Endometrial Cancer: Surgery

 

Surgery is the main treatment for endometrial cancer. Surgery is done by a gynecologic oncologist. This doctor is a specialist who has had extra training in the diagnosis and treatment of female cancers. The goal is to remove all of the cancer. In most cases, this means removing the uterus (hysterectomy). In some cases, the ovaries and other tissues near the uterus are also removed. After the uterus is removed, you will no longer be able to become pregnant.

Types of surgery to treat endometrial cancer

Endometrial cancer can be treated with:

• Simple hysterectomy

• Bilateral salpingo-oophorectomy

• Lymph node removal

• Radical hysterectomy

Hysterectomy

The surgeon takes out your uterus and cervix. The cervix is the lower part of the uterus that connects to, and opens into, the vagina. Your surgeon may also take out some nearby lymph nodes to check them to see if the cancer has spread. The surgeon will do the hysterectomy in one of these ways: 

• Simple or total abdominal hysterectomy. The surgeon makes a cut (incision) in the belly. The incision may start at the belly button and goes about 3 to 4 inches down toward the genital area. (This is called a midline incision.) The other possible incision is made across the lower part of your belly and is called a bikini incision. The surgeon takes out your uterus and cervix through this opening.

• Vaginal hysterectomy. The surgeon takes out the uterus and cervix through the vagina. A small cut is made at the top of the vagina. This method is more difficult for the surgeon to do than an abdominal cut. But your recovery may be easier.

• Laparoscopic-assisted hysterectomy. The surgeon makes small incisions in your abdomen. He or she places a long, thin tool called a laparoscope into one incision. The scope has a tiny camera attached to a telescope. This tool lets the surgeon see your uterus, fallopian tubes, and ovaries. The surgeon places other tools through other incisions. These are used to detach your uterus. The uterus is then removed through your vagina. The surgeon can also check some lymph nodes through the laparoscope. This procedure may be done using a robotic system controlled by the surgeon. This robotic method can give better control during the surgery.

Bilateral salpingo-oophorectomy

The surgeon will usually take out one or both ovaries and both fallopian tubes. This is often done at the same time as the hysterectomy. Your age helps determine whether the surgeon takes out the ovaries. In some younger women with early stage cancer, the ovaries may not need to be removed. This prevents a young woman from going through menopause at a young age.

Lymph node removal

The surgeon will likely take out lymph nodes from your pelvis and possibly higher up in your abdomen. It depends on how much cancer there is in the uterus and how deeply it has grown into the uterine wall. Lymph node removal lets your healthcare team check for cancer cells. It also helps the surgeon know if tissue outside the uterus needs to be removed. Cancer cells found in the lymph nodes means that cancer has spread. This information helps your healthcare provider plan other treatment you might need. Lymph nodes can be removed during a hysterectomy. They can also be removed at another time using a laparoscope or robotic method. This is called laparoscopic or robotic lymph node sampling.

Radical hysterectomy

This type of surgery is not often done for endometrial cancer. This surgery is for women whose cancer has spread to the cervix or the tissue around the uterus (the parametrium). The radical hysterectomy may be done through an abdominal incision. Or it may be done through laparoscopy or robot-assisted surgery. 

The surgeon removes:

• The uterus

• Tissues next to the uterus called the parametrium and uterosacral ligaments 

• The cervix, which is the area that connects your vagina to your uterus

• The upper part of your vagina

• Some nearby lymph nodes

• Both ovaries and fallopian tubes

Risks of surgery for endometrial cancer

All surgery has risks. The risks of endometrial cancer surgery may include:

• Excess bleeding

• Infection

• Damage to nearby organs

• Bulging of organs under the incision (hernia)

• Medical complications such as heart attack, stroke, pneumonia, or blood clots

• Swelling of the legs (lymphedema), which can occur after the lymph nodes are removed

Your risks depend on your overall health, the exact type of surgery you need, how it's done, and other factors. Talk with your healthcare provider about which risks apply most to you.

It's important you know that you will not be able to get pregnant or carry a baby after a hysterectomy.

Making a decision

Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:

• What type of surgery will be done?

• How will the surgery be done and where will the incision(s) be?

• Which organs will be removed?

• Will lymph nodes be removed?

• What are the risks and possible side effects of the surgery?

• How long will I need to be in the hospital?

• When can I return to my normal activities?

• Will the surgery leave scars and, if so, what will they look like?

• How will surgery affect my sex life?

Getting ready for your surgery

Tell your healthcare team if you are taking any medicines. This includes prescription and over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking anything that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form. This form says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist. You can ask questions about the anesthesia and how it will affect you. Just before your surgery, you’ll be given anesthesia so that you sleep through the surgery and don’t feel pain.

After your surgery

You may have to stay in the hospital for several days. This depends on the type of surgery you had. For the first few days after surgery, you are likely to have pain from the incision. Your pain can be treated with medicine. Talk with your healthcare provider about your options for pain relief. Pain medicine can help your healing. For example, if you don’t control pain well, you may not want to cough or get up very often. But you need to do that as you recover from surgery.

If you have a radical hysterectomy, you will likely have a urinary catheter for a few days. This is a tube put through your urethra and into your bladder. Your urine then flows into a bag outside your body. In some cases, you may go home with the catheter still in.

You may have constipation from the pain medicine, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or using a stool softener. This is very important as straining to move the bowels can cause bleeding or breakdown or separation of areas that have been stitched (sutured) together.

You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person.

Recovering at home

When you get home, you may get back to light activity. You should avoid strenuous activity for about 6 weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover. Ask when it's OK for you to have sex and what you can expect it to be like after surgery.

Follow-up care

You may need radiation or hormone therapy after surgery. Your healthcare provider will talk with you about this or any other treatments that you need to help reduce the risk of the cancer coming back.

When to call your healthcare provider

Let your healthcare provider know right away if you have:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Changes in bladder function or trouble passing urine

• Increase in pain

• Fever

• Chills

• Swelling in your legs

• Chest pain or trouble breathing

Before you leave the hospital or surgical center, talk with your healthcare provider. Make sure you know how to check for signs of a serious problem. Know when to call your healthcare provider after surgery with questions or problems. Know what number to call after office hours, on weekends, and on holidays.