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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
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A hysterectomy (an operation to remove the womb) is used as a treatment for many different conditions. This information is about having a hysterectomy to treat cancer. If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment or speak to one of our cancer support service nurses| .
A hysterectomy is often one of the main treatments for cancers of the ovary| , womb , cervix and the fallopian tubes. Women with vaginal cancer| may sometimes need a hysterectomy if their cancer has spread further. Cancers of these organs are sometimes called gynaecological cancers .
Surgery is usually carried out in specialist cancer centres or units by surgeons who are experts in this type of operation. You may be referred to a specialist cancer nurse (gynaecology nurse specialist) who will give you information and emotional support.
A hysterectomy is also sometimes used to treat changes in the cells of the cervix called cervical intra-epithelial neoplasia (CIN)| . These cells are not cancer but in some women they may develop into cancer if they are not treated. In this situation a hysterectomy is usually done in women who can't have (if they are post-menopause, for example) or don't want to have more children and have CIN which keeps coming back.
A woman's reproductive system is made up of the parts of the body involved in having sexual intercourse, producing and fertilising eggs, carrying a baby and giving birth. A hysterectomy can be carried out for cancers which start in any of these organs.
The female reproductive system includes the:
There are different types of hysterectomy. The operation that you will have will depend on your type of cancer, its stage and grade. The stage of your cancer describes its size and whether it has spread. The grade is how the cells look when examined under a microscope. This gives an idea of how the cancer may behave.
Once your specialists know the stage and grade of your cancer, they can decide on the most appropriate treatment for you.
At the same time as having your womb removed you may have some other surgery as well. This will depend on the type and stage of the cancer you have.
One of the ways in which a cancer may spread is through the nearby lymph nodes. The lymph nodes in the pelvis are often removed during a hysterectomy to find out if the cancer has spread. They may all be removed (called lymphadenectomy) or some of them are removed (lymph node sampling).
The kind of hysterectomy you have and any other surgery usually depends on your type of cancer. If you have:
You will probably have a total hysterectomy which means that the womb and cervix are removed. This is usually done in combination with removing both your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
You will usually have an omentectomy and the lymph nodes in the pelvis may also be removed. Sometimes the appendix is removed. If the cancer has spread to the bowel or to the lining of the abdomen (peritoneum) the affected parts may also be removed.
You will probably have a total hysterectomy which means that the womb and cervix are removed. This is done in combination with removing both ovaries and fallopian tubes (bilateral salpingo-oophorectomy). You may have an omentectomy and the lymph nodes in the pelvis removed.
Some surgeons may leave one ovary behind in young women to prevent an early menopause. However, an ovary can only be left behind if the cancer is still in the early stages and there is no risk that it has spread.
You will probably have a radical (Wertheim's) hysterectomy. This involves removing the womb, the cervix and its surrounding tissue, fallopian tubes, pelvic lymph nodes, the upper vagina and sometimes the ovaries.
In young women with early cancers (cancer that is still in the first stages and hasn't spread) the ovaries are usually left behind to prevent early menopause, but they are usually removed in older women.
The operation is similar to the surgery that's done for cancer of the ovary. You may have a total hysterectomy, which involves removing the womb and cervix. The ovaries and fallopian tubes will also be removed (bilateral salpingo-oophorectomy). You may also have an omentectomy (removal of the omentum) and the lymph nodes in the pelvis removed.
There are different ways in which a hysterectomy can be done. The most common way of carrying out a hysterectomy for cancer is through the abdomen.
The operation is carried out under a general anaesthetic. The surgeon makes a 10cm (4in) cut across your tummy (abdomen), just above the pubic hair. Or they may need to cut downwards from the belly button to the pubic hair.
The surgeon removes the womb and other organs where necessary and lifts them out through the cut in your abdomen. The muscles and tissues are then repaired and the wound is closed with staples or a continuous stitch, before it's covered with a dressing. You can expect to be in hospital between three and seven days after a total hysterectomy and between five and eight days after a radical hysterectomy.
When a hysterectomy is carried out through the vagina there is no visible scar. It is carried out under general anaesthetic. The surgeon makes the necessary cuts internally and then gently removes the womb, and other reproductive organs where necessary, through the vagina. The surgeon then sews up the top of the vagina. You are usually in hospital for three to five days after your operation.
Keyhole surgery (also called laparoscopic surgery ) is also sometimes used to carry out a hysterectomy for cancers of the womb and cervix. The advantages are that you usually only need to stay in hospital for two to three days and your recovery is much faster. However, this operation is not appropriate for everyone.
Instead of having a large wound in your tummy, you will have several smaller wounds (which eventually won't be noticeable). The doctor makes small cuts (incisions) in your tummy. Small surgical instruments and a laparoscope (telescope with camera on end) can be inserted through these. The womb and ovaries are then removed through the vagina.
Before your operation you will have some tests to prepare you for surgery and to make sure that it can be done as safely as possible. You will usually have blood and urine tests, your blood pressure checked and an electrocardiogram or ECG (heart tracing). Some women may also have a chest x-ray or a heart scan (echocardiograph). These tests can be done the day before your operation or a few days or weeks beforehand at a pre-assessment clinic.
You will be admitted to hospital either on the day before your operation or on the actual day. A doctor can explain more about your operation and ask you to sign a consent form. You will see an anaesthetist before your operation, who may arrange for you to have some tablets or an injection to help you relax. A nurse may shave some of your pubic hair to make sure the area is as clean as possible to prevent infection. You will be asked not to eat or drink anything for several hours before your operation.
If you smoke, try not to smoke for a few days before your operation. It's best to have your lungs free from cigarette smoke when you are having a general anaesthetic.
After your operation you will be encouraged to start moving about as soon as possible. You will have been given white support stockings to wear before your operation. These help prevent blood clots developing in the legs and you may be asked to wear them for up to six weeks after you go home. If you have to stay in bed, it is important to keep up regular leg movements and deep breathing exercises. You will be shown how to do these by a physiotherapist or by your specialist nurse.
Drips and drains A drip (intravenous infusion) will be used to give you fluids until you are able to eat and drink normally, which is usually after a few days.
You may have a drainage tube in your wound or tummy (abdomen) to drain excess fluid into a small bottle. This is usually removed after a few days.
Some women have a special catheter (supra-pubic catheter) which is put into the bladder through the abdomen and is stitched into place. The catheter may be left in for up to ten days after the operation to allow the bladder to rest. It's more usual to have this type of catheter after a radical hysterectomy.
The sensation of wanting to pass urine may feel different after your operation and some women may have some longer term problems. Occasionally this may mean having tests to check it out and possibly some treatment.
Pain It's quite normal to have some pain or discomfort for a few days but this can be controlled effectively with painkillers. If the pain is not controlled, it is important to let your doctor or nurse know as soon as possible so that your painkillers can be changed.
You may be given painkillers through an epidural for the first day after surgery. An epidural is a small, thin tube which is inserted into your back (in the space around your spinal cord) to give you continuous pain relief.
Some women may have their painkillers through a small pump attached to the arm or hand (Patient Controlled Analgesia or PCA). This allows you to press a button and painkillers are released directly into the bloodstream. The machine is set so that you always get a safe dose and can't have too much.
Care of your wound After a hysterectomy the wound is closed using clips or stitches. These are usually removed before you go home. Some surgeons use dissolving stitches that don't need to be removed. These will dissolve completely when the area is healed. Dissolving stitches are also used for vaginal hysterectomy.
To begin with your scar may feel itchy. It will look like a red line, which may feel a bit lumpy. This will gradually fade until it looks like a thin white line. If your wound becomes hot, painful or begins to bleed or leak any fluid it's important to let your doctor know straightaway.
Hygiene It is important to have a bath or shower every day while you are in hospital and when you go home. It's common to have a vaginal discharge for up to six weeks after your hysterectomy. This is usually reddish brown in colour. If the discharge becomes bright red, heavy or contains clots contact your doctor straightaway. Use sanitary pads rather than tampons which can increase the risk of an infection at this time.
Complications Complications from having a hysterectomy are uncommon. However, as with any major surgery, there are risks. These include a reaction to the anaesthetic, bleeding, infection or a blood clot, usually in a vein in the leg.
Some rare complications can include injury to nearby organs and tissues in the abdomen.
Some women develop lymphoedema| in their legs. Lymphoedema is a swelling of the limbs caused by a build up of lymph fluid in the tissues. It can happen as a result of the lymph nodes being removed during a hysterectomy.
Going home If you think you might have problems when you go home (if you live alone or have lots of stairs to climb) let the nurse or hospital social worker know when you are admitted. Social workers are often available to give practical advice and many are also trained counsellors. If you would like to talk to a social worker you can ask your nurse to arrange it for you.
Before you leave hospital you will be given an appointment to return to a clinic for a check up. This is a good time to discuss any problems you may have. If you have any problems or worries before this time, you can phone your ward nurses, hospital doctor or GP.
It's important to get plenty of rest when you go home after a hysterectomy. You may find you feel tired for several weeks or longer so it's a good idea to take things easy and have regular rest periods. Getting back to normal is a gradual process and it can take some time.
It will also take a while for your tummy (abdominal) muscles and skin to heal. You will need to avoid strenuous physical activity or heavy lifting for at least three months.
Some women find it uncomfortable to drive for a few weeks after their operation. So it may be a good idea to wait a while before you start driving again. Your insurance company may have guidelines about this. You can also contact the DVLA (Drivers and Vehicles Licensing Association)| for advice.
Looking after, or supporting a family can be hard even when you are well. Women with young children, or with elderly relatives to care for, won't be able to do all the things that they usually manage to do for several weeks after a hysterectomy. This can be difficult to adjust to and cope with. It's important to be realistic about what you can manage and to accept help from your partner, family and friends. You can also speak to a social worker about getting help for a while after your operation.
It is usually safe to start gentle exercise about six to eight weeks after a hysterectomy. Walking is good exercise. Begin with ten minutes a day, gradually increasing it as you feel able. You can do gentle swimming once your wound has healed and any vaginal discharge has stopped. Avoid strenuous exercise for at least 12 weeks.
Going back to work will depend on things like the type of work you do, how much surgery you had and how you are recovering. Depending on your individual circumstances it may be anything from six weeks to six months. You may need more time off if you are having further treatment (chemotherapy| and radiotherapy| ). Your doctor will be able to advise you when to return to work.
Some women may want to work part-time at first. There may be certain things that your employer can do to make things easier for you. If you usually stand for long periods, you can ask to do work that allows you to sit more. If you sit for long periods it is important to get up and move around every now and then. Our section on work and cancer| may be useful.
One of the common questions women ask after a hysterectomy is whether the operation will affect their sex life. Getting back to a normal sex life after a hysterectomy is perfectly safe and healthy. You won't have any more periods or be able to become pregnant.
To allow the wound to heal properly, most women are advised to wait at least six weeks after their operation before having sexual intercourse. After this time many women find that they have no difficulties in their sexual relationships. Some women do have problems.
Once the womb is removed, the surgeon stitches up the top end of the vagina. This makes it slightly shorter than it was before which is not usually a problem. To begin with, while healing is taking place, you may want your partner to be gentle, or you may not want to have penetrative sex.
A hysterectomy may affect a woman's experience of orgasm. Most women find that they are still able to have an orgasm, but the sensation may be different from before the operation.
Some women may be frightened that sex will be painful after a hysterectomy. They may feel less feminine or worry their partners will feel differently about them. Your partner may be concerned about causing any discomfort and also need some reassurance.
Another fear may be that cancer can be passed on to your partner during intercourse. This is not true and it's perfectly safe for you to continue to have a sexual relationship.
Knowing that the operation was needed because of a cancer can also increase anxiety and tension. For some women this may result in a deceased sex drive or a loss of sexual pleasure for a time.
Any sexual problems usually settle with time as life begins to get back to normal after the surgery. If they don't improve your doctor, or specialist nurse will be able to give you advice. They may be able to arrange for you to have counselling, which is often helpful.
Our section on sexuality and cancer| has more detailed information.
In younger women who are still having periods, removing the ovaries will bring on an early menopause. This can be difficult to cope with particularly when you are already coping with cancer. For some women it may be a difficult reminder that they can no longer have children. There is an organisation called The Daisy Network| , which supports women who have had an early menopause.
Some of the main physical effects of the menopause are:
Some women may be prescribed hormone replacement therapy (HRT), depending on the type of cancer they have. This can help to reduce some of the changes caused by the menopause. Taking HRT (under the age of 50) to help with some of the symptoms of an early menopause doesn't increase your risk of getting breast cancer| .
Lubricants such as Aquaglide, Senselle® or Replens MD® can be brought from most chemists and can ease any discomfort during intercourse.
Your doctor or specialist nurse can give you more information on how menopausal symptoms can be managed.
Being told that you have cancer and that treatment will make you permanently infertile can be very difficult. You may be single or already have children, or may not have thought about becoming a mother before. Whatever your situation, the loss of fertility| can be overwhelming. Women can be asked to be referred to a fertility specialist before their hysterectomy.
Women who have a partner and are interested in surrogacy (another woman carrying a child in her womb for you) may want to share embryos (fertilised eggs). Due to the immediate need for surgery and the wait to see an infertility specialist on the NHS, some women may have their eggs collected privately before their operation. Some women may also want to consider adoption.
A diagnosis of cancer takes time to come to terms with. You are likely to experience a number of different emotions| , from shock and disbelief to fear and anger. Having major surgery can often leave you feeling vulnerable. Younger women in particular, often find it difficult to come to terms with the fact that they can no longer have children after a hysterectomy. You may feel as if you have lost some of your identity as a woman. These are all natural, understandable emotions to have at this time.
Everyone has their own way of coping with difficult situations. Some women find it helpful to talk to friends or family, while others prefer to get help from people outside their situation. Others prefer to keep their feelings to themselves. There is no right or wrong way to cope and help is there if you need it.
Counselling can usually be arranged by the hospital or your GP. Our cancer support service| can give you details of how to find counsellors in your local area or see our list of counselling organisations| .
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography| .
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