What is the surgical treatment for gynecological cancer?
Gynecological cancer is located in the female reproductive system, in organs and regions such as the uterus, cervix, endometrium, ovaries, vagina, and vulva. It can be treated in several ways, depending on the type of disease, its location, and whether it has spread (metastasized). As a general rule, the approach includes gynecological surgery, chemotherapy, and/or radiation therapy.
Surgical treatment, in most cases, is the main element, as the removal of the tumor and possible metastases significantly increases the chance of cure and improves the patient’s survival.
Types of surgery for gynecological cancer
In most cases of gynecological cancer, minimally invasive surgeries can be performed, where the procedure is done through small incisions in the skin and guided by the surgeon using a high-definition screen. The less invasive approach allows the patient to recover more quickly and with fewer complications compared to traditional open surgery.
Women with advanced ovarian, uterine, or peritoneal cancer benefit from radical cytoreductive gynecologic oncologic surgery (also known as debulking). In this technique, the tumor is completely removed (or at least as much as possible). Chemotherapy may be administered neoadjuvantly (before gynecological surgery) or adjuvantly (after the procedure).
For cervical cancer, there are five main types of surgery in the treatment of lesions, whether precancerous or cancerous:
- Cryosurgery: a metal probe cooled with liquid nitrogen is inserted directly into the cervix to destroy abnormal cells by freezing them. It can be performed in a doctor’s office;
- Laser surgery: a laser beam is used to burn abnormal cells. It can also be done in a doctor’s office, under local anesthesia;
- Conization: a cone-shaped tissue sample is removed from the cervix using a scalpel (cone biopsy), laser (laser conization), or a wire heated by electricity (loop electrosurgical excision procedure, LEEP). In addition to being used for cancer diagnosis, cone biopsy can also be adopted as a treatment. Depending on the case, it can completely remove precancerous lesions and some early-stage cancers;
- Simple hysterectomy: Gynecologic oncologic surgery involves the complete removal of the uterus (body and cervix) while preserving nearby structures such as the vagina, pelvic lymph nodes, and ovaries;
- Radical hysterectomy: In this gynecologic oncologic surgery, the uterus is removed along with nearby tissues and the upper part of the vagina near the cervix. The ovaries are not removed in this gynecologic oncologic surgery unless there is a clinical indication for it (the procedure is called bilateral oophorectomy). If deemed necessary by the doctor, some pelvic lymph nodes may be removed.
In the surgical treatment of ovarian cancer, the main objectives are staging and reducing the tumor volume. Depending on the situation, it may be necessary to perform a hysterectomy along with the removal of the ovaries (bilateral oophorectomy), fallopian tubes (bilateral salpingo-oophorectomy), omentum (the layer of fatty tissue that covers the abdominal organs), and some lymph nodes in the region.
Possible adverse effects of gynecological surgery
The major concerns for women with gynecological cancer are usually related to fertility and sexual pleasure.
Any type of hysterectomy results in infertility, as the woman will be without a uterus. In the case of bilateral oophorectomy, if performed alone, it may be possible to consider freezing eggs before surgery, if there is time based on the tumor’s growth rate.
In any case, both surgeries do not interfere with sexual pleasure, as the region around the clitoris and the vaginal lining remain with unchanged sensitivity.
Aside from these issues, the main complications of gynecological cancer surgeries are:
- Hemorrhage;
- Infection at the incision site;
- Urinary or intestinal problems;
- Early menopause;
Prolapse of the vaginal vault (after a hysterectomy, the top part of the vagina can fall toward the vaginal opening because the structures in this region weaken. Follow-up with a specialized physiotherapist is usually very helpful, focusing on strengthening the pelvic floor muscles); and
Lymphedema (swelling in the legs caused by the removal of lymph nodes).
