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.
Types of surgery to treat endometrial cancer
Endometrial cancer can be treated with:
The surgeon takes out your uterus and cervix. The cervix is the top of the vagina that connects to the uterus. Your doctor may also take out some nearby lymph nodes to check them to see if the cancer has spread. The doctor will do the hysterectomy in one of 3 ways:
Simple or total abdominal hysterectomy. The surgeon makes a cut (incision) in the belly. The incision starts at the belly button and goes about 3 to 4 inches down toward the genital area. 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 it may be easier to recover from.
Laparoscopic hysterectomy. The surgeon makes small incisions in your abdomen. He or she places a tool called a laparoscope into one incision. It has a 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.
The surgeon will take out one or both ovaries and both fallopian tubes. The surgeon removes these organs at the same time as the uterus and cervix. Your age helps determine whether the doctor 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 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 may mean that cancer has spread. This information helps your doctor 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.
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 (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:
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:
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.
Before your surgery
Your healthcare team will talk with you 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 the surgery will be done and where the incision(s) will be
Which organs will be removed
Whether lymph nodes will be removed
The risks and possible side effects of the surgery
When you can return to your normal activities
If the surgery will leave scars and what they will look like
Getting ready for your surgery
Tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form.
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 2 to 7 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 or nurse 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 turn over often, which you need to do as you recover from surgery.
If you have a radical hysterectomy, you will likely have a urinary catheter for a few days. This 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 the use of a stool softener.
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 okay for you to have sex and what you can expect it to be like after surgery.
You may need radiation treatment 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:
Redness, swelling, or fluid leaking from the incision
Changes in bladder function or trouble passing urine
Swelling in your legs