Surgery for Uterine Sarcomas
Surgery is the main (primary) treatment for uterine sarcoma. The major goal of surgery is to remove all of the cancer. This usually means removing the uterus, but in some cases the fallopian tubes, ovaries, and part of the vagina may also need to be removed. Some lymph nodes or other tissue may be taken out as well to see if the cancer has spread outside the uterus. Which procedures are done depend on the type and grade of the cancer and how far it has spread (see How is uterine sarcoma staged?). The patient's general health and age are also important factors. In some cases, tests done before surgery allow the doctor to plan the operation in detail ahead of time. These tests include imaging studies, such as CT scans, MRIs, chest X-rays and ultrasound, as well as a pelvic examination, endometrial biopsy, and/or D&C. In other cases, the surgeon has to decide which options to take based on what is found during surgery. For example, sometimes there is no way to know for certain that a tumor is cancer until it is removed during surgery.
This surgery removes the whole uterus (the body of the uterus and the cervix). This procedure is sometimes called a simple hysterectomy or a total hysterectomy. In a simple hysterectomy, the loose connective tissue around the uterus (parametrium), the tissue connecting the uterus and sacrum (uterosacral ligaments), and the vagina remain intact. Removing the ovaries and fallopian tubes is not actually part of a hysterectomy—officially it is a separate procedure known as a bilateral salpingo-oophorectomy (BSO). The BSO is often done along with a hysterectomy in the same operation (see below).
If the uterus is removed through an incision in the front of the abdomen, the surgery is called an abdominal hysterectomy. When the uterus is removed through the vagina, it is called a vaginal hysterectomy. If the lymph nodes need to be removed and tested, this can be done through the same incision as the abdominal hysterectomy. If a hysterectomy is done through the vagina, lymph nodes can be removed using a laparoscope. A laparoscope is a thin lighted tube with a video camera at the end. It can be inserted into the body through a small incision (cut) and allows the doctor to see inside the patient without making a big incision. The doctor can use surgical instruments that are inserted through other small incisions to operate. The laparoscope is sometimes used to help remove the uterus when the doctor is doing a vaginal hysterectomy. This is called a laparoscopic assisted vaginal hysterectomy. The uterus can also be removed through the abdomen with a laparoscope, sometimes using a robot, as well. Laparoscopic procedures require less recovery time than a regular abdominal hysterectomy but often the surgery takes longer. You should talk with your surgeon about what approach will be used and why it is the best for you.
Either general or regional anesthesia is used for the procedure--this means that the patient is asleep or sedated and numb from the waist down. For an abdominal hysterectomy the hospital stay is usually 3 to 5 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 recovery. After a hysterectomy, a woman cannot become pregnant and give birth to children. Surgical complications are uncommon but could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems.
This operation removes the entire uterus as well as the tissues next to the uterus and cervix (parametrium and uterosacral ligaments) and the upper part (about 1 inch) of the vagina (near the cervix). This operation is used more often for cervical carcinomas than for uterine sarcomas.
Radical hysterectomy is most often done through an abdominal surgical incision, although it can also be performed through the vagina or laparoscopically with or without the assistance of the DaVinci® robot. Most patients undergoing a radical hysterectomy also have some lymph nodes removed, either through the abdominal incision or laparoscopically. Radical hysterectomy can be done using either general or regional anesthesia.
Because more tissue is removed by a radical hysterectomy than with a simple hysterectomy, the hospital stay may be longer. The surgery leaves the woman unable to become pregnant and give birth to children. Complications are similar to, but more common than those associated with a simple hysterectomy and could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems. If some of the nerves of the bladder are damaged, a catheter will be needed to empty the bladder for some time after surgery. This usually improves and the catheter can be removed later.
This operation removes both fallopian tubes and both ovaries. In treating endometrial carcinomas and uterine sarcomas, this operation is usually done at the same time the uterus is removed (either by simple hysterectomy or radical hysterectomy). If both of your ovaries are removed, you will go into menopause if you have not done so already.
Symptoms of menopause include hot flashes, night sweats, and vaginal dryness. These symptoms are caused by a lack of estrogen and may be improved with estrogen therapy. This therapy also lowers a woman's risk of osteoporosis (weakening and thinning of the bones). However, since estrogen can cause some types of uterine sarcoma to grow, many doctors are concerned that it could increase the chance of the cancer coming back. Most experts in this field consider estrogen therapy too risky for most women who have had uterine sarcoma. Some doctors prescribe it only when the stage and grade of the cancer indicate a very low risk of the cancer coming back. A woman who has had uterine sarcoma should discuss the risks and benefits of estrogen therapy with her doctor before making a decision. Other treatments can be used to help relieve symptoms of menopause and prevent osteoporosis that do not affect the risk of the cancer coming back.
Lymph node surgery
Your surgeon may do a procedure called a lymph node dissection or a lymph node sampling, which removes lymph nodes in the pelvis and around the aorta (the main artery that runs from the heart down along the back of the abdomen and pelvis). These lymph nodes are examined under a microscope to see if they contain cancer cells. If cancer is found in the lymph nodes, it means that the cancer has already spread outside of the uterus. This carries a poor prognosis (outlook). This operation is done through the same surgical incision in the abdomen as the simple abdominal hysterectomy or radical abdominal hysterectomy. If a vaginal hysterectomy has been done, the lymph nodes can be removed with laparoscopic surgery.
Removing lymph nodes in the pelvis can lead to a buildup of fluid in the legs, a condition called lymphedema. This occurs more often if radiation is given after surgery. More information about lymphedema can be found in Lymphedema.
Other procedures that may be done during surgery
- 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. The omentum is sometimes removed at the same time the hysterectomy is done if cancer has spread there or as a part of staging.
- 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.
- Pelvic washings: 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.
- Tumor debulking: If cancer has spread throughout the abdomen, the surgeon may attempt to remove as much of the tumor as possible. This is called debulking. For some types of cancer, debulking can help other treatments (like radiation or chemotherapy) work better. Its role in treating uterine sarcoma is not clear.
Sexual impact of surgery
If you are premenopausal, removing your uterus causes menstrual bleeding (periods) to stop. If your ovaries are also removed, you will go into menopause. This can lead to vaginal dryness and pain during intercourse. These symptoms can be improved with estrogen treatment, but women who have been treated for certain cancers may need to avoid this hormone. Other medicines may be helpful for those women.
While physical and emotional changes can affect the desire for sex, these surgical procedures do not prevent a woman from feeling sexual pleasure. A woman does not need ovaries or a uterus to have sex or reach orgasm. Surgery can actually improve a woman's sex life if the cancer had caused problems with pain or bleeding during sex.
For more information on this topic, see our document Sexuality for the Woman With Cancer.
Last Medical Review: May 12, 2014 Last Revised: February 15, 2016