Hysterectomy for womb cancer
Surgery to remove the womb (hysterectomy)
Surgery is the main treatment for womb cancer, also known as endometrial or uterine cancer. A surgeon experienced in treating gynaecological cancers will do the operation.
After the operation, they can tell you more about the stage of the cancer. It can take about 2 to 3 weeks for the stage to be confirmed.
The surgeon usually removes:
- the womb and the cervix – this is called a total hysterectomy
- the fallopian tubes and both ovaries – this is called a bilateral salpingo-oophorectomy or BSO.
Depending on the stage, grade and type of womb cancer, your surgeon may also recommend removing:
- lymph nodes close to the womb (pelvic nodes)
- lymph nodes higher up in the abdomen (para-aortic nodes)
- the omentum – a layer of fat and tissue covering the organs in the front of the tummy area (abdomen).
They then check these for cancer cells. Before the operation, your surgeon will talk to you about the surgery. They will explain the benefits and disadvantages, including the side effects and what to expect. Ask them any questions you may have.
Early menopause
If you are still having regular periods, after having a hysterectomy and your ovaries removed, you will start the menopause. This can cause menopausal symptoms.
Sometimes it may be an option not to have your ovaries removed. This will prevent an early menopause. This is usually only possible if you have a low-grade, early-stage cancer.
Before your operation
If you smoke, giving up before your operation will help reduce your risk of chest problems. It will also help your wound to heal after the operation and reduce side effects of further treatment such as radiotherapy. Your GP can give you advice and support.
You will go to a pre-assessment clinic a few days or weeks before the operation. You will have tests to check you are fit for surgery, such as blood tests and an electrocardiogram (ECG) to check your heart.
A member of the team will explain the operation to you. Make sure you discuss any questions or concerns that you have about the operation with them. You are usually admitted to hospital on the morning of your operation. You will be given elastic stockings (TED stockings) to wear during and after the operation. These help prevent blood clots forming in your legs.
Some hospitals follow an enhanced recovery programme. This aims to:
- reduce the time you spend in hospital
- speed up your recovery
- involve you more in your own care.
Your doctor or nurse may give you information about diet and exercise before surgery. Or they may make any arrangements needed for you to go home. Your doctor or nurse will tell you if an enhanced recovery programme is suitable for you and if it is available.
Having a hysterectomy
A hysterectomy can be done in different ways.
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Laparoscopic hysterectomy (keyhole surgery)
During laparoscopic surgery, the surgeon operates through small incisions (cuts) in the tummy (abdomen). They use small surgical instruments and a thin telescope with a video camera on the end (laparoscope). The laparoscope lets the surgeon see inside the body.
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Abdominal surgery
During abdominal surgery, the surgeon makes one cut in the tummy. Afterwards, you have a wound that goes across your tummy just above the hips, or that goes down from the belly button to just above the hips. Before the operation, your surgeon will discuss with you which cut they will make.
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Robotic surgery
Robotic surgery is like laparoscopic surgery, but the laparoscope and instruments are attached to robotic arms. The surgeon controls the robotic arms.
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Vaginal surgery
During vaginal surgery, the surgeon operates through a cut at the top of the vagina. The surgeon may combine this with laparoscopic surgery.
Your surgeon will talk to you about the most suitable type of surgery for you.
How quickly you recover from your womb cancer operation depends on the type of surgery you have. We have more information about recovering from womb cancer surgery.What else may be done during the surgery
After your operation, your surgeon can tell you more about the stage of the cancer. The stage and grade of the cancer helps your specialist decide if you need further treatment to reduce the risk of the cancer coming back. This is called adjuvant treatment.
If you have stage 2 or stage 3 cancer you are likely to be offered adjuvant treatment. Usually this is radiotherapy to the pelvic area. Sometimes chemotherapy is given with radiotherapy or on its own.
Removing lymph nodes
The surgeon may remove lymph nodes close to the womb (pelvic nodes) and higher up in the abdomen (para-aortic nodes). This is so they can be checked for cancer cells. How many lymph nodes need to removed depends on the stage, grade and type of womb cancer.
If the womb cancer is early, small and low grade, you may not need to have any lymph nodes removed.
Sometimes your surgeon will talk to you about removing only 1 or 2 lymph nodes closest to the cancer to check for cancer cells. This is called a sentinel lymph node biopsy. It may help decide if more treatment is needed.
If scans show the cancer has spread further, they may recommend removing more lymph nodes during the surgery.
Your surgeon will talk to you about the possible benefits and disadvantages of removing lymph nodes.
If the cancer has spread outside the womb
If the cancer has spread to organs close by, such as the bladder or bowel, you may have an operation to remove as much of the cancer as possible. This helps to control the cancer. It may also make the treatment you have after surgery more effective.
Very rarely, if the cancer has spread throughout the pelvis, you may have surgery to remove the bladder and the bowel, as well as the womb. This is a major operation called pelvic exenteration.
If the cancer has spread to the liver or lungs, surgery is not usually possible. Sometimes you may be able to have an operation to remove a secondary tumour, but this is rare. This is only possible if it is contained in one area, and there are no signs of cancer elsewhere in the body.
About our information
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References
Below is a sample of the sources used in our womb cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Concin et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. International Journal of Clinical Oncology. 2021. Available from www.pubmed.ncbi.nlm.nih.gov/33397713/
Royal College of Radiotherapy: Clinical Oncology. Radiotherapy dose fractionation, third edition. 2019. Available from www.rcr.ac.uk/publication/radiotherapy-dose-fractionation-third-edition
Sundar et al. BGCS uterine cancer guidelines: Recommendations for practice. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017. Available from www.bgcs.org.uk/wp-content/uploads/2019/05/BGCSEndometrial-Guidelines-2017.pdf
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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