Surgery for endometrial cancer

Hysterectomy

The main treatment for endometrial cancer is an operation to take out the uterus and cervix. This is called a hysterectomy. When the uterus is removed through a cut (incision) in the belly, it is called a simple or total abdominal hysterectomy. If the uterus is removed through the vagina, it is known as a vaginal hysterectomy.

A hysterectomy can also be done through the belly (abdomen) using laparoscopy. Laparoscopy is a technique that lets the surgeon look at the inside of the abdomen and pelvis through tubes put in through very small incisions. Small instruments can be controlled through the tubes. This allows the surgeon to operate without making a large cut into the abdomen. Surgery for endometrial cancer using laparoscopy seems to be just as good as standard operations if done by a surgeon who has a lot of experience in laparoscopic cancer surgery. The DaVinci ^® robot is being used more often to perform laparoscopic procedures.

Bilateral salpingo-oophorectomy

Removing the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) is not actually part of a hysterectomy: it is a separate type of procedure. But it is often done at the same time as a hysterectomy. If both ovaries are removed, you will go into menopause (change of life) if you have not done so already.

If you are younger than 45 and you have stage I endometrial cancer, you may discuss keeping your ovaries with your surgeon, because although women whose ovaries were removed had a lower chance of the cancer coming back, removing the ovaries didn’t seem to help them live longer.

Lymph node surgery

To find out the stage of the cancer, lymph nodes in the pelvis and around the aorta will also need to be removed (see below). This can be done at the same time as the hysterectomy or as a separate procedure.

Lymph node removal: When many lymph nodes in a certain area are removed it is called lymph node dissection. In this operation, lymph nodes from the pelvis and the area around the main artery that carries blood from the heart (the aorta) are removed. When only a few of the lymph nodes are removed, it is called lymph node sampling. Either way, the lymph nodes that are removed are looked at to see if they contain cancer cells. Lymph node removal can be done at the same time as an abdominal hysterectomy or with a laparoscope (explained below).

Laparoscopic lymph node surgery: For this procedure, thin tubes are put into the belly (abdomen) through very small cuts (incisions). Small tools can be controlled through the tubes and the doctor can take out some lymph nodes. This approach can shorten the time needed to recover from surgery. A recent study showed that laparoscopic surgery (with lymph node removal) works as well (at least in the short-term) as open abdominal surgery.

Pelvic washings

To do a pelvic washing, the surgeon “washes” the abdominal and pelvic areas with salt water (saline) and then sends the fluid to the lab to see if it contains cancer cells.

Other methods to look for cancer spread

Omentectomy: The omentum is a layer of fatty tissue that covers the belly contents like an apron. Cancer sometimes spreads to this tissue. When this tissue is removed, it is called an omentectomy. Sometimes the omentum is removed during a hysterectomy to see if cancer has spread there.

Peritoneal biopsies: The tissue lining the pelvis and abdomen is called the peritoneum. Peritoneal biopsies remove small pieces of this lining to check for cancer cells.

Tumor debulking

If cancer has spread throughout the abdomen, the surgeon may try to remove as much of the tumor as possible. This is called debulking. Debulking a cancer can help other treatments work better. Tumor debulking is helpful for other types of cancer, and it may also be helpful in treating women some women with endometrial cancer.

Recovery after surgery

For an abdominal hysterectomy, the hospital stay is usually 3 to 7 days. Complete recovery takes about 4 to 6 weeks. A laparoscopic procedure and vaginal hysterectomy usually require a hospital stay of 1 to 2 days and 2 to 3 weeks for recovery. Problems are rare but could include a lot of bleeding, wound infection, and damage to the urine system or the intestines.

Side effects of surgery

A woman cannot become pregnant after a hysterectomy. For women who had not gone through menopause before surgery, taking out the ovaries will cause menopause. This can lead to symptoms like hot flashes, night sweats, and vaginal dryness. Taking out lymph nodes in the pelvis can lead to a buildup of fluid in the legs, a problem called lymphedema. This happens more often if radiation is given after surgery.