Surgery for Endometrial Cancer
Surgery is often the main treatment for endometrial cancer and consists of a hysterectomy, often along with a salpingo-oophorectomy, and removal of lymph nodes. In some cases, pelvic washings are obtained, the omentum is removed, and/or peritoneal biopsies are obtained. If the cancer has spread throughout the pelvis and abdomen, a debulking procedure (removal of as much cancer as possible) may be done. These are discussed in detail below.
The main treatment for endometrial cancer is an operation to remove the uterus and cervix (called a hysterectomy). When the uterus is removed through an incision in the abdomen, it is called a simple or total abdominal hysterectomy. If the uterus is removed through the vagina, it is known as a vaginal hysterectomy. Removing the ovaries and fallopian tubes, a bilateral salpingo-oophorectomy (BSO), is not actually part of a hysterectomy; it is a separate procedure that is often done during the same operation (see below).
For endometrial cancer, removing the uterus but not the ovaries is seldom recommended, but it may be considered in women who are premenopausal. To decide what stage the cancer is in, lymph nodes in the pelvis and around the aorta will also need to be removed (see below). This can be done through the same incision as the abdominal hysterectomy. If the hysterectomy is done vaginally, lymph nodes can be removed by laparoscopy.
When endometrial cancer has spread to the cervix or the area around the cervix (called the parametrium), a radical hysterectomy is done. In this operation, the entire uterus, the tissues next to the uterus (parametrium and uterosacral ligaments), and the upper part of the vagina (next to the cervix) are all removed. Both fallopian tubes and ovaries are removed at the same time. This operation is most often done through an incision in the abdomen, but it can also be done through the vagina.
When a vaginal approach is used, laparoscopy is used to help safely remove the necessary organs and tissues. Laparoscopy is a technique that lets the surgeon look at the inside of the abdomen and pelvis through tubes inserted into very small incisions. Small surgical instruments can be controlled through the tubes, allowing the surgeon to operate without a large incision in the abdomen. This can shorten the time needed for recovery from surgery. Both a hysterectomy and a radical hysterectomy can also be done through the abdomen using laparoscopy.
Surgery for endometrial cancer using laparoscopy seems to be just as good as more traditional open procedures if done by a surgeon who has a lot of experience in laparoscopic cancer surgeries. The DaVinci® robot is increasingly used to perform laparoscopic procedures, however long-term outcomes are not yet known.
For any of these procedures, general anesthesia will be used so the patient is asleep or sedated during these operations.
This operation removes both fallopian tubes and both ovaries. This procedure is usually done at the same time the uterus is removed (either by simple hysterectomy or radical hysterectomy) to treat endometrial cancers. Removing both ovaries means that you will go into menopause if you have not done so already.
If you are younger than 45 when you get 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
Pelvic and para-aortic lymph node dissection: This operation removes lymph nodes from the pelvis and the area next to the aorta to see if they contain cancer cells that have spread from the endometrial tumor. It is called a lymph node dissection when most or all of the lymph nodes in a certain area are removed. This procedure is usually done at the same time as the operation to remove the uterus. If you are having an abdominal hysterectomy, the lymph nodes can be removed through the same incision. In women who have had a vaginal hysterectomy, these lymph nodes may be removed by laparoscopic surgery.
Laparoscopy is a technique that lets the surgeon look at the inside the abdomen and pelvis through tubes inserted into very small incisions. Small surgical instruments can be controlled through the tubes, allowing the surgeon to remove lymph nodes. This approach avoids the need for a large incision in the abdomen so the recovery time is often shorter.
When only a few of the lymph nodes in an area are removed, it’s called lymph node sampling.
Depending on the grade, the amount of cancer in the uterus and how deeply the cancer invades the muscle of the uterus, lymph nodes may not need to be removed.
Sentinel lymph node mapping
Sentinel lymph node mapping (SLN) may be used in early-stage endometrial cancer if your doctor learns from x-ray results that there has been no obvious spread of cancer to the lymph nodes in your pelvis. In this procedure, a blue dye is injected into the area with the cancer, usually near the cervix. The lymph nodes that turn blue (from the dye) are removed at surgery. These lymph nodes are examined closely to see if they contain any cancer cells. This procedure is usually done at the same time as surgery to remove the uterus. Your doctor will determine if you are eligible for SLN.
Pelvic washings (peritoneal lavage)
In this procedure, the surgeon “washes” the abdominal and pelvic cavities with salt water (saline) and sends the fluid to the lab to see if it contains cancer cells. This is also called peritoneal lavage.
Other procedures that may be used to look for cancer spread
- Omentectomy: The omentum is a layer of fatty tissue that covers the abdominal contents like an apron. Cancer sometimes spreads to this tissue. When this tissue is removed, it is called an omentectomy. This may be done during a hysterectomy if cancer has spread there or to check 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 attempt to remove as much of the tumor as possible. This is called debulking. Debulking a cancer can help other treatments, like radiation or chemotherapy, work better. Tumor debulking is helpful for other types of cancer, and it may also be helpful in treating some types of endometrial cancer.
Recovery after surgery
The hospital stay for an abdominal hysterectomy is usually from 3 to 7 days. The average hospital stay after an abdominal radical hysterectomy is about 5 to 7 days. Complete recovery can take 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. Complications of these surgeries are unusual and vary with the surgical approach, but they could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems.
A radical hysterectomy affects the nerves that control the bladder, so a catheter is used to drain urine and is kept in place for at least a few days after surgery. If the bladder hasn’t recovered completely when it is removed, it may be replaced for a time or you may be shown how to insert a catheter yourself several times a day to empty your bladder until bladder function returns.
For more information on surgery for cancer, see Cancer Surgery.
Side effects of surgery
Any hysterectomy causes infertility (not being able to start or maintain a pregnancy). For women who were premenopausal before surgery, removing the ovaries will cause menopause. This can lead to symptoms such as hot flashes, night sweats, and vaginal dryness. Removing lymph nodes in the pelvis can lead to a build-up of fluid in the legs, a condition called lymphedema. This happens more often if radiation is given after surgery.
Surgery and menopausal symptoms can also affect your sex life. For more, see Sexuality for the Woman With Cancer.
Last Medical Review: February 10, 2016 Last Revised: February 29, 2016