Hysterectomy for endometrial cancer

A hysterectomy is the surgical removal of a woman’s uterus. A hysterectomy to remove endometrial cancer usually includes the removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy). Your doctor will also do a pelvic and paraaortic lymph node biopsy to find out the stage and grade of the cancer. Most cases of endometrial cancer are diagnosed during the earliest stage, while cancer is still contained in the uterus and can be cured.

Your surgery will depend on how much of your reproductive system may be affected by endometrial cancer.

  • A total hysterectomy is the removal of the uterus and cervix.
  • A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries. This is the most common surgery done for endometrial cancer.
  • A radical hysterectomy is the removal of the uterus, cervix, surrounding tissue, upper vagina, and usually the pelvic lymph nodes . The number of lymph nodes removed depends on how far the cancer has spread.

A hysterectomy can be done either through the abdomen or the vagina. In both procedures, general anesthesia usually is used. The type of hysterectomy you have depends on your medical history and general state of health and on the extent of the cancer growth. Medical centers and surgeons may prefer to do the type of surgery that they have more experience with. Pelvic and paraaortic lymph nodes will be biopsied during surgery to help find out the stage of cancer.

  • Abdominal hysterectomy: The uterus, ovaries, and fallopian tubes are removed through an incision (laparotomy) in the abdomen.
    • An abdominal incision provides a large opening into the abdomen for the surgeon to easily see the organs and to determine the extent of the cancer.
    • An abdominal hysterectomy will leave a scar (usually 5 inches) on the abdomen.
    • The usual stay in the hospital after an abdominal hysterectomy is 3 days.

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  • Vaginal (transvaginal) hysterectomy: The uterus and ovaries are removed through an incision in the vagina. This method is only done in certain cases for cancer surgery.
      • A vaginal hysterectomy leaves no scar on the abdomen.
      • You usually stay in the hospital for 1 or 2 days after a vaginal hysterectomy.
      • Visibility and operating space are more limited in a vaginal hysterectomy than in abdominal surgery, and so vaginal hysterectomy can be more difficult for the surgeon.
      • Some surgeons perform vaginal hysterectomies with the assistance of a laparoscope to inspect the pelvic region. In laparoscopically assisted vaginal hysterectomy (LAVH), a lighted viewing instrument (laparoscope) is inserted through small incisions in the abdomen. Uterine tissue and pelvic lymph nodes are examined and removed for staging. And the uterus, ovaries, and fallopian tubes are removed through the incision in the vagina.

When done by an experienced surgeon, vaginal hysterectomy may have a quicker recovery and fewer complications than abdominal surgery.

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Endometrial Cancer Surgery