Hysterectomy for Endometrial Cancer
Women with endometrial cancer need an operation to remove their womb (uterus and cervix), fallopian tubes and ovaries. This procedure is known as a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Sometimes it is also necessary to remove other tissues as well. This can include the omentum (a layer of fatty tissue in the abdomen), this is known as omentectomy. Lymph glands in the pelvis and around the aorta may also be removed. The operation is carried out under general anaesthetic, usually through a vertical (midline) or transverse (bikini-line) incision. Sometimes, this operation is performed using keyhole surgery (laparoscopy).
The aim of surgery is to remove all of the disease, diagnose spread and identify if there is any disease left at completion of surgery.
The main alternative is to decide not to have surgery. Other alternative treatments may include hormone treatment and or radiotherapy. Mr Chattopadhyay will discuss the best treatment options for you.
Staging of Endometrial Cancer
Histology (microscopic examination) determines the stage of the disease. If the histology result (tissue analysis) confirms that all the cancer has been removed, that it was not found deep within the wall of the womb and that lymph nodes (if removed) do not contain cancer, no further treatment will be necessary.
If however the histology results indicate that you need further treatment, you may need radiotherapy and/or chemotherapy.
What are the risks of the operation?
There are risks and complications associated with any major abdominal surgery. It is important to realise that these risks and complications are rare. These will be discussed with you before your operation.
The operation is carried out under general anaesthetic and the anaesthetist will visit you before your operation and discuss the anaesthetic with you. You will have some blood loss at the time of your operation and blood transfusion is sometimes required in about one in five operations. Rarely, there may be internal bleeding after the operation, making a second operation necessary.
As with any major operation involving the pelvic organs there is a small risk of injury to bladder or ureter (tube which carries urine to the bladder), this is about three in 100, or injury to bowel one in 100. If this occurs the injury will be repaired at the time of surgery.
Also there is a small risk of developing an infection which may be in the chest (three in 100) wound (five in 100), pelvis (four in 100) or urine (10 in 100). To reduce this risk you will be given an antibiotic just before the start of the operation.
Patients may suffer from blood clots in the leg or the pelvis, rarely this can lead to a blood clot in the lungs. Moving around as soon as possible after your operation can help prevent this. The physiotherapist will visit you before and after your operation to give advice and to help with your mobility. To reduce the risk of blood clots you will also be given injections to thin your blood during your stay in hospital. With any type of operation there is an associated very small risk of death.
Some women have loss of feeling in the bladder that may take some time to return to normal. During this time, you need to take special care to empty your bladder regularly.
Rarely, a hole may develop in the bladder or in the ureter (tube carrying urine to the bladder). If this happens it is generally identified at the time of surgery. If not, it results in leakage of urine into the vagina. The hole may close without surgery, but another operation may be necessary to repair this.
For women who need their lymph nodes removed, there is a small risk of swelling in the legs or lower abdomen (Lymphoedema).
If the pelvic lymph nodes are removed during the operation, the lymphatic system may be affected, resulting in a build up of fluid in one or both legs, or in the genital area. The problem can be treated, but you can take preventative measures to reduce the risk of this happening. The nurses or doctor will discuss this with you.
Pain control after surgery
You may be offered an epidural to relieve pain after surgery; an epidural is a type of anaesthetic. It does not make you unconscious, but it stops any sensation in the lower body. This means you don’t have any feeling in your abdomen (stomach), pelvis and legs.
You will also be given painkillers to relieve the pain after the operation; this usually starts after stopping the epidural. You may also have a PCA (Patient Controlled Analgesia) device where you control the amount of pain killer according to your needs.
You may be in hospital for up to eight days; this will depend on your individual needs. It may be recommended that you receive chemotherapy and or radiotherapy following your surgery. Mr Chattopadhyay will discuss this once the final results are available. Your final results will be discussed in the gynaecological cancer multidisciplinary team meeting (MDT) at the Leicester Royal Infirmary.
It can take up to three months to fully recover from your operation, sometimes longer. The ward staff will give you further information about your recovery prior to discharge from the ward.
You will be given follow up appointment before you leave the hospital
Hormone Replacement Therapy
If you have not already experienced the menopause you will have a premature menopause when both of your ovaries are removed during the operation. If this is the case, you may need Hormone replacement therapy (HRT). Mr Chattopadhyay will discuss the options with you.