Surgery

Surgery is the most common treatment for endometrial cancer. The most common surgical procedure is the removal of the uterus as well as both ovaries and fallopian tubes. This is called a total abdominal hysterectomy (or simple hysterectomy) and bilateral salpingoophorectomy. Your doctor may also recommend sampling the pelvic lymph nodes, to determine whether the cancer has spread to these areas.

Hysterectomy means the removal of the uterus. Oophorectomy is the removal of one or both ovaries. When an oophorectomy is unilateral, only one ovary is removed; if it is bilateral, both ovaries are removed. Salpingectomy is the removal of the fallopian tubes, which can also be unilateral (the removal of just one) or bilateral (both). A salpingo-oophorectomy combines both procedures. Lymph nodes may also be removed from your abdomen, to determine if the cancer has spread.

Hysterectomy Procedures

A simple hysterectomy is the removal of the uterus (the body of the uterus and the cervix). The loose connective tissue around the uterus and the tissue connecting the uterus and sacrum are not removed.

There are two ways of doing a simple hysterectomy:

• An abdominal hysterectomy removes the uterus through a 10- to 15- centimetre incision in the abdomen. Lymph node sampling/dissection can also be done through the same incision. The benefit of an abdominal hysterectomy is that it allows the surgeon a better view of the pelvic cavity.

• A vaginal hysterectomy removes the uterus through the vagina. Lymph nodes can also be removed by laparoscopic lymph node sampling. This procedure is not commonly used to treat endometrial cancer. A vaginal hysterectomy is sometimes performed in combination with a laparoscopy, using an instrument the size and shape of a pencil, with a light on one end, to remove the uterus.
  

  A vaginal hysterectomy is less painful, the recovery and healing period is shorter, and the procedure leaves no scar; however, it is more difficult for the surgeon to see if the cancer has spread and there is a greater chance of complications. Following vaginal hysterectomy, urinary tract difficulties or back pain may occur; some women also experience pain during intercourse if the vagina is shortened significantly as a result of the procedure.

A hysterectomy is done with a general anesthetic. You will need to stay in the hospital for a few days following the procedure. Bleeding and abdominal pain are expected. Your doctor may prescribe antibiotics, to prevent infection, as well as pain medication. Expect to need six to eight weeks to recover from an abdominal hysterectomy, and at least four to six weeks to recover from a vaginal hysterectomy.

If the cancer has spread to the cervix, a radical hysterectomy may be required. This involves removing the uterus, the tissues around the uterus (parametrium and uterosacral ligaments), and the upper part of the vagina next to the cervix. This procedure can take up to three hours and will require five to eight weeks recovery time. Most patients also have lymph node sampling or dissection done if a radical hysterectomy is done. A radical hysterectomy is usually performed by a specially trained gynecologist called a gynecologic oncologist.

Lymph Node Sampling

Lymph node samples may be removed to determine if the cancer has spread, using one of two procedures:

• Pelvic/para-aortic lymph node dissection is the surgical removal of lymph nodes from the pelvis and the area in the abdomen beside the spine. This operation can be performed at the same time as a simple abdominal hysterectomy or radical abdominal hysterectomy.
• Laparoscopic lymph node sampling or laparoscopy is a new procedure for viewing the inside of the abdomen and pelvis. This technique involves inserting a tube into a small incision (as opposed to the large incision necessary for a simple abdominal or radical abdominal hysterectomy).

Risks

Complications are unusual for hysterectomies but include excessive bleeding, wound infection, damage to the urinary tract or gastrointestinal system, pelvic pain, bone and joint pain and, on rare occasions, blood clots. Women who have both their ovaries removed along with the hysterectomy experience menopause if they have not already been through menopause before the surgery. This can result in an increased risk for circulatory disease and osteoporosis.

When the uterus is removed, there is also the possibility of prolapse, or “dropping,” of the other organs, such as the bladder or colon.

When lymph nodes are removed, there is also the risk of vein inflammation, nerve damage and lymphedema. Lymphedema can occur immediately after the surgery or several months or years later. A technique called sentinel node biopsy may avoid these risks.

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