The possibility of cervical cancer after a hysterectomy is a common concern. A hysterectomy is the surgical removal of the uterus, performed for various reasons, including fibroids, endometriosis, and certain cancers. The risk of cancer depends almost entirely on the specific type of hysterectomy performed, as surgical methods vary in the reproductive organs they remove. Understanding these anatomical changes is the first step in assessing future cancer risk.
What a Total Hysterectomy Removes
A total hysterectomy involves the complete removal of both the uterus and the cervix. The cervix is the narrow, lower portion of the uterus that connects the main uterine body to the vagina. This is the most common type of hysterectomy performed today.
A supracervical or subtotal hysterectomy removes only the upper part of the uterus, leaving the cervix intact. Since cervical cancer originates in the cells lining the cervix, whether this organ is removed dictates the future risk of the disease.
The Risk of Cervical Cancer After Removal
When a total hysterectomy is performed, the organ where cervical cancer originates is completely removed. Consequently, the risk of developing new cervical cancer is virtually eliminated for most individuals. This means routine cervical cancer screening, such as a traditional Pap test, is generally no longer needed.
There are, however, rare exceptions where a risk remains. If the hysterectomy was performed because of existing high-grade precancerous lesions or invasive cervical cancer, a small risk of recurrence exists. Microscopic cancer cells may have already spread beyond the cervix before surgery was completed. While this scenario is uncommon, the risk is not completely nullified for those with a pre-existing cancer diagnosis.
Distinguishing Between Cervical and Vaginal Cancers
It is important to distinguish between cervical and vaginal cancers, as removing the cervix does not eliminate the risk for all gynecological cancers. Vaginal cancer is a separate disease that develops in the cells lining the vagina, which remains in place after a total hysterectomy. The top portion of the vagina is called the vaginal cuff, which is where the cervix was surgically detached and closed.
The cells in the vaginal cuff can be susceptible to the same risk factors that cause cervical cancer. The human papillomavirus (HPV) is the primary driver for both cervical and vaginal cancers, meaning a persistent HPV infection can still cause abnormal cell changes in the vagina. While vaginal cancer is significantly rarer than cervical cancer, this distinction explains why some form of post-operative screening may still be necessary for high-risk individuals.
When Follow-Up Screening Is Still Necessary
Even after a total hysterectomy, continued monitoring is recommended in certain circumstances. This is typically done using a vaginal vault smear, which collects cells from the top of the vagina, rather than a traditional Pap test. The need for this specialized screening depends on the reason for the hysterectomy and the patient’s medical history.
Screening is required if the hysterectomy was performed to treat high-grade precancerous lesions, such as cervical intraepithelial neoplasia (CIN) grade 2 or 3, or if the patient has a known history of high-risk HPV infection. These individuals are at a higher risk of developing vaginal intraepithelial neoplasia (VAIN), which can precede vaginal cancer. Follow-up is also necessary if a subtotal hysterectomy was performed, as the remaining cervix is still susceptible to cancer. Patients who had a total hysterectomy for benign reasons, such as uterine fibroids, generally do not require further screening.