Surgery for cancer of the uterus

Cancer of the uterus is usually treated with an operation that removes the uterus and cervix (total hysterectomy), along with both fallopian tubes and ovaries (bilateral salpingo-oophorectomy). If the cancer has spread beyond the cervix, the surgeon may also remove a small part of the upper vagina and the ligaments supporting the cervix.

For more advanced or higher-grade tumours, the surgeon may suggest removing some nearby lymph nodes at the same time. This is called a pelvic lymphadenectomy, lymph node dissection or lymph node sampling and helps show whether cancer has spread outside the uterus.

Options for preserving fertility

If you have not yet been through menopause, the removal of the ovaries will bring it on. If your ovaries appear normal and you don’t have any risk factors, you may be able to keep your ovaries.

A small number of women with early uterine cancer choose to wait until after they have had children to have a hysterectomy. These women are offered hormone therapy instead. This is not standard treatment and they need to be monitored closely. If having children is important to you, talk to your doctor about your particular situation.

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Total hysterectomy and bilateral salpingo-oophorectomy

Most women with uterine cancer will have this operation, which removes the uterus, cervix, fallopian tubes and ovaries (as shown by the dotted line on the diagram below).

Sometimes one or more pelvic lymph nodes (shown in grey) are also removed.

A pathologist examines all removed tissue and fluids for cancer cells. The results will help confirm the type of uterine cancer you have, if it has spread (metastasised), and its stage and grade. The cancer may also be tested for particular gene changes.

uterus - total hysterectomy

How the surgery is done

The surgery will be performed under a general anaesthetic. It can be done in different ways, as shown in the diagrams below. The type of hysterectomy offered to you will depend on a number of factors, including:

  • your age and build
  • the size of your uterus
  • the size of the tumour
  • the surgeon’s specialty and experience.

Your surgeon will talk to you about the most appropriate surgery for you and explain the risks and benefits.

laparoscopy hysterectomy

Laparoscopic hysterectomy

Also called keyhole surgery, this method uses a laparoscope, a thin tube with a light and camera. The surgeon inserts the laparoscope and instruments through 3–4 small cuts in the abdomen. The uterus and other organs are removed via the vagina.

Robotically assisted hysterectomy

A robotically assisted hysterectomy is a special form of laparoscopic hysterectomy. The instruments and camera are inserted through 4–5 small cuts and then controlled by robotic arms guided by the surgeon, who sits next to the operating table.

abdominal hysterectomy

Abdominal hysterectomy (laparotomy)

The surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made along the pubic line instead. The uterus and other organs are then removed.

vaginal hysterectomy

Vaginal hysterectomy

The surgery is performed through a small cut at the top of the vagina. This method does not allow the surgeon to check whether the cancer has spread to other parts of the pelvis.

Video: What is surgery?

Watch this short video to learn more about surgery.

This information was last reviewed in March 2019
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