Every year in France, 3,000 women learn that they have cervical cancer. The diagnosis is established after carrying out various examinations (smear, HPV test) which noted the presence of precancerous lesions or a high-risk papillomavirus (HPV) infection.
In the event of a suspicious result, the gynecologist examines the cervix under a microscope. This colposcopy, performed in the doctor’s office, can identify the abnormal area. The gynecologist takes a sample. If the biopsy confirms the presence of precancerous cells, surgery is scheduled.
Conization of the cervix in the operating room
The intervention takes place in the operating room, under local, locoregional or general anesthesia, according to the wishes of the patient. The goal is to remove the diseased area.
“We speak of conization because we usually remove part of the cervix on 1 to 2 centimeters in diameter and 1 cm in height, the neck being about 5 cm high, ”explains Prof. Jean Gondry, gynecologist and president of the French Society for Colposcopy and Cervico-vaginal Pathology.
The wound then closes, without the need for stitches. “There may be some bleeding in the following 15 days, then the wound heals”, explains Professor Gondry.
This procedure must be performed by a trained gynecologist to limit the risk of sequelae. Some practitioners have signed a quality charter in which they undertake to respect good practices. The list is available on the website of the French colposcopy society.
What are the risks ?
Removal of the part of the cervix does not no effect on fertility of the patient. Her chances of getting pregnant are the same as before the procedure. However, the risk of not carrying this pregnancy to term increases slightly. Professor Gondry is reassuring:
“The removal of the cervix over more than 1 cm in height multiplies by two or three the risk of premature labor before 8 months. But the natural risk is only 8 to 9%. So in 80% of cases, childbirth is completed after conization ”.
It also happens that by closing, the scar closes the opening of the cervix. “This can make surveillance examinations more difficult, without other consequences”, assures Professor Gondry.
Sometimes the uterus needs to be removed
In some cases, depending on the location of the abnormal cells, the surgeon has no choice but to remove the uterus. This situation only represents 10% of cases. THE’hysterectomy is practiced in women who no longer have a pregnancy plan. Otherwise, the surgeon removes only the cervix and places his patient under surveillance.
At a more advanced stage of cancer
When the cancer is more invasive and has grown deep into the cervix, treatment should be adjusted. It may be a hysterectomy (removal of the uterus) followed by a pelvic lymph node dissection. When the tumor has spread and is more than 4 cm in height, “Surgical treatment no longer has its place. We immediately propose a chemotherapy and an radiotherapy “, specifies Professor Gondry.
At this stage, the prognosis is more reserved. Corn, treated early, cervical cancer is treatable in 70 to 80% of cases. However, there may beurinary and digestive sequelae, not to mention the inability to have a child after a hysterectomy.
This is the reason why Professor Gondry insists on screening and prevention. Screening exams (smear or HPV test depending on age) are supported. Vaccination is offered to young girls aged 11 to 14. It effectively protects against papillomavirus responsible for cervical cancer.