Your gynaecologist will discuss your surgery with you. The type of surgery depends on the size of the cancer and whether it has spread beyond the cervix. Before any operation it is important to make sure that you have discussed it fully with your gynaecologist.

According to NHS guidelines, any surgery for cancer of the cervix should be carried out in specialist cancer centres by a gynaecological oncologist or a gynaecologist with a specialist interest in cancer.

Surgery for cancer of the cervix usually involves removing the womb (hysterectomy), nearby lymph nodes and a small part of the vagina.

If the cancer cells have spread only very slightly beyond the surface cells of the cervix, it may be possible to treat this with a cone biopsy (see diagnosis), laser therapy or using cold coagulation. An operation called a trachelectomy may also be possible.

The ovaries and fallopian tubes may also be removed (bilateral salpingo-oophorectomy) but, where possible, they are not taken out in young women as this brings on an early menopause. Surgery is used more often for young women than radiotherapy, as radiotherapy to the pelvic area stops the ovaries from working and brings on an early menopause.

If it is necessary to remove the ovaries, the symptoms of the menopause can often be prevented by giving hormone replacement therapy (HRT) as tablets, skin patches or creams. Your doctor will be able to discuss this with you in detail.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery and, even if you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

When you get back to the ward you will have a drip (an intravenous infusion) going into a vein in your arm until you are able to eat and drink normally. You will probably have drainage tubes from the wound to drain off any excess fluid. The drip and drains are taken out within a few days.

Usually a small tube (catheter) is put into your bladder to drain your urine into a collecting bag. You may have vaginal bleeding and discharge for a few days after the sugery.

After your operation you may need to take regular painkilling drugs, which are very effective in controlling any pain. If you still have pain, it is important to let the nurse know as soon as possible, so that your painkillers can be changed until you find a type and dose that is effective.

Most women are ready to go home about 6–8 days after their operation, once their stitches or clips have been removed. If you think you might have problems when you go home, for example if you live alone or have several flights of stairs to climb, let the ward nurse or social worker know when you are admitted to the ward, so that help can be arranged.

Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check up. This will be a good time to discuss any problems you may have after your operation – but remember, you can usually ring your hospital doctor, specialist nurse or ward nurse at any time if you have any problems.

Sex

Although you will no longer have your monthly periods or be able to become pregnant, you will be able to go back to your usual sexual activities when you are ready.

Your doctor will probably advise you not to have sexual intercourse for at least six weeks after your operation, to allow the wound to heal properly. Many women need more time before they are ready to resume a sexual relationship. This is a very important part of your recovery so don’t be afraid to discuss it with your doctor, specialist nurse or one of the Cancerbackup nurses.

We have a section on sexuality and cancer which you may find helpful.

Physical activity

After a hysterectomy it is important to avoid strenuous physical activity or heavy lifting for about two months. Your physiotherapist or nurse will give you advice about this. Some women also find it uncomfortable to drive for a few weeks after their operation and it is probably a good idea to wait a few weeks before you start driving again. Some insurance companies have guidelines about this and it may be helpful to contact your own company.

Getting support

Some women take longer than others to recover from their operation. If you find you are having problems, it may be helpful to talk to someone who is not directly associated with your illness. The nurses at Cancerbackup are always happy to talk with you and they may be able to put you in touch with a counsellor or a support group in your area, so you can discuss your experiences with other women who are in a similar situation.

Most women will have no long-term complications after surgery for cancer of the cervix. However, some women may be affected and your surgeon or specialist nurse will explain the possible complications to you.

Some women may have bladder or bowel problems after a hysterectomy, because of damage to these organs (or the nerves that control them) during the surgery.

If the lymph nodes have been removed there is a risk of developing swelling (lymphoedema) in one or both legs. This is a build up of lymph fluid that cannot drain away normally because the glands have been removed. It is more likely to happen if you have had radiotherapy to the pelvic area as well as surgery.

If you develop any problems after your surgery, let your surgeon or nurse know as it is often possible to treat or manage them.

For some women with a very early cancer of the cervix, it may be possible to have a trachelectomy. In this type of surgery the cervix and the upper part of the vagina are removed, but the rest of the womb is left in place. The lymph glands in the pelvis are also removed, usually through a tiny cut in the abdominal skin (called keyhole surgery).

As the womb is not removed, trachelectomy can mean that it may still be possible for the woman to have children. During pregnancy, a stitch is made at the bottom of the uterus to keep the womb closed. There is a higher chance of miscarriage after this procedure, and the baby will be delivered by Caesarian section.

Trachelectomy is only suitable for women with early stage cancer of the cervix.

This type of surgery is not common and is only done in a few hospitals in the United Kingdom. You may need to ask your gynaecologist to refer you to a specialist hospital if you would like to discuss the possibility of having a trachelectomy. It is important that your doctor fully explains to you the benefits and possible risks of this type of operation.

If, after initial treatment, your cancer comes back in the pelvic area, it may be possible to have an operation called a pelvic exenteration. This is a major operation that involves removing all of the structures in the pelvic area and can include the womb, cervix, vagina, ovaries, bladder and the lower end of the large bowel (rectum). This type of operation is only suitable for a small number of women and you will need to have various investigations and scans to see if it is possible.

Part of the operation involves creating two openings (stomas) on the abdominal wall. These are needed because the operation removes the bladder and the rectum and you will need two stoma bags: one to collect your bowel motions and one for urine. These stomas are known as a colostomy and a urostomy. Before the operation you will see a nurse who specialises in the care of people with stomas (a stoma nurse). The nurse will explain all about stomas and how to look after them and can answer any questions you may have. The stoma nurse will also visit you after the operation to help you.

The operation also involves making (reconstructing) a new vagina.

A pelvic exenteration is a big operation, and many women find that recovery can be difficult, both physically and emotionally. It is important that you understand exactly how the operation may affect you so it is a good idea to talk to your surgeon or specialist nurse. They can support you in deciding whether pelvic exenteration is right for you.