Surgery for uterine cancer

Most women with uterine cancer will have surgery. The type of surgery you have depends mainly on the stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your age, overall health and personal preferences.

Surgery may be done for different reasons. You may have surgery to:

• stage the cancer
• completely remove the tumour
• remove as much of the tumour as possible (called debulking)
• relieve pain or ease symptoms (called palliative surgery)

Staging is done during surgery. Accurate staging is very important because doctors use the stage to determine the type and length of treatment they give after surgery.

The surgeon does a pelvic exam while you are under general anesthetic. Then the surgeon makes an incision, or cut, in the abdomen to examine the organs and see if the cancer has spread to them. This is called abdominal exploration. During abdominal exploration, the surgeon:

• examines all of the surfaces in the pelvis and abdomen
• takes biopsy samples from the peritoneum and any areas that look like cancer
• removes lymph nodes in the pelvis and from around the aorta
• does a total hysterectomy and bilateral salpingo-oophorectomy
• removes the omentum (in some cases)
• removes any tumours in the peritoneum

The surgeon may also rinse the pelvic and abdominal cavities with saline and then collects a sample of the fluid (called pelvic washings).

Tissue samples, lymph nodes and pelvic washings are sent to the lab and examined under a microscope to check for cancer cells.

The same surgery can also be done using less invasive methods with laparoscopy or robotic surgery.

The following types of surgery are done to treat uterine cancer. You may also have other treatments before or after surgery.

A hysterectomy removes the uterus. The following types of hysterectomies may be done to treat uterine cancer:

Total hysterectomy removes the cervix and uterus.

Radical hysterectomy removes the cervix, uterus, some of the structures and tissues near the cervix and upper vagina and nearby lymph nodes. Surgery to remove these lymph nodes is called a lymph node dissection or lymphadenectomy (LND).

A hysterectomy may be done through the abdomen (called abdominal hysterectomy). Less often, hysterectomy may be done through the vagina (called vaginal hysterectomy). Some doctors may also do a hysterectomy by laparoscopic or robotic surgery. Laparoscopic and robotic surgeries use a thin, tube-like instrument with a light and lens (called a laparoscope) to look at organs inside the body. The surgeon makes small incisions, or cuts, in the abdomen and then passes the laparoscope and surgical tools through those cuts to remove tissue.

Find out more about hysterectomy.

Surgery to remove both ovaries and fallopian tubes is called a bilateral salpingo-oophorectomy. Sometimes this surgery is done during a hysterectomy. Some women with early stage uterine cancer who have not reached menopause may not need to have the ovaries removed.

Surgery to remove lymph nodes is called a lymph node dissection. It is often done at the same time as a radical hysterectomy. Surgeons may or may not remove lymph nodes at the same time as a total hysterectomy. During these surgeries, the surgeon may remove lymph nodes in the pelvis and around the aorta so they can be checked to see if they have cancer cells in them.

Pelvic lymph nodes are in the pelvis. They are called regional lymph nodes because they are close to the uterus. They are the first group of lymph nodes that uterine cancer may spread to. The operation to remove them is called a pelvic lymph node dissection (PLND).

Para-aortic lymph nodes are at the back of the abdomen around the lower part of the aorta (the large artery that carries blood away from the heart). When uterine cancer spreads to lymph nodes outside of the pelvis, it most often spreads to the para-aortic lymph nodes. The surgeon will check the para-aortic lymph nodes for cancer if the uterine tumour is large or if cancer is found in the pelvic lymph nodes.

Learn more about lymph node dissection.

An omentectomy is surgery to remove the omentum to check for cancer cells. This may be done during surgery to stage the cancer.

A pelvic exenteration is surgery to remove the cervix, uterus, vagina, ovaries, fallopian tubes and nearby lymph nodes. The bladder, rectum or both may be removed. In some cases, the vulva is also removed.

This surgery is sometimes done to treat uterine cancer that recurs, or comes back, within the pelvis (called local recurrence) after it is has been treated with radiation therapy.

Find out more about pelvic exenteration.

If cancer has spread throughout the pelvis and abdomen, doctors will try to remove as much of it as possible. This is called debulking. Debulking may help other treatments, such as radiation therapy or chemotherapy, work better. It may also help relieve symptoms of advanced cancer.

Side effects can happen with any type of treatment for uterine cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type and site of the surgery and your overall health.

Surgery for uterine cancer may cause these side effects:

• bladder problems, including losing the feeling of having to urinate or not being able to empty the bladder completely
• lymphedema in the legs
• treatment-induced menopause
• sexual problems, including vaginal dryness and painful intercourse
• bowel obstruction

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.