Surgery for endometrial cancer
The main treatment for endometrial cancer is an operation to take out the uterus and cervix. This is called a hysterectomy. If only the uterus is removed, it is called a simple or total hysterectomy. If the tissue around the uterus (including the upper part of the vagina) is also removed, it is called a radical hysterectomy. This is used for more advanced cancers.
Standard (or “open”) hysterectomies are done two ways:
- In an abdominal hysterectomy, the uterus is removed through a cut (incision) in the belly
- In a vaginal hysterectomy, the uterus is removed through the vagina
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. Laparascopic surgery can also be done using a special robot such as the DaVinci® robot.
Removing the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) is not officially part of a hysterectomy but it is often done at the same time. For some younger women with very early stage endometrial cancer, leaving the ovaries in may be an option.
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 an abdominal or laparoscopic hysterectomy or as a separate procedure.
If many of these lymph nodes are removed it is called a lymph node dissection. If only a few of the lymph nodes are removed, it is called lymph node sampling. Either way, the removed lymph nodes are looked at to see if they contain cancer cells.
To look for small numbers of cancer cells that are too small to see, the surgeon can “wash” the abdominal and pelvic areas with salt water (saline). The fluid is sent 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. When this tissue is removed, it is called an omentectomy. Sometimes the omentum is removed during a hysterectomy because it contains cancer or so it can be checked for cancer spread.
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.
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 or vaginal hysterectomy usually requires 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. Women who had a radical hysterectomy may need a catheter to drain the bladder for a time after surgery.
More detailed information about surgery for endometrial cancer can be found in our document Endometrial Cancer.
For more on lymphedema, see our document Understanding Lymphedema – for Cancers Other than Breast Cancer.
Surgery and menopausal symptoms can also affect your sex life. For more, you can read our booklet Sexuality for the Woman With Cancer.
Last Medical Review: 11/08/2013
Last Revised: 02/03/2014