What is the surgical treatment for gynecological cancer
Gynecological cancer is a cancer located in the female reproductive system, in organs and areas such as the uterus, uterine 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 already spread (if it has metastasized). As a rule, the approach includes gynecological surgery, chemotherapy, and/or radiotherapy. Surgical treatment, in most cases, comes as the main element, because the removal of the tumor and possible metastases significantly increases the chance of cure and increases the patient’s survival.
Types of surgery for gynecological cancer
It is possible, in most cases of gynecological cancer, to perform minimally invasive surgery, in which the procedure is performed through small incisions made in the skin and commanded by the surgeon through a high definition screen. The less invasive approach allows the patient to recover more quickly and with less complications when compared to traditional open surgery.
Women with advanced ovarian cancer, uterine cancer, or peritoneal cancer benefit from radical cytoreductive surgery (also known as debulking). In this technique, the tumor is completely removed (or at least as much of it as possible). Chemotherapy can be performed as a neoadjuvant (before gynecological surgery) or adjuvant (after the procedure).
For uterine cervix 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 uterine cervix with the goal of destroying the abnormal cells by freezing them. It can be performed in the doctor’s office;
- Laser surgery: a laser beam is used to burn the abnormal cells. It can also be done in the doctor’s office, under local anesthesia;
- Conization: a cone-shaped sample of tissue is removed from the uterine cervix using a scalpel (cone biopsy), by laser (laser conization), or a wire heated by electricity (Leep electrosurgical procedure). In addition to being used for cancer diagnosis, the cone biopsy can also be used as treatment. Depending on the case, it is capable of completely removing precancerous lesions and some early stage cancers;
- Simple hysterectomy: consists in the complete removal of the uterus (body of the uterus and uterine cervix) and preservation of the nearby structures, such as the vagina, the pelvic lymph nodes and the ovaries;
- Radical hysterectomy: the uterus is removed along with the tissues surrounding it and the upper part of the vagina, near the uterine cervix. The ovaries are not removed unless there is a clinical indication for this (the procedure is called bilateral oophorectomy). If the doctor deems it necessary, some pelvic lymph nodes can be removed.
In the surgical treatment of ovarian cancer, the main objectives are staging and reducing the volume of the tumor. Depending on the situation, it is necessary to perform the hysterectomy along with the removal of the ovaries (bilateral oophorectomy), the fallopian tubes (bilateral salpingo-oophorectomy), the omentum (layer of fatty tissue lining the abdominal organs) and some lymph nodes in the region.
Possible Adverse Effects in Gynecologic Surgery
The biggest women’s concerns with gynecological cancer are usually about fertility and sexual pleasure.
Any type of hysterectomy results in infertility, since the woman will lose her uterus. In the case of the bilateral oophorectomy, performed in isolation, one can study the possibility of performing egg freezing cycles before the surgery, if there is time through the growth speed of the tumor.
In any case, both surgeries do not interfere with sexual pleasure, since the area around the clitoris and the vaginal lining remain with unchanged sensitivity.
Aside from these issues, the main complications of gynecological cancer surgeries are:
- Scar infection;
- Urinary or intestinal problems;
- Premature menopause;
- Prolapse of the vaginal vault (after hysterectomy, the upper part of the vagina can fall toward the vaginal opening, because the structures in this region are weakened. Follow-up with a specialized physiotherapist is usually very helpful in strengthening the pelvic floor muscles); and
- Lymphedema (swelling in the legs caused by the removal of lymph nodes).