Pre-cancer (dysplasia) or very small lesions can be treated with minor surgery that may even be performed within the gynecologic practice. Larger tumors or cancer that has spread may require a more extensive surgery, such as a hysterectomy or radical hysterectomy, and additional treatment options including radiation and chemotherapy.
Penn gynecological oncologists work with patients to develop individual treatment plans and can often preserve reproductive options for women who wish to still have children. Our gynecologic surgeons are skilled in open surgery and are experts in using advanced minimally invasive laparoscopic and robotic-assisted surgical techniques. Alongside this innovative technology, our physicians, nurses and support staff give patients compassionate, exemplary and individualized surgical care.
Our gynecologic specialists continue their efforts to devise and enhance new and even better options for complex gynecologic surgery through the Penn Center for Advanced Gynecologic Surgery.
Conization (Cone Biopsy)
Penn Medicine physicians use conization, including cold-knife cone and loop electrosurgical procedure (LEEP), to diagnose and treat cervical cancer and precancerous lesions of the cervix.
During the procedure, a piece of tissue is removed from the cervix using either a scalpel (cold-knife cone biopsy) or a thin wire heated with electricity (loop electrosurgical procedure or LEEP). Conization is rarely used as the sole treatment for cervical cancer unless a woman wants to preserve her ability to have children and the amount of cancer present in the cervix is very small. The tissue removed during conization is checked under a microscope. If the outer edges of the tissue, called margins, still show precancerous changes, additional treatment may be needed to make sure that all of the abnormal cells are removed.
At Penn Medicine, minimally invasive techniques such as laparoscopic robotic-assisted surgery have become the standard of care for treating certain gynecologic cancers. For some types of cervical cancer, surgeons remove the body of the uterus and the cervix in a procedure known as a hysterectomy.
Hysterectomy may be performed as an open procedure, known as an abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. If lymph node sampling is needed, this can be done through the same incision as the abdominal hysterectomy.
Removing the uterus through the vagina is called vaginal hysterectomy. This procedure is minimally-invasive, sometimes with the assistance of a laparoscope, which is a thin camera inserted into the abdomen to facilitate the procedure and allow for abdominal and pelvic lymph node biopsies if necessary.
Our surgeons consider medical history, stage of cancer and current health condition to determine the type of surgery needed. Dependent upon the extent of the cancer, surgeons may also perform biopsies in other areas of the abdomen.
A simple hysterectomy removes only the uterus and cervix. Removing the ovaries and fallopian tubes is not always necessary for adequate treatment of cervical cancer.
When surgeons perform a radical hysterectomy, the entire uterus, as well as the tissues next to the uterus (parametrium and uterosacral ligaments), and the upper part (about an inch) of the vagina (near the cervix) are removed.
Usually performed abdominally, radical hysterectomy can also be performed vaginally, laparoscopically, or robotically. Most patients undergoing a radical hysterectomy also have a lymph node dissection, in which lymph nodes are removed either through the abdominal incision or by laparoscopic or robotic lymph node sampling.
Penn gynecologists may use laser surgery to treat pre-invasive forms of cervical cancer, known as cervical dysplasia. Laser surgery focuses a high-energy light beam on abnormal cervical cells and vaporizes them.
Pelvic exenteration is a radical cervical cancer surgery that removes all organs from the pelvic region. It is not commonly performed, but may be used to in special cases to treat cervical cancer that has recurred. A variety of structures or organs adjacent to the cervix may be removed during the procedure, including the:
- Parametria and uterosacral ligaments
- Fallopian tubes and ovaries
- Bladder and rectum
During the operation, stomas are created to allow urine and stool to collect in special bags. Some patients may have a type of reconstruction that allow a continent stoma (one that does not require a bag) for urine. If the vagina is removed, an artificial vagina can be created through reconstructive surgery. Plastic surgeon use grafts of muscle and skin to reconstruct the vagina.