Hysterectomy for endometrial cancer

Surgery Overview

A hysterectomy is the surgical removal of a woman's uterus. A hysterectomy to remove endometrial cancer usually includes the removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy). Your doctor will determine the stage and grade of the cancer by examining the tissues that are removed during a hysterectomy. Most cases of endometrial cancer are diagnosed during the earliest stage, while cancer is still contained in the uterus and can be cured.

Your surgery will depend on how much of your reproductive system may be affected by endometrial cancer.

• A total hysterectomy is the removal of the uterus and cervix.
• A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries. This is the most common surgery done for endometrial cancer.
• A radical hysterectomy is the removal of the uterus, cervix, surrounding tissue, upper vagina, and usually the pelvic lymph nodes. The number of lymph nodes removed depends on how far the cancer has spread.

A hysterectomy can be done either through the abdomen or the vagina. In both procedures, general anesthesia usually is used. The type of hysterectomy you have depends on your medical history and general state of health, and the extent of the cancer growth. Medical centres and surgeons may prefer to do the type of surgery that they have more experience with. Lymph nodes may be removed (lymphadenectomy) during surgery to help confirm the stage of cancer.

• Abdominal hysterectomy: The uterus, ovaries, and fallopian tubes are removed through an incision (laparotomy) in the abdomen.
  • An abdominal incision provides a large opening into the abdomen for the surgeon to easily see the organs and determine the extent of the cancer.
  • An abdominal hysterectomy will leave a scar (usually 13 cm) on the abdomen.
  • The usual stay in the hospital after an abdominal hysterectomy is 3 days.
• Vaginal (transvaginal) hysterectomy: The uterus and ovaries are removed through an incision in the vagina. This method is only done in certain cases for cancer surgery.
  • A vaginal hysterectomy leaves no scar on the abdomen.
  • You usually stay in the hospital for 1 or 2 days after a vaginal hysterectomy.
  • Visibility and operating space are more limited in a vaginal hysterectomy than in abdominal surgery, and so vaginal hysterectomy can be more difficult for the surgeon.
  • Some surgeons perform vaginal hysterectomies with the assistance of a laparoscope to inspect the pelvic region. In laparoscopically assisted vaginal hysterectomy (LAVH), a lighted viewing instrument (laparoscope) is inserted through small incisions in the abdomen. Uterine tissue and pelvic lymph nodes are examined and removed for staging, and the uterus, ovaries, and fallopian tubes are removed through the incision in the vagina.

When done by an experienced surgeon, vaginal hysterectomy may have a quicker recovery and fewer complications than abdominal surgery.

What To Expect After Surgery

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. Usually the stay in the recovery area is for 1 to 4 hours. You will then be moved to a hospital room. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery.

You will likely stay in the hospital 1 to 4 days after a hysterectomy. About 4 to 6 weeks after the hysterectomy, your doctor will examine you in his or her office. You should be able to return to all of your normal activities, including having sexual intercourse, in about 6 to 8 weeks. Some light bleeding or spotting is expected for up to 6 weeks following a hysterectomy. If your vaginal bleeding is heavier or different than what you were told to expect, call your doctor.

Following a hysterectomy, you will not be able to become pregnant.

After a hysterectomy, call your doctor if you have:

• Chest pain, a cough, or difficulty breathing.
• Bright red vaginal bleeding that soaks two or more pads in an hour or forms large or painful clots.
• Pain or tenderness, swelling, or redness in your legs.
• A fever of 38°C (100°F) or higher.
• Pain that is not relieved by your pain medication or pain that is getting worse.
• Pus coming from your incision.
• Difficulty passing a stool, especially if you have not had a normal bowel movement for 3 to 5 days, or if you have mild pain or swelling in your lower abdomen.
• Difficulty passing urine, pain or burning when you urinate, blood in your urine, or cloudy urine.
• Pain, discomfort, or bleeding during intercourse.
• Hot flashes, sweating, flushing, or a fast or pounding heartbeat.

Why It Is Done

Endometrial cancer most often occurs in the inner lining of the uterus, and is contained within the uterus in the earlier stages. Removal of the uterus reduces the risk of cancer recurring or spreading. The ovaries are a common site for spread (metastasis) of endometrial cancer cells and so are almost always removed at the same time.

How Well It Works

Removal of the uterus, fallopian tubes, and ovaries reduces the risk of spread or recurrence of endometrial cancer.

A 2002 study comparing results from abdominal (laparotomy) hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH) for early-stage endometrial cancer found similar rates of success. The study reported that 92% of women who underwent abdominal surgery and 90% of women who underwent laparoscopic vaginal hysterectomy were cancer-free 5 years after treatment.¹ Vaginal hysterectomy is not commonly done for endometrial cancer. Medical centres and surgeons may prefer to do the type of surgery that they have more experience with.

Risks

Most women do not have complications after a hysterectomy. However, complications that may occur include:

• Fever. A slight fever is common after any surgery.
• Difficulty urinating.
• Urinary incontinence.
• Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks following a hysterectomy is expected. However, call your doctor if bleeding continues to be heavy.
• The formation of scar tissue (adhesions).

Rare complications include:

• Infection.
• Blood clots in the legs (thrombophlebitis) or lungs (pulmonary embolus).
• Injury to other organs, such as the bladder or bowel.
• A collection of blood at the surgical site (hematoma).

You may develop other physical problems after a hysterectomy. In some women, the pelvic muscles and ligaments that support the vagina, bladder, and rectum may become weak. The weakness may cause bladder or bowel problems, such as cystocele, urinary incontinence, or rectocele. Kegel exercises may help strengthen the pelvic muscles and ligaments. However, some women need other treatments, including additional surgery.

Vaginal dryness may develop if your ovaries were removed during your hysterectomy. If sexual intercourse is painful because of vaginal dryness, use a vaginal lubricant such as K-Y jelly, Astroglide, or Replens or a polyunsaturated vegetable oil that does not contain preservatives. Do not use petroleum jelly (for example, Vaseline) as a lubricant, because it increases the risk of vaginal irritation and infection.

Your doctor will tell you how long you should wait after surgery before engaging in sexual intercourse. Pain during intercourse (dyspareunia) may occur if your vagina was shortened during your hysterectomy. Changing positions may help make intercourse less painful. If you continue to have difficulty with intercourse after a hysterectomy, talk with your doctor.

What To Think About

It is normal to feel a variety of emotions about having a hysterectomy. These are often based on beliefs about the importance of your uterus, fears about your health or personal relationships, and concerns about your enjoyment of sexual activities after surgery. Talk with your doctor about your specific fears and anxieties.

The hospital or surgery centre may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: February 21, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Ross Berkowitz, MD - Obstetrics and Gynecology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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