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Simple Hysterectomy
A simple hysterectomy involves surgically removing the uterus through an incision in
the abdomen or vagina under general or epidural (regional) anesthesia. A simple
hysterectomy does not usually involve removing any tissues near the uterus (such as the
parametria and uterosacral ligaments), the vagina, the pelvic lymph nodes, the ovaries, or
the fallopian tubes. The procedure is most commonly used to treat stage I cervical cancer.
In some cases, simple hysterectomy may also be performed on patients with stage 0
(carcinoma in situ) cervical cancers if abnormal cells are found in the margins (edges) of
a cone biopsy sample or on non-cancerous conditions, such as fibroids
(small tumors).
A simply hysterectomy is typically performed in a hospital and involves a few days of
recovering in the hospital (approximately three to five days for an abdominal hysterectomy).
Patients take approximately four to six weeks to heal from a simple hysterectomy. Possible
complications of a simple hysterectomy include excessive bleeding, wound infection, or
damage to the urinary or intestinal systems. A hysterectomy will result in permanent
infertility.
Radical Hysterectomy
As with a simple hysterectomy, a radical hysterectomy involves surgically removing the
uterus, usually through an incision in the abdomen. This procedure involves also removing
the tissues near the uterus (parametria and uterosacral ligaments), the upper portion of
the vagina, and the pelvic lymph nodes. The ovaries and fallopian tubes are usually left
intact unless there is a specific reason why they should be removed. Recent technological
advances now make it possible for the radical hysterectomy to be performed through the
vagina when using laparoscopy. Laparoscopy allows surgeons to view the pelvis and abdomen
through a tube inserted through a small surgical incision below the navel. Pelvic lymph
nodes may be removed through the tube instead of a large incision in the abdomen.
A radical hysterectomy and removal of the pelvic lymph nodes is most commonly used to
treat stage I or stage II cervical cancers. A radical hysterectomy is usually performed in
a hospital and requires a five to seven day recovery in the hospital. As with a simply
hysterectomy, the possible complications of a radical hysterectomy include excessive
bleeding, wound infection, or damage to the urinary and intestinal systems. Hysterectomy
causes permanent infertility. Although the vagina is shortened during hysterectomy, the
procedure does not usually interfere with a woman’s sexual function. In fact, many
women report an improved sexual life after hysterectomy because the procedure can
alleviate symptoms that may make sexual intercourse uncomfortable (such as pain or
bleeding during intercourse).
Pelvic Exenteration
Pelvic exenteration involves removing the bladder, vagina, rectum, and/or a portion of
the colon in addition to performing a radical hysterectomy (see description above). The
procedure is rarely performed and is usually reserved for treating recurring invasive
cervical cancer that has spread past the cervix. Pelvic exenteration may involve
performing several additional procedures to ensure urine and feces can still be stored and
eliminated. Plastic surgery can be performed to create an artificial vagina.
Radiation Therapy
Radiation therapy (or radiotherapy) uses high-energy
rays to stop cancer cells from growing and dividing. There are two main types of radiation
therapy: external beam and internal beam (also called brachytherapy). External beam
radiation is delivered from a source outside the body on the specific area of the body
that has been affected by the cancer. Experts compare the experience of external beam
radiation to having a diagnostic x-ray, except that radiation is
usually administered for a longer period of time and at a higher dose. Internal beam
radiation involves either placing a capsule of radioactive material into the vagina near
the tumor, or placing small radioactive needles directly into the tumor.
For external beam radiation, the physician will measure the correct angles for aiming
the radiation beam at the specific area of the body and make ink marks on the
patient’s skin. The procedure itself is pain-free. While the radiation is being
administered, the technologist will leave the room and monitor the patient on a
closed-circuit television. However, patients should be able to communicate with the
technologist at any time over an intercom system.
Side effects of radiation therapy vary among patients. The most common side effect is
fatigue (extreme tiredness). Fatigue can be especially bothersome in the later weeks of
treatment. Patients who experience fatigue after radiation sessions should get plenty of
rest and try to maintain an active lifestyle. While many patients can still work and
participate in normal activities during radiation therapy, some patients find it necessary
to limit their work or activities until treatment has been completed. Another side effect
that may occur from pelvic radiation is vaginal stenosis, a narrowing of the vagina caused
by scar tissue. Vaginal stenosis may cause pain or discomfort during sexual intercourse.
Click here to learn more about radiation therapy.
Chemotherapy
Chemotherapy involves using anticancer drugs to help control or prevent the growth of
cancerous tumors. Chemotherapy is often used as an adjuvant (supplemental) therapy in
addition to other treatments, such as surgery or radiation therapy, which are designed to
achieve local control of the cancer. Normally, chemotherapy is administered through a
semipermanent catheter (a flexible tube) implanted into a large vein, or by a smaller,
temporary, intravenous catheter placed into the smaller veins in the arm or hand. Some
chemotherapy drugs are administered orally in form of pills or liquid. Chemotherapy may
also be given intramuscularly (injected in the muscle), under the skin, topically (on the
skin), or injected locally into the cancer area.
Chemotherapy may be used to:
- cure cancer
- stop cancer from spreading to other parts of the body
- slow cancer growth
- kill cancer cells
- relieve symptoms of cancer
Chemotherapy is a systemic form of treatment; that is, it is distributed throughout the
bloodstream, affecting tissues and organs throughout the entire body. In this way, chemotherapy is
different from local treatments such as surgery or radiation therapy, which only target
specific parts of the body. Both local and systemic treatments are used to provide optimal
cancer control, and the approach is tailored to the individual patient.
Cervical cancer patients who undergo chemotherapy may be given one drug or a
combination of two or more drugs during treatment. Most physicians believe that
combination chemotherapy (administering two or more drugs) is most effective for cervical
cancer patients because combination therapy has been shown to provide better cancer cell
control with lower doses of individual drugs. With combination chemotherapy, better
results may be achieved while causing fewer of the side effects associated with higher
doses of an individual drug. At this time, there are over 90 chemotherapy drugs used to
treat different types of cancer.
Chemotherapy drugs most often used to treat cervical cancer include:
- cisplatin (brand name, Platinol)
- ifosfamide (brand name, Ifex)
- fluorouracil (brand names, Fluorouracil, 5-Fu, Adrucil)
The side effects a cancer patient experiences while undergoing chemotherapy vary
significantly depending on several factors, including the types of drugs used, their
dosages, and the duration of treatment. Some patients experience few to no negative
effects from chemotherapy. In most cases, the benefits of treating cancer with
chemotherapy far outweighs the risks or inconveniences of any side effects. The most
common side effects of chemotherapy include nausea, hair loss, and fatigue.
Updated: June 3, 2008
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