The cervix is part of the female reproductive tract that lies between the uterus and the vagina. It’s a narrow, short, cone-shaped organ that’s sometimes referred to as the mouth of the uterus. Check out an interactive diagram of the cervix.
Surgical removal of the cervix is called a radical trachelectomy (RT), or a cervicectomy. It involves removing the cervix and some surrounding tissue as well as the upper one-third of the vagina and pelvic lymph nodes.
The cervix is commonly removed through the vagina (called an RVT) or sometimes through the abdomen (RAT).
The primary reason for undergoing RT is cervical cancer. Cervical cancer is the third-leading cause of cancer deaths among women and one of the most common cancers affecting the female reproductive tract.
Many cervical cancers stem from infection with the human papillomavirus (HPV), which is transmitted via sexual intercourse. According to the Centers for Disease Control and Prevention, 9 out of 10 HPV infections clear up on their own within two years, which means you don’t have to resort to a radical trachelectomy to treat an HPV infection.
Talk to your doctor about getting the HPV vaccine and regular screening if any of the following are true, as they place you at higher risk:
- You’ve had unsafe sex.
- You’re transgender.
- You’re a man who has sex with other men.
- You have a disease or condition that compromises your immune system.
- You smoke.
- You have a sexually transmitted disease.
Early-stage cervical cancer often goes undetected due to lack of symptoms. When it’s discovered, it’s typically during a routine Pap smear.
Later-stage cases can cause the following symptoms:
- vaginal bleeding
- pelvic pain
- pain during sex
RT is considered a safe alternative to a hysterectomy (removal of both the cervix and uterus) for women with early-stage cervical cancer and tumors less than 2 centimeters who want to preserve their childbearing capabilities. (A baby develops inside the uterus. When the uterus is removed, there’s nowhere for a fetus to grow.)
According to a review of research, there was no significant difference in women who had RT versus those who had a hysterectomy in terms of:
- five-year disease recurrence rate
- five-year mortality rate
- surgical complications, either during the procedure or after
One of the biggest pros of RT versus hysterectomy is that the procedure preserves the uterus, and thus a woman’s ability to become pregnant. Research has indicated that 41 to 79 percent of women who attempted to become pregnant after RT were able to conceive.
For women with early-stage cervical cancer, other research indicates RT may be superior to hysterectomy in ways beyond preserving fertility. One study — albeit with a small sample size —showed that women who undergo RT versus a hysterectomy have:
- less blood loss (and the subsequent need for blood transfusions)
- shorter hospital stays
RT does require hospitalization and general anesthesia, which carries risks of its own. In addition, other risks include:
- leaking urine
- painful sex
- painful periods
- blood clots
- thigh numbness
RT risk also includes the buildup of lymphatic fluid. This is the fluid that flows through lymph vessels and helps fight disease and infection. The buildup can result in swelling in the arms, legs, and abdomen. In some cases, the swelling can be severe.
When it comes to pregnancy, women with RT who conceive are considered to have high-risk pregnancies. They’re typically advised to have cesarean deliveries.
Most doctors will place a stitch (called a cerclage) between the vagina and uterus to keep the area partially closed in an attempt to support a growing fetus. However, many women who receive RT and become pregnant deliver prematurely (before 37 weeks). There’s also a greater risk of miscarriage.
Research shows that women who receive RT:
- Have a 25–30 percent chance of delivering a preterm baby (versus the 10 percent chance for other women). Preterm birth puts a baby at risk for heart and lung problems as well as learning and developmental delays.
- Are more likely to encounter second-trimester pregnancy loss than women who don’t have the procedure.
RT is an in-hospital procedure done under general anesthesia. It involves the surgeon removing lymph nodes in the pelvis and examining them for cancer cells.
If cancer cells are found in the lymph nodes, the surgeon stops the procedure. The woman will be advised about other treatment options. (These may include a hysterectomy with chemotherapy, radiation, or both.)
If no cancer cells are found in the lymph nodes, the surgeon removes the cervix, part of the vagina, and some surrounding tissue. They will likely put in place a stitch to hold the uterus and vagina together.
There are several ways the cervix and other relevant matter can be removed:
- Via the vagina in a procedure called a radical vaginal trachelectomy.
- Via the abdomen in a surgery called radical abdominal trachelectomy.
- Laparoscopically (called a laparoscopic radical trachelectomy). This involves making a small incision in the abdomen and inserting a laparoscope (a thin, lighted instrument with a lens) to remove tissue.
- Using a robotic arm (called a robotic trachelectomy) inserted through tiny cuts in the skin.
How long it will take you to recover depends on your health before the procedure and what sort of trachelectomy you had.
In general, trachelectomies using laparoscopy or a robotic arm are easier to recover from because they’re less invasive. Most people will be in the hospital for about three to five days.
After the trachelectomy, you can expect:
- vaginal bleeding for two or more weeks
- pain (you’ll be prescribed pain medication)
- a urinary catheter (a thin tube inserted into the bladder to release urine) in place for one to two weeks postsurgery
- instructions to limit physical activity, such as exercising, climbing stairs, or even driving, possibly for several weeks
- instructions to refrain from sex or putting anything in your vagina until you get your doctor’s OK, usually four to six weeks after surgery
- to be out of work for four to six weeks
Possible short-term physical side effects include
- physical weakness
- urinary incontinence
- painful periods
- vaginal discharge
- risk of infection
- limb swelling
RT can have additional consequences. According to a 2014 study, during the year after surgery, women undergoing RT were more likely than women who didn’t have the procedure to have:
- sexual dysfunction
- lower sex drive (although desire returned to normal at the end of the 12 months)
- sexual worry
More positive side effects are:
- reduced blood loss and quicker recovery times with laparoscopic or robotic RT
- the preservation of fertility
RT is an increasingly common and effective treatment for young women with early-stage cervical cancer. The survival rates for RT are comparable to those for hysterectomy.
Women who undergo RT may have more difficulty conceiving and maintaining a pregnancy than women who don’t have the procedure. But they do have good odds of delivering healthy babies.
Talk to your doctor about the risks and advantages of RT if you have a condition that can be treated with RT or hysterectomy.