Surgical treatments

Stage O is usually treated by ablative techniques such as cryosurgery, but may be treated by cone biopsy if the transformation zone cannot be visualised. Hysterectomy may may be indicated if future child bearing is not wished.

Stage IA may be treated by cone biopsy or hysterectomy.

Complications associated with conisation include:

• cervical stenosis } but both reduced by prior
• cervical incompetence } targetting by colposcopy

Stage IB and IIA tumours may be treated by radical hysterectomy and bilateral pelvic lymph node clearance. Radical hysterectomy entails removal of the uterus with adjacent portions of the vagina, cardinal and uterosacral ligaments, and bladder pillars.

Radical hysterectomy in these patients if favoured:

• in premenopausal women - as the ovaries can be preserved and complications of vaginal irradiation e.g. dyspareunia can be avoided
• where the tumour is small
• where future child bearing is not wished
• where radiotherapy would be undesirable - patients with existing colonic diverticular disease or chronic PID; those with a fear of radiation; and those for whom the most rapid form of treatment is best i.e. psychologically compromised patients

Complications associated with radical hysterectomy include:

• ureteric fistula or stricture - now less than 2% of cases
• bladder dysfunction - through interruption of part of the autonomic nerve supply traversing the cardinal and the uterosacral ligaments. Dysfunction usually lasts for some months and may be permanent
• DVT and PE - less common with prophylactic measures such as early ambulation, low dose subcutaneous heparin