A hysterectomy is a surgical procedure to remove a woman’s uterus. The uterus is where a fetus grows during pregnancy. A hysterectomy often also involves removal of the cervix. The cervix is the lower part of the uterus that connects to the vagina.
Since cervical cancer starts in the cells of the cervix, removing the cervix through hysterectomy eliminates the tissue where cervical cancer begins. This means the most common type of hysterectomy, called a total hysterectomy, prevents future development of cervical cancer.
However, there are some less common scenarios where a woman can still develop cervical cancer even after having a hysterectomy. Let’s explore those in more detail.
Types of hysterectomy
There are three main types of hysterectomy:
A total hysterectomy is the removal of the uterus and cervix. This eliminates the possibility of developing cervical cancer in the future since the cervix is removed.
A partial hysterectomy is the removal of the upper part of the uterus, but leaves the cervix in place. Since the cervix remains, there is still a chance of developing cervical cancer later on.
A radical hysterectomy removes the uterus, cervix, and surrounding structures. This is done in cases of invasive cervical cancer to help prevent its spread. Even with a radical hysterectomy, there are still some rare instances where cervical cancer could recur.
Reasons cervical cancer can still occur after hysterectomy
Here are some explanations for how cervical cancer might still arise in someone who previously had a hysterectomy:
Residual cervical tissue remains
If the hysterectomy was not complete and some cervical tissue was accidentally left behind, precancerous cells could remain in that tissue and progress to cervical cancer down the road. This is very uncommon with modern surgical techniques.
Cancer already present at time of surgery
In rare cases, a small focus of cancer may have already been present in the cervix at the time of the hysterectomy. If it was missed during examination and surgery, the cancer cells could continue to grow and spread after the procedure.
Cellular changes already underway
Certain strains of human papillomavirus (HPV) can cause cellular changes that eventually lead to cervical cancer. If those precancerous cellular changes were already present but not yet detectable when the hysterectomy was performed, the process could continue and manifest as cancer later on.
Vaginal cancer is mistaken for cervical cancer
Cancer can also arise in the top portion of the vagina closest to where the cervix used to be. This might be mistakenly diagnosed as cervical cancer, even though the cervix itself was already removed.
The risk of developing cervical cancer after a hysterectomy is very low. But here are some factors that can slightly increase a woman’s risk:
- Lymph nodes removed during hysterectomy were found to contain cancer cells
- Cancerous or precancerous tissue was found in the margins after hysterectomy
- A less aggressive cancer subtype, like adenocarcinoma
- HPV infection prior to hysterectomy
- Weakened immune system that could allow cancer cells to grow
- History of smoking
These are potential symptoms of cervical cancer arising after hysterectomy:
- Unexpected vaginal bleeding or spotting
- Watery, blood-tinged vaginal discharge
- Pelvic or abdominal pain
- Pain during intercourse
- Foul-smelling vaginal odor
- Unexplained weight loss
Any bothersome or unexplained symptoms should be evaluated promptly by a doctor. Cervical cancer found early is much more treatable.
Cervical cancer after hysterectomy may be diagnosed through:
The doctor feels for any signs of cancer in the upper vagina or surrounding pelvic structures.
Colposcopy with biopsy
A specialized microscope called a colposcope examines the vagina and cervix remnants closely. Any abnormal tissue is biopsied.
Imaging like CT, MRI, or PET scans help determine if cancer has spread beyond its original site.
Certain blood tests can detect substances shed by cervical tumors into the bloodstream.
Treatment options are similar to those used for cervical cancer in women who didn’t have a hysterectomy:
Additional surgery may be done to remove any remaining cervical tissue or cancerous tissue in surrounding structures.
High energy x-rays are used to kill cancer cells and shrink tumors. May be combined with chemotherapy.
Cancer-killing medications are administered systemically through an IV. Often combined with radiation.
Newer medications that specifically target cancer cells while causing less harm to healthy cells.
Medications that help the body’s immune system recognize and attack cancer cells more effectively.
The stage and location of the recurrent cancer will determine the best treatment approach. The goal is to eliminate all cancer while preserving as much quality of life as possible.
There is no absolute way to prevent the very small chance of cervical cancer recurrence after hysterectomy. But these steps can help lower risk:
- Quit smoking
- Get the HPV vaccine if eligible
- Practice safe sex to avoid contracting HPV
- Maintain a healthy immune system
- Have regular gynecologic exams that include vaginal cytology tests
Report any abnormal symptoms or findings that develop after hysterectomy to your doctor promptly. Routine screening with your gynecologist is also recommended even after hysterectomy.
The chances of developing cervical cancer after having a hysterectomy are extremely small. Well under 1% of women who have had a hysterectomy are later diagnosed with cervical cancer.
In the very unlikely case where cervical cancer does recur after hysterectomy, the prognosis depends most on how early it is detected:
- Early stage detection – 5 year survival over 90%
- Late stage detection – 5 year survival 15-35%
The overall odds of surviving later stage cervical cancer have improved in recent years thanks to advances in surgery, radiation, chemotherapy, and immunotherapy.
In summary, having a hysterectomy that removes the cervix provides excellent protection against cervical cancer in the vast majority of women. But extremely rare cases can sometimes still arise. Staying vigilant about symptoms and maintaining follow-up exams with your gynecologist are always wise precautions.
While hysterectomy drastically reduces the risk of cervical cancer, extremely uncommon cases can still sometimes occur. This is usually due to residual cervical tissue being left behind during surgery or precancerous changes already underway prior to the procedure. Symptoms like vaginal bleeding or pelvic pain after hysterectomy should never be ignored. Prompt evaluation and treatment provide the best odds of cure if cervical cancer is detected after hysterectomy. But the overall likelihood of developing cervical cancer again after removing the cervix remains extremely low in most women.