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 your ovaries appear normal, you don’t have any risk factors, and it is an early-stage, low-grade cancer, you may be able to keep your ovaries.

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.

 Learn more about:

• Total hysterectomy and bilateral salpingo-oophorectomy
• How the surgery is done
• Treatment of lymph nodes
• What to expect after surgery
• Taking care of yourself at home after a hysterectomy
• Side effects of surgery

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 to help with staging.

A pathologist examines all removed tissue and fluids. The results will help confirm the type of uterine cancer, 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. The hysterectomy can be done in different ways.

Laparoscopic hysterectomy (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 (belly). The uterus and other organs are removed through the vagina.

Robotic-assisted hysterectomy

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

Abdominal hysterectomy (open surgery or 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.

Your surgeon will discuss the most appropriate surgery for you, and explain the risks and benefits. The type of hysterectomy you have will depend on a number of factors, such as your age and build; the size of your uterus; the tumour size; and the surgeon’s specialty and experience.

Treatment of lymph nodes

Cancer cells can spread from the uterus to the pelvic lymph nodes. If cancer is found in the lymph nodes, your doctor may recommend you have additional treatment, such as chemotherapy or radiation therapy.

Lymphadenectomy (lymph node dissection)

For more advanced or higher-grade tumours, the surgeon may remove some lymph nodes from the pelvic area to see if the cancer has spread beyond the uterus.

Sentinel lymph node biopsy

This test helps to identify the pelvic lymph node that the cancer is most likely to spread to first (the sentinel node). While you are under anaesthetic, your doctor will inject a dye into the cervix. The dye will flow to the sentinel lymph node, which will be removed for testing. If it contains cancer cells, this will guide additional treatment, such as chemotherapy and radiation therapy. Sentinel lymph node biopsies are available only in some treatment centres.