the side effects associated with menopause. The impact of losing reproductive organs is far reaching, affecting future plans as well as emotional well-being.
Surgery is a common form of therapy in the treatment of early stage cervical cancer. The risks of surgery, while remote, should be discussed with your doctor prior to surgery. The potential short-term side effects may cause varying degrees of discomfort that can usually be managed by you and your doctor. Potential long-term effects such as bladder and bowel problems, early induced menopause, as well as the physical loss of reproductive organs, are reportedly the most difficult for patients to deal with emotionally and physically. Using a surgeon and medical team highly experienced in performing hysterectomies may decrease your surgical risks and provide optimal management of side effects. Support groups, family support or professional support may help patients emotionally cope with side effects. Before undergoing any treatment you should understand your responsibility, your medical team’s role, explore treatment options, ask questions and get a second opinion(s).
Information presented in The Daily Tip is offered as a guide to augment a patient’s research of cancer and treatment and does not replace the advice of a doctor. For more information on a specific cancer, go to CancerConsultants.com,www.cancer.gov, and consult your physician.