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Types of radical hysterectomy, from A to D | CION Cancer Clinics
Surgeons use the Querleu-Morrow system to describe how wide a radical hysterectomy is. Type A removes the least tissue beside the cervix and type D the most, with sub-types marked by a number. The letter describes the operation, not your cancer. This page explains each type, how it matches older names on your notes, and what decides the one you are offered. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What do the types of radical hysterectomy mean?
- How do types A, B, C and D differ?
- How do the old Piver types match the new ones?
- What decides which type you are offered?
- What do the other words on the note mean?
- What do families often assume about the type?
- What can the type not tell you?
- Common questions about the types of radical hysterectomy
The short answer
What do the types of radical hysterectomy mean?
The Querleu-Morrow system sorts radical hysterectomy into four types, A to D, by how far out from the cervix the surgeon removes tissue. Type A removes the least and type D the most. Types B and C also have sub-types marked with a number.
Why surgeons use a system at all
For many years the word "radical" meant different things in different hospitals. One surgeon's radical operation could be much wider than another's. A shared system lets your surgeon write down exactly what was done, so that a pathologist, a radiation oncologist or a second-opinion doctor reads the same thing.
What the letter tells you
The letter describes how much of the tissue beside the cervix, the parametrium, was removed. It says nothing about the stage of your cancer or how well you will do. Two women with the same stage may be given different types because their tumours sit differently.
You may see an older system on your notes instead, with Roman numerals. The older and newer types roughly line up, as the table further down shows.Type by type
How do types A, B, C and D differ?
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Type A: the smallest
The tissue beside the cervix is cut just outside the cervix, without moving the ureter, the tube from the kidney to the bladder. It sits between a simple and a true radical operation, and suits some very small cancers.
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Type B: cut at the level of the ureter
The surgeon frees the ureter and removes tissue up to where it passes through. Type B1 does this alone. Type B2 also removes some lymph nodes from the side of the pelvis.
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Type C: cut out towards the main pelvic vessels
More of the tissue beside the cervix is removed, along with more of the vagina and the supporting ligaments. Type C1 tries to keep the nerves to the bladder and bowel. Type C2 does not, because the cancer position does not allow it.
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Type D: out to the pelvic side wall
The widest operation. Type D1 goes out to the side wall of the pelvis with its large blood vessels. Type D2 also removes nearby muscle or lining. It is rarely used and mainly for cancer that has come back in the pelvis.
Not sure whether this applies to you?
Ask an oncologistOlder notes
How do the old Piver types match the new ones?
Older Piver-Rutledge name
Roughly matching Querleu-Morrow type
Class I, extrafascial hysterectomy
Close to type A
Class II, modified radical hysterectomy
Close to type B
Class III, the classic radical operation
Close to type C
Classes IV and V, extended operations
Close to type D, or beyond it
Planning the operation
What decides which type you are offered?
The aim is to remove enough tissue to take the cancer out with a clear edge, and no more than that.
Size of the tumour
Smaller cancers confined to the cervix may need a narrower operation. Larger ones need more tissue removed around them.
How deep it has grown
The biopsy and MRI show how far into the wall of the cervix the cancer reaches. Deeper growth brings it closer to the parametrium.
Spread into small vessels
If cancer cells are seen inside tiny blood or lymph vessels, often written as LVSI, the team may plan a wider margin.
Your general health
Wider types take longer and carry more effects on the bladder and bowel. Heart, lung and kidney health all count.
Also weighed
- Whether nerves can safely be kept
- Whether radiation may be needed anyway
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On your operation note
What do the other words on the note mean?
- Paracervix
- The part of the tissue beside the cervix that the type letter mainly describes.
- Uterosacral ligament
- A band of tissue running from the cervix towards the back of the pelvis. Wider types remove more of it.
- Vesicouterine ligament
- Tissue between the womb and the bladder. The ureter runs through it on its way to the bladder.
- Nerve-sparing
- The surgeon tried to keep the nerves that control bladder, bowel and sexual function. Usually written with type C1.
- Pelvic lymphadenectomy
- Removal of lymph nodes, small glands that filter fluid, from the pelvis. It is recorded separately from the type.
Commonly believed
What do families often assume about the type?
"Type D is the stronger operation, so ask for it."
A wider operation is not a more effective one for every cancer. Removing more than needed adds effects on the bladder, bowel and sex life without adding benefit.
"Type A means the surgeon did less work."
It means the cancer needed less tissue removed. Choosing the narrowest safe operation is careful planning, not a shortcut.
"The letter shows how serious the cancer is."
The letter describes the operation, not the disease. Stage, grade and the pathology report tell you about the cancer itself.
"If the notes say C2, the nerves were cut by mistake."
C2 is a planned choice. It is used when the cancer lies so close to the nerves that keeping them would risk leaving cancer behind. Ask your surgeon to explain the reason.
Being straight with you
What can the type not tell you?
The type cannot tell you whether surgery is the right treatment for you, or how your recovery will go. It is a description of the operation for other doctors, and your treating team decides it with your scans, biopsy and health in front of them.
Who a radical hysterectomy does not suit
It is usually not the first choice when scans show cancer spreading beyond the cervix or into lymph nodes. In that case radiation with chemotherapy is generally used. Some women are also not fit enough for a long pelvic operation.
What to ask your surgeon
Ask which type is planned and why that width was chosen. Ask whether nerve-sparing is possible, and whether keyhole or open surgery is planned. Ask how likely it is that you will need radiation after the operation, and what effects on the bladder you should expect.
Questions we are asked
Common questions about the types of radical hysterectomy
Which type is the most common for cervical cancer?
For early cervical cancer that needs a radical operation, types B and C are the ones most often used. Type A suits some very small cancers, and type D is rare. Your surgeon picks the type from your own scans and biopsy, so the common choice may not be yours.
Is Wertheim's hysterectomy one of these types?
Wertheim's hysterectomy is an older name for the radical operation. It does not match one type exactly. It is usually closest to the older Piver class II or III, which roughly line up with types B and C. Ask your surgeon to write the Querleu-Morrow type.
Does a wider type mean a longer recovery?
Generally, yes. Wider operations take longer, remove more supporting tissue and come closer to the bladder nerves. That often means a longer time with a catheter and a slower return to normal activity. Recovery still varies a great deal from one woman to another.
Can the type change during the operation?
Sometimes. If the surgeon finds the cancer is larger than the scans suggested, or has reached lymph nodes, the plan may change. Some surgeons stop and advise radiation instead. Ask before surgery what they would do in that situation, so you are not surprised.
Where will I find the type written down?
It is usually recorded in the operation note and the discharge summary. The pathology report describes the tissue that was removed but may not use the letter. If you cannot find it, ask the team to note it for you, especially if you want a second opinion.
Does nerve-sparing make the operation less thorough?
It is offered only where keeping the nerves does not mean leaving cancer behind. When the cancer lies too close to the nerves, the surgeon removes them. Ask whether nerve-sparing is suitable in your case and what it would change for your bladder.
Are the lymph nodes part of the type?
No, apart from type B2. Lymph node removal is described separately, often by level, meaning how high up in the pelvis and abdomen the nodes were taken. Your notes may list both the type of hysterectomy and the level of node removal side by side.
I want a second opinion. What should I bring?
Bring the biopsy report, the MRI and any PET-CT on disc as well as the written reports, and your blood tests. If surgery has already happened, bring the operation note, the pathology report and the discharge summary. The type letter on those papers helps the next doctor quickly.
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Sources
- Cancer Research UK — Surgery for cervical cancer
- National Cancer Institute — Cervical Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for cervical cancer
- Cancer.Net (ASCO) — Cervical Cancer: Types of Treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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