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CION Cancer Clinics
Why the parametrium is removed in a radical hysterectomy | CION Cancer Clinics
The parametrium is the tissue on each side of the cervix. It is removed in a radical hysterectomy because it is the first place cervical cancer usually spreads, often in amounts too small for a scan to show. Removing it gives a clear edge of healthy tissue. This page explains what it contains, how it is removed and what the pathology report means. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why does a radical hysterectomy remove the parametrium?
- What runs through the parametrium?
- How is the parametrium taken out?
- What do the words on the pathology report mean?
- What do people often misunderstand about this?
- What happens if cancer is found in the parametrium?
- Common questions about removing the parametrium
The short answer
Why does a radical hysterectomy remove the parametrium?
The parametrium is removed because it is the first place cervical cancer usually spreads when it grows beyond the cervix. Taking it out with the womb removes cancer cells that may be sitting there too small to see on any scan.
What the parametrium is
It is the band of soft tissue on each side of the cervix and the lower part of the womb. It holds the cervix in place, and it carries blood vessels, small lymph channels and nerves. It does not do a job you will miss in the way you would miss an organ.
Why a simple hysterectomy is not enough for cancer
A simple hysterectomy cuts close to the cervix. If cancer has crept a little way into the parametrium, that cut can pass straight through it and leave cancer behind. The radical operation cuts further out, so the edge of what is removed sits in healthy tissue. Surgeons call that edge the margin.
Why it cannot simply be checked first
An MRI of the pelvis is good at showing a large tumour pushing into the parametrium. It cannot reliably show a few cancer cells scattered inside it. There is no safe way to sample the whole parametrium with a needle before surgery. Removing it and examining it under the microscope is how the team finds out for certain.
How much parametrium is removed varies. It depends on the size of the cancer and is planned before the operation.Inside the tissue
What runs through the parametrium?
This is why removing it takes care and time. Several important structures pass through or right beside it.
The ureters
These are the tubes that carry urine from each kidney to the bladder. They pass through a tunnel in the parametrium, so the surgeon has to free them gently before any tissue is removed.
Blood vessels
The main arteries and veins that supply the womb run here. They are sealed and divided one by one, which is part of why the operation takes longer than a simple hysterectomy.
Lymph channels
Fine channels carry fluid from the cervix to the pelvic lymph nodes. Cancer cells can travel along them, which is why the nodes are usually removed in the same operation.
Bladder and bowel nerves
Nerves that control bladder emptying, bowel function and sexual feeling run in the deeper part of this tissue.
Why this matters later
- The bladder may be slow to empty for a while
- Bowel habit can change
- Vaginal feeling and lubrication can change
Not sure whether this applies to you?
Ask an oncologistIn the operation
How is the parametrium taken out?
Opening the spaces
The surgeon opens the natural tissue planes around the womb, the bladder and the rectum. This gives a clear view of the parametrium from every side before anything is cut.
Freeing the ureters
Each ureter is traced and lifted gently out of its tunnel. Protecting them is one of the most careful parts of the whole operation.
Dividing the tissue
The vessels are sealed and the parametrium is divided at the planned distance from the cervix. Where it is safe for the cancer, the deeper nerves may be kept.
Removing it in one piece
The womb, cervix, parametrium and upper vagina come out together. Keeping them in one piece lets the pathologist check every edge under the microscope.
On your report
What do the words on the pathology report mean?
- Parametrium
- The tissue on each side of the cervix. The report says whether cancer was found in it.
- Parametrial involvement
- Cancer cells were found in the parametrium. This usually means more treatment is advised after surgery.
- Paracervix
- Another name for the part of the parametrium closest to the cervix. Some reports use the two words for the same area.
- Margins clear
- No cancer cells were found at the cut edges of the tissue removed.
- LVSI
- Lymphovascular space invasion. Cancer cells were seen inside small blood or lymph vessels near the tumour.
- Pelvic lymph nodes
- Small glands in the pelvis. The report lists how many were removed and whether any contained cancer.
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Commonly believed
What do people often misunderstand about this?
"If the scan showed nothing there, they should leave it."
Scans cannot see very small groups of cancer cells. The parametrium is removed because it can hold cancer the MRI missed, and only the microscope can confirm it is clear.
"Removing more tissue means the cancer is worse."
No. The parametrium is removed in early cervical cancer precisely because the disease is still contained. Removing it is part of treating an early cancer thoroughly.
"Cancer in the parametrium means surgery failed."
Finding it means the operation did its job of showing what was there. The team then uses that information to plan further treatment, usually radiation.
"Bladder trouble afterwards means something went wrong."
Some slowing of the bladder is an expected effect of removing this tissue, because the bladder nerves run through it. It usually improves over the following weeks and months.
Being straight with you
What happens if cancer is found in the parametrium?
If the pathology report shows cancer in the parametrium, your team will usually advise more treatment. This is most often radiation to the pelvis, commonly given with chemotherapy. It is called adjuvant treatment, which means treatment given after surgery to lower the chance of the cancer coming back.
What if it is clear
If the parametrium, the margins and the lymph nodes are all clear, many women need no further treatment and move on to regular follow-up checks. Some still have radiation if the report shows other features, such as a large tumour or cancer cells in small vessels. Your team will explain which applies to you.
Who the radical operation does not suit
When scans before surgery already show cancer in the parametrium, surgery is usually not the first choice. Radiation with chemotherapy is generally used instead, because doing both surgery and radiation adds the side effects of each.
What this page cannot tell you
It cannot tell you how much parametrium you need removed, or whether surgery is right for you. Only your own team, with your scans and biopsy, can weigh that. Ask them how wide the planned operation is, whether nerve-sparing is possible, and what would happen if the report found cancer in the parametrium.
Did you know
At CION every surgical case is discussed at a tumour board, with surgeons, radiation oncologists and medical oncologists together, before the plan is confirmed. The pathology report is reviewed the same way after the operation.
Questions we are asked
Common questions about removing the parametrium
Will I miss the parametrium once it is gone?
Not as tissue. It does not make hormones or do a job your body relies on. What you may notice are the effects on the nerves and vessels that run through it, mainly a bladder that is slow to empty for a while, some bowel change and a shorter vagina.
Is the ureter at risk during this operation?
It is one of the structures the surgeon works hardest to protect, because it passes through the parametrium. Injury is uncommon, but it can happen. Ask your surgeon how they check the ureters during the operation and what signs you should report afterwards.
Can the nerves in the parametrium be saved?
Sometimes. A nerve-sparing approach tries to keep the deeper nerves that control the bladder and bowel. Whether it is possible depends on the size and position of the cancer, because the first priority is removing the cancer completely.
Does every radical hysterectomy remove the same amount?
No. Surgeons describe the operation by type, according to how far out from the cervix the parametrium is cut. Smaller cancers may need less removed. Your surgeon plans the width from your MRI and biopsy before the day of surgery.
How will I know whether the parametrium was clear?
The pathology report will say so. It usually takes some days after the operation to come back. Your surgeon will go through it with you, explain whether the parametrium, margins and lymph nodes were clear, and whether more treatment is advised.
Why was my mother told she needs radiation instead of this?
When scans suggest the cancer has already reached the parametrium, radiation with chemotherapy usually treats that area better than surgery. It avoids a large operation followed by radiation anyway. The team chooses based on the scans, not because one treatment is lesser.
Can this be done by keyhole surgery?
The parametrium can be removed by open or keyhole surgery. For cervical cancer, many teams now prefer the open route after research raised concerns about keyhole surgery in this setting. Ask your surgeon which route is planned and the reasons for it.
Will removing it affect my sex life?
It can. The vagina is a little shorter, and nerves involved in arousal and lubrication run near this tissue. Many women find sex comfortable again with time, lubricants and gentle stretching. It is a normal thing to raise with your team, and they will not be embarrassed.
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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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
- NHS — Cervical cancer: 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.
Keep reading
Related pages
Radical Hysterectomy: What Is DifferentHow the radical operation compares with a simple oneNerve-Sparing Radical HysterectomyKeeping the bladder nerves where it is safeWhy Some Patients Need Radiation After Radical SurgeryWhat happens when the report finds cancer in the parametriumThe Pathology Report After SurgeryReading the report that comes back after the operation
Talk to us
Have a pathology report you want explained?
Send it to us or call the helpline. A surgical oncologist will explain what it says about the parametrium and what comes next. One helpline serves every CION centre.