Surgery for Uterine Sarcomas

Surgery is the main treatment for uterine sarcoma. The goal of surgery is to remove all of the cancer as one piece. This usually means removing the entire uterus (hysterectomy). 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. What's done depends on the type and grade of the cancer and how far it has spread. (See How Is Uterine Sarcoma Staged?) The patient's overall health and age are also important factors.

In some cases, tests done before surgery let the doctor plan the operation in detail ahead of time. These tests include imaging studies, like ultrasound, as well as a pelvic exam, endometrial biopsy, and/or D&C. In other cases, the surgeon has to decide what needs to be done based on what's found during surgery. For example, sometimes there's no way to know for certain that a tumor is cancer until it's removed during surgery.

Simple hysterectomy

This surgery removes the whole uterus (the body of the uterus and the cervix). This also is sometimes called a total hysterectomy. In a simple hysterectomy, the loose connective tissue around the uterus (called the parametrium), the tissue connecting the uterus and sacrum (the uterosacral ligaments), and the vagina remain intact. Removing the ovaries and fallopian tubes is not really part of a hysterectomy -- officially it's 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 (cut) in the front of the abdomen (belly), the surgery is called an abdominal hysterectomy. When the uterus is removed through the vagina, it's called a vaginal hysterectomy.

If 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 put into the body through a small incision and lets the doctor see inside the body without making a big incision. The doctor can use long, thin tools that are put in through other small incisions to operate. A 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 with a robotic approach, in which the surgeon sits at a control panel in the operating room and moves robotic arms to operate. Laparoscopic procedures have shorter recovery times than regular abdominal hysterectomies, but often the surgery takes longer. Talk with your surgeon about how the surgery will be done and why it's the best plan for you.

Either general or regional anesthesia is used for the procedure. This means that the patient is in a deep sleep or is 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 mean 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 rare but could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems.

Radical hysterectomy

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 not often used for uterine sarcomas.

Radical hysterectomy is most often done through an abdominal surgical incision, but it can also be done through the vagina or laparoscopically, with or without a robotic approach (in which the surgeon sits at a control panel in the operating room and moves robotic arms to operate). Most patients having 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.

This surgery leaves the woman unable to become pregnant and give birth to children.

Complications are much like, 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 gets better and the catheter can be taken out later.

Bilateral salpingo-oophorectomy

This operation removes both fallopian tubes and both ovaries. In treating uterine sarcomas, this operation is usually done at the same time the uterus is removed. 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. Estrogen therapy also lowers a woman's risk of osteoporosis (weakening and thinning of the bones). But estrogen can cause some types of uterine sarcoma to grow, so 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

Sometimes it looks like the cancer may have spread outside the uterus or nearby lymph nodes look swollen on imaging tests. In this case, your surgeon may do 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 then checked under a microscope to see if they have cancer cells. If cancer is found in the lymph nodes, it means that the cancer has already spread outside of the uterus. This isn't good and means the woman has 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 build-up of fluid in the legs, called lymphedema. This is more likely if radiation is given after surgery. You can find out more about this 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, its 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 then 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 isn't clear.

Sexual impact of surgery

If you are premenopausal, removing your uterus stops menstrual bleeding (periods). If your ovaries are also removed, you will go into menopause. This can lead to vaginal dryness and pain during sex. These symptoms can be improved with estrogen treatment, but this hormone isn't safe for all women with uterine sarcoma. 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. See Sex and the Woman With Cancer for more on this.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: October 12, 2017 Last Revised: November 20, 2017

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