Cancer of the uterus is usually treated by removing the uterus. The operation is called a hysterectomy. Sometimes the operation can be done through keyhole surgery, where four or five small holes are made in the abdomen. The surgeon uses a small camera to see inside the abdomen (laparoscopy) before removing the uterus through the vagina.
For a hysterectomy the cut is made along the pubic hair line or from the pubic area to the belly button. Once the abdomen is open, the surgeon washes out the area with a fluid, which is sent to a pathologist, who checks the fluid for cancer cells.
The surgeon checks all the organs in the abdomen, looking for signs of cancer spread (metastasis). This part of the operation is called a laparotomy.
The surgeon then removes the uterus (hysterectomy). The fallopian tubes and ovaries are usually removed. This is called a bilateral salpingo oophorectomy. The pathologist will look at the uterus to work out the type of cancer and whether the cancer has spread to the muscle wall of the uterus. If the cancer is only on the surface or is in a very early stage, you may not need to have any more treatment.
If the cancer has spread into the muscle wall of the uterus, this increases the risk of spread to the lymph nodes in the abdomen. Removal of lymph nodes is called a lymphadenectomy. If you have cancer in the lymph nodes, additional treatment may be recommended.
If the cancer has spread to the cervix, a small part of the upper vagina and the ligaments supporting the cervix are also removed. This operation takes longer.
All treatments have possible complications: for example, bleeding or an infection. Although they are uncommon, your doctor will discuss them with you before your surgery.
After the operation
When you wake up from the operation, you will have several tubes in place. An intravenous drip will give you fluid as well as medication. There may also be one or two tubes in your abdomen to drain away fluid from the operation site. There may be a catheter in your bladder to drain away urine. As you recover from the operation, these tubes will be removed, usually within three to five days.
As with all major operations, you will have discomfort or some pain. You will have pain relievers through an intravenous drip or through an epidural into your spine. This epidural pain relief is similar to that given to women during childbirth. It is best to let your nurse know when you are starting to feel uncomfortable – don’t wait until the pain becomes severe.
Some patients are comfortable using patient controlled analgesic (PCA). PCA is delivered through a drip and allows you to choose when you receive a dose of pain-relieving medication. A few days after your operation, your doctor will have all the test results and will discuss any further treatment with you. Further treatment will depend on the type of cancer, the stage of the disease and if there is any remaining cancer.
Side effects of surgery
This is major surgery so you may be in hospital for several days. Your recovery time will depend on different factors (type of surgery or general health). Don’t expect to get back to your normal activities too quickly. For some women it may take six weeks or longer. During this time, avoid heavy work and lifting and housework (for example vacuuming, laundry tasks or driving) for the first few weeks. Standing for stretches of time can be tiring too.
After surgery, some women develop internal scar tissue called adhesions. Sometimes this can be painful and may affect the working of the bowel and the bladder. Occasionally, adhesions to the bowel or bladder may need to be treated with surgery.
If you have not been through menopause, removing your ovaries will cause menopause. This may cause strong symptoms such as hot flushes. These may be more severe than a ‘normal’ menopause, where the reduction of hormones happens more slowly. If you have been through menopause, there may be a recurrence of hot flushes.
For more information, see the section on menopause (“Coping with Side Effects”). The Cancer Society has an Information Sheet titled “Early Menopause and Cancer” that you can view and print from our website.
Physical and emotional changes may affect how you feel about sex and how you respond sexually. Changes to your sexual feelings or not being able to get pregnant may be very upsetting and difficult to accept. Some of these issues are discussed in the ‘Sexuality and cancer’ section.