A hysterectomy, a surgical procedure to remove the uterus, often raises questions about future health risks. A common concern is whether cervical cancer can still develop. The answer is nuanced, depending on the type of hysterectomy performed and an individual’s medical history.
Understanding Hysterectomy and Cervical Cancer
A hysterectomy involves the surgical removal of the uterus, which is the organ where a fetus grows during pregnancy. The specific type dictates which parts are removed. In a supracervical or subtotal hysterectomy, only the upper part of the uterus is removed, leaving the cervix in place. A total hysterectomy involves the complete removal of both the uterus and the cervix. A radical hysterectomy is a more extensive procedure, typically performed for cancer, removing the uterus, cervix, surrounding tissues, and the upper portion of the vagina.
Cervical cancer originates in the cells of the cervix, the lower part of the uterus that connects to the vagina. This cancer is primarily caused by persistent infection with certain high-risk types of Human Papillomavirus (HPV). HPV is a common virus transmitted through sexual contact, and while most infections are cleared by the body’s immune system without causing problems, some high-risk strains can lead to abnormal cell changes that may progress to cancer over time.
Post-Hysterectomy Cancer Risks
The possibility of developing cervical cancer after a hysterectomy largely depends on whether the cervix was removed. If a supracervical hysterectomy was performed, leaving the cervix intact, the risk of developing cervical cancer persists. This is because the cells that can become cancerous are still present in the cervix, necessitating continued screening.
For those who have had a total hysterectomy, which includes the removal of the cervix, the risk of developing cervical cancer is virtually eliminated. However, a total hysterectomy does not remove the vagina. Although rare, vaginal cancer can develop in the lining of the vagina. This risk is particularly relevant if there was a history of HPV infection, severe precancerous cervical lesions (such as CIN 2 or CIN 3), or cervical cancer prior to the hysterectomy, as HPV can still affect vaginal tissues. Abnormal cells known as vaginal intraepithelial neoplasia (VAIN) can develop and, in some instances, progress to vaginal cancer.
Continued Screening and Monitoring
Continued medical follow-up is important due to varying risks after a hysterectomy. If a supracervical hysterectomy was performed, regular Pap tests are still recommended to screen for cervical cancer. For individuals who have undergone a total hysterectomy, the need for ongoing screening depends on their medical history.
If there was a history of abnormal cervical cells or cervical cancer, a vaginal vault Pap test may be recommended. This test collects cells from the top of the vagina, known as the vaginal cuff or vault, to check for abnormal cells or the presence of high-risk HPV. However, if a hysterectomy was performed for benign conditions and there is no history of abnormal Pap smears, routine vaginal vault screening may not be necessary.
Recognizing Symptoms
Staying aware of potential symptoms is important, even after a hysterectomy. While these signs are not exclusive to cancer and can indicate other, less serious conditions, they warrant evaluation by a healthcare professional.
Abnormal vaginal bleeding is a significant symptom to monitor, whether it occurs between periods, after sexual activity, or after menopause. Any unusual vaginal discharge, such as that which is watery, bloody, or foul-smelling, should also prompt medical attention.
Other symptoms that should be discussed with a doctor include persistent pelvic pain or pressure, and pain during sexual intercourse. The presence of a noticeable mass or lump in the vagina is another sign that requires prompt medical assessment. Additionally, changes in urinary or bowel habits, such as painful or frequent urination, or constipation, can sometimes be associated with gynecological concerns.