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.
Learn more about:
- Total hysterectomy and bilateral salpingo-oophorectomy
- Laparoscopic hysterectomy
- Robotically assisted hysterectomy
- Abdominal hysterectomy (laparotomy)
- Vaginal hysterectomy
- What to expect after the operation
- Taking care of yourself at home after a hysterectomy
- Side effects of surgery
- Video: What is surgery?
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.
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.
Laparoscopic hysterectomyAlso 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 hysterectomyA 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 (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 hysterectomyThe 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?
A/Prof Alison Brand, Director, Gynaecological Oncology, Westmead Hospital, NSW; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria; Prof Jonathan Carter, Director, Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Dr Robyn Cheuk, Senior Radiation Oncologist, Royal Brisbane and Women’s Hospital, QLD; Dr Alison Davis, Medical Oncologist, Canberra Region Cancer Centre, The Canberra Hospital, ACT; Kim Hobbs, Clinical Specialist Social Worker, Westmead Hospital, NSW; Nicole Kinnane, Nurse Coordinator, Gynaecology Oncology, Peter MacCallum Cancer Centre, VIC; Jennifer Loveridge, Consumer; Pauline Tanner, Gynaecology Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, North Metropolitan Health Service, WA. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
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