Surgery for womb cancer
Surgery is the main treatment for womb cancer. Your operation will be carried out by a surgeon who is experienced in treating gynaecological cancers.
After the operation, your surgeon can tell you more about the stage of the cancer.
Hysterectomy (removing the womb)
Back to top
Usually you will have a total hysterectomy, which involves removing the womb and the cervix. The fallopian tubes and both ovaries are also removed (called a bilateral salpingo-oopherectomy). There are different ways in which a hysterectomy can be carried out. Your surgeon will advise you on which type is suitable for you.
This is the most common type of hysterectomy. The surgeon makes a cut (incision) across your tummy (abdomen) above the pubic hair, or sometimes downwards from your belly button to the pubic hair.
Laparoscopic hysterectomy (or keyhole hysterectomy)
The surgeon makes small cuts in your tummy and inserts small surgical instruments and a laparoscope (a telescope with a camera on the end) through these. The surgeon sees pictures on a screen and can check closely to see if the cancer has spread. The womb and ovaries are removed through the vagina or the cuts in the tummy. Women recover faster from this type of hysterectomy. It involves a shorter stay in hospital, but it’s not suitable for everyone.
We have more information about different types of hysterectomy in our section about having a hysterectomy.
What else may be done?
Back to top
During the operation, the surgeon will check organs nearby to find out more about the stage of the cancer. This involves putting some fluid into your tummy (abdomen) and removing it so that it can be tested for cancer cells.
Doctors sometimes call this abdominal washing or peritoneal washing.
Removing lymph nodes
You may have some or all of the lymph nodes close to the womb (pelvic nodes) and at the back of the tummy (para-aortic nodes) removed and checked for cancer cells. Your surgeon will talk to you about the benefits and disadvantages of removing some or all of the lymph nodes.
Knowing if the cancer has spread to the lymph nodes helps your specialist decide if you need further treatment. You’ll have lymph nodes removed if you have stage 2 or 3 womb cancer, but if you have stage 1 cancer it may not be necessary. If your CT or MRI scan has already shown that the cancer has spread to the lymph nodes, the surgeon will remove them.
When the cancer has spread outside the womb
If the cancer has spread to organs close by, such as the bladder or bowel, an operation to remove as much of the cancer as possible is usually done. This helps to control the cancer and may make the treatment you have after surgery more effective. Very rarely, if the cancer is widespread in the pelvic area, surgery to remove the bladder and the bowel, as well as the womb, may be done. This is a major operation called pelvic exenteration.
Speak to one of our cancer specialists on 0808 808 00 00 for more information on pelvic exenteration.
If the cancer has spread to the liver or lungs, surgery is not usually possible. Very occasionally, an operation to remove a secondary tumour that’s contained in one area may be done. But this would only be done when the cancer elsewhere in the body is under control.
Before your operation, you’ll have some tests to prepare you for surgery. These tests are usually done a few days or weeks beforehand at a pre-assessment clinic. A member of the surgical team and a specialist nurse will discuss the operation with you. You’ll also be visited by the doctor who will give you your anaesthetic (the anaesthetist). You’ll usually be admitted to hospital on the morning of your operation.
You’ll be given special elastic stockings (TED stockings) to wear during and after the operation to prevent blood clots forming in your legs. Make sure you discuss any questions or concerns that you have about the operation with your nurse or doctor.
If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection, and will help your wound to heal after the operation. Your GP can give you advice and you may find it helpful to read our information on giving up smoking.
It’s a scary time when you don’t know exactly what you’re dealing with, but I found that once treatment started it was easier to think positive.’
Some hospitals follow an enhanced recovery programme, which aims to reduce the time you are in hospital and to speed up your recovery. It also gets you more involved in your own care. For example, you’ll be given information about diet and exercise before surgery and any arrangements needed for you to go home will be put in place. Your doctor will tell you if an enhanced recovery programme is suitable for you and if it’s available, as not all hospitals follow this.
How quickly you’ll recover will depend on the type of operation you have and the extent of the surgery.
If you’re in an enhanced recovery programme, you’ll be encouraged to get out of bed on the evening of the operation, if possible. Your drip, which gives fluids into your vein, will be removed soon after surgery and you’ll be able to start drinking and eating again.
In the ward
After your operation, you’ll be given fluids into a vein in your hand or arm, called a drip or an intravenous infusion. Once you’re eating and drinking normally again, it’ll be taken out. You’ll usually have a tube (catheter) put in during the operation to drain urine from your bladder. This can be taken out a few hours after your surgery, but in some cases it may need to stay in for longer. If you have a wound drain (a fine tube in the wound draining fluid that collects into a small bottle), it’s usually taken out a few days after the operation.
After your operation, you’ll have some pain and discomfort, which will be controlled with painkillers. Depending on the extent of your surgery, you may need a strong painkiller for the first day or two after your operation.
You may be given this as injections into a muscle (given by the nurses), or through a pump known as a patient-controlled analgesia (PCA) pump. The pump is attached to a fine tube (cannula), which is placed in a vein in your arm. It allows you to release painkillers directly into your blood by pressing a button. The machine is set so you always get a safe dose and can’t have too much.
Some women may be given painkillers through an epidural infusion for the first few days. A fine tube is inserted in your back, into the space just outside the membranes surrounding your spinal cord. A local anaesthetic and other painkilling drugs are given by infusion (drip) into this space using an electronic pump.
The drugs work by numbing the nerves in the operation area, giving you continuous pain relief. It’s important to let the nurses or doctor know if your painkillers aren’t working for you. They can increase the dose or prescribe a different painkiller. Painkillers can cause constipation, so you may be offered laxatives. Let your nurse know if you have any problems going to the toilet.
After your operation, you’ll be encouraged to start moving around as soon as possible. This is important for your recovery as it helps prevent chest infections and blood clots.
If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse can help you do these exercises.
You’ll have a dressing covering your wound, which may be left undisturbed for the first few days. After this, you’ll usually have the dressings changed if there’s any leakage from the wound. If necessary, you can have any stitches or staples removed after you’ve gone home. This will be done by a district nurse or at your GP surgery.
Always let your doctor know if your wound becomes hot, painful or starts to leak fluid – these are possible signs of infection.
You may be ready to go home between two and eight days after an abdominal hysterectomy. If you’ve had laparoscopic (keyhole) surgery, you can usually go home
1–4 days after your operation. Your nurse will give you advice on looking after yourself so that your wound heals and you recover well.
You’ll be given an appointment to come back to the outpatient clinic to see the surgeon. At this appointment, your surgeon will examine you and check the wound. You’ll be given information about the results of the operation and you’ll be advised if you need further treatment.
How quickly you recover will depend on the operation you’ve had. It’s important to take things easy for a while, try to get plenty of rest and eat well. If you’re having any problems it’s important to contact your doctor or specialist nurse.
You’ll be advised to avoid strenuous physical activity or heavy lifting for about three months after a hysterectomy and six weeks after laparoscopic surgery. Your physiotherapist or specialist nurse will give you advice about this. Do some light exercise, such as walking, that you can gradually increase.
This will help you build up your energy levels and feel better.
Some women find driving uncomfortable after their operation, so it’s probably a good idea to wait for a few weeks before driving again. Some insurance policies give specific time limits, so you may need to check this with your insurance company.
Don’t drive unless you feel you have full control of the car.
Try to have a shower or bath every day to keep your wound clean. It’s common to have a reddish brown vaginal discharge for up to six weeks after a hysterectomy. Use sanitary pads rather than tampons to reduce the risk of infection.
Your surgeon will usually advise you not to have sex for at least six weeks after your operation, to allow the wound to heal properly. After that you’ll be able to go back to your usual sex life. But it’s not unusual to need more time before you feel ready, especially if you’re having other treatment as well.
For younger women who haven’t reached the menopause, a hysterectomy and removing the ovaries will bring on the menopause. This means you will get menopausal symptoms.
Possible long-term complications
Back to top
Most women have no long-term complications after surgery. But having other treatments as well as surgery may increase the risk of problems. Rarely, women have bladder or bowel problems after a hysterectomy because of damage to the nerves during the operation. If you have had the pelvic lymph nodes removed, there’s a risk of developing swelling (lymphoedema) in one or both legs. This is a build up of lymph fluid in the tissues. Lymphoedema isn’t common, but if you have radiotherapy as well as surgery there’s more risk.
You can read more in our section about lymphoedema and how you can try to reduce the risk of getting it.
It’s not unusual to feel anxious after surgery. You may feel your recovery is taking longer than you had expected it would, or you may be worried about having further treatment. It’s often helpful to talk about your feelings with your family and friends.
Your specialist nurse or cancer support specialists can also give you support. You can talk to our cancer support specialists on 0808 808 00 00 and get information about local support groups.