Surgery for uterine cancer

Surgery is the primary treatment for women with uterine cancer. This operation, called a hysterectomy, includes removing the uterus, often together with the ovaries and ovarian tubes. Sometimes the pelvic lymph nodes, or those along the aorta, the largest artery, will need to be removed as well. The surgery you need will depend on the stage of your tumor.

We distinguish between 4 stages:

In stage 1, the tumor is confined to the uterine wall or muscle.
In stage 2, the tumor visibly spread to the cervix but remains contained to the uterus.
In stage 3, the tumor has spread outside of the uterus but remains contained to the pelvis.
In stage 4, the tumor has spread to the bladder, rectum, or other organs in the abdomen.

These stages determine the type of surgery you will need. Most operations are performed through an incision in the abdomen, although other tumors can be removed through the orifice itself, in combination with abdominal keyhole (laparoscopic) surgery. The total time of the procedure will depend on the tumor stage and the type of surgery you are having.

A hysterectomy - what to expect?

Before your surgery, you will be invited to come in for preoperative screening. All types of hysterectomies are performed under general anesthesia.

For stage 1 uterine cancer, the uterus will be removed, often together with the ovaries containing potential metastases. This procedure is minimally invasive (laparoscopic).

For stage 2 uterine cancer, you will receive a Wertheim-Meigs operation: Your uterus and ovaries will have to be removed, together with the pelvic lymph nodes and, if necessary, the supportive tissue surrounding the uterus.

Stage 3 uterine cancer is usually treated by debulking. This is a surgical procedure through which all visible tumor tissue is removed. This treatment is usually given in combination with chemotherapy and/or radiation therapy.

For stage 4 uterine cancer, the treatment we provide is highly personalized. Treatment will usually consist of a combination of therapies, and will aim to treat the symptoms and retain the best quality of life possible. This is a palliative treatment.

Efficacy

The tumor will be removed during the surgery, together with some additional tissue at the margins, which will be analyzed for the presence of remaining cancer cells

If there is reason to believe that there are still some cancer cells in your body, you will receive radiation therapy, or a combination of radiation therapy and chemotherapy.

If no cancer cells were found in the tissue surrounding the tumor, you may still need internal radiation therapy (brachytherapy). We will invite you to come in for regular screenings for five years after your surgery.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation for the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as an electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General and local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side effects

A hysterectomy will affect your fertility. Removal of ovaries will precipitate menopause.

Depending on your age, you may need hormone replacement therapy, or we can give you suggestions for lifestyle adjustments that can help you maintain your bone density.

After the procedure

You will need care over the first few days following your surgery. We will check your pulse, blood pressure, and blood loss.

It may take some time before you can continue your day-to-day activities. Please make sure to get plenty of rest during your recovery.

Some people will need radiation therapy, chemotherapy, or hormone replacement therapy after surgery.

Fertility preservation

Treatment for uterine cancer may negatively affect your fertility levels, which is why the Netherlands Cancer Institute, in collaboration with the Amsterdam UMC, location AMC and the LUMC, offers fertility preservation. Treatment can induce early menopause. Your practicing physician will discuss your options in preventing or treating menopausal symptoms with you.