Radical hysterectomy and radical trachelectomy

Both operations treat an early cervical cancer by removing it with wide margins. They are often called radical because the surgeon removes the tissue next to the cervix, called the parametrium, which may hold microscopic spread, and not just the cervix itself.

Simple hysterectomy, which removes the womb and cervix without the surrounding tissue, is used only for the smallest cancers or as treatment for other problems. LLETZ or cone biopsy may be enough for the very earliest stage 1A1 disease, according to Macmillan.

The NHS describes it as removing the cervix, the upper vagina and the womb, with the ovaries and tubes possibly removed too. Macmillan adds that after the menopause the tubes and ovaries are usually taken as well. Before the menopause, ovaries can often be left in place so that hormone production continues, depending on the cancer type and the surgeon’s advice.

The operation can be done through an abdominal incision, by keyhole surgery or with robotic assistance. Macmillan lists abdominal, vaginal, laparoscopic and robotic routes, and some teams use nerve-sparing techniques to protect bladder function. The surgeon chooses the approach based on the cancer, the evidence available and experience.

This fertility-sparing option is for people with a small early cancer who want to keep the chance of pregnancy. Macmillan describes the surgeon removing the cervix and upper vagina, then placing a stitch at the bottom of the womb to keep it closed in pregnancy. The womb, tubes and ovaries stay.

Pregnancies after the operation need caesarean delivery, and Macmillan notes that the risk of miscarriage is raised. Pregnancy care is under an obstetric team with experience of high-risk cases. If the nodes show cancer or the pathology is unfavourable, the plan may change to chemoradiotherapy, which ends fertility.

Lymph nodes from the pelvis are examined for cancer cells. Macmillan notes that analysis of the removed tissue may show cancer cells in blood or lymph vessels, nodes or surrounding tissue, which can mean that more treatment is advised. The NHS lists chemoradiotherapy as the main treatment for larger or spread cancers.

For that reason, surgery for cervical cancer is planned by a multidisciplinary team before the operation so that the combination of surgery and radiotherapy is avoided where possible, as the two together raise the risk of late side effects.

Most people go home within a few days, and normal activities usually resume over weeks. Cancer Research UK lists organ damage, lymphoedema, infection, blood clots and bleeding as possible complications. Bladder emptying problems and bowel changes can occur in the short term.

If both ovaries are removed before the menopause, an early menopause follows. NHS information on hysterectomy notes that ovary failure can occur even when ovaries are left, and that bone health is a concern for younger women who lose them. Lymphoedema, sexual health and menopause support are covered in our guide to living after treatment.