Hysterectomy for womb cancer
Surgery is the main treatment for womb cancer. A surgeon who is experienced in treating gynaecological cancers will do the operation. After the operation, all the tissue that has been removed is checked under a microscope to find out the stage of the cancer. It can take about 2 weeks for the stage to be confirmed.
The surgeon usually removes:
- the womb and the cervix (called a total hysterectomy)
- the fallopian tubes and both ovaries (called a bilateral salpingo-oophorectomy or BSO).
During the operation the surgeon also checks organs nearby for signs of cancer.
If you have a type 2 cancer, your surgeon may also remove:
- 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 at the front of the abdomen, which covers the organs in the tummy area.
Before the operation, your surgeon will talk to you about the possible benefits and disadvantages of removing the lymph nodes and possibly the omentum.
If you are still having regular periods, a hysterectomy and removing the ovaries will end this and the menopause will start. This can cause menopausal symptoms.
You may be offered the option to not have their ovaries removed, to prevent an early menopause. This is usually only possible if you have a low-grade, early-stage cancer.
A hysterectomy can be done in different ways.
During laparoscopic surgery, the surgeon operates through small cuts in the 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.
During abdominal surgery, the surgeon makes one cut (incision) in the tummy (abdomen). Afterwards, you have a wound that goes across your tummy close to the bikini line or that goes down from the belly button to the bikini line.
Robotic surgery is like laparoscopic surgery, but the laparoscope and instruments are attached to robotic arms. The surgeon controls the robotic arms.
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.
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. 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 echocardiogram (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 will usually be admitted to hospital on the morning of your operation. You will be given elastic stockings (TED stockings) to wear during and after the operation to 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.
For example, your doctor or nurse may give you information about diet and exercise before surgery. Or they may put in place 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.
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.
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 is widespread in the pelvic area, 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. Very occasionally, an operation may be done to remove a secondary tumour that is contained in one area. This would only be done if there are no signs of cancer elsewhere in the body.