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Surgical Procedures for Uterine (Endometrial) Cancer

Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
Surgical removal of the uterus is recommended for all stages of uterine cancer unless the cancer is widespread. In the early stages, it may be curative.

Hysterectomy

The standard surgical procedure for uterine cancer is a total abdominal hysterectomy and bilateral salpingo-oophorectomy. This involves removing the entire uterus and both ovaries and fallopian tubes. In cases in which the risk of spread to lymph nodes is considered low, some lymph nodes will be removed to check for cancer cells. In more advanced or aggressive forms of the disease, the lymph nodes in the pelvis and possibly around the aorta (the large artery in the abdomen) are removed more completely.
During the procedure, the doctor may take samples from other tissue to check for cancer cells. This is done to determine the cancer’s stage.
Description of the Procedure:
A cut is made in the lower abdomen to expose the tissues and blood vessels that surround the uterus and cervix. These tissues are cut and the blood vessels are tied off to remove the uterus. Stitches are placed in these deep structures, which will eventually dissolve. The uterus is removed and the vagina is closed to prevent infection and to keep the intestines from dropping downward. You will stay in the hospital for several days.
Effectiveness
For Stage I disease, surgery provides 90% five-year survival rates.
Possible Complications
  • Thrombophlebitis (blood clots in the veins or lungs)
  • Infection (at the wound site or deep inside the abdomen or pelvis)
  • Vaginal and/or internal bleeding 
  • Bowel obstruction
  • Injury to the intestines, bladder, or urinary tract
  • Persistent pain
  • Anesthesia-related problems, such as breathing trouble, reactions to the drugs, and poor pain relief
  • Diminished sexual response
  • Fatigue
  • Weight gain
  • Depression
  • Nausea and vomiting (usually mild)
  • Fistula formation, which occurs when a hole forms between the bladder, intestines, and vagina
Postoperative Care
  • The first night after the surgery, you may be asked to sit up in bed and walk a short distance. 
  • If there is no evidence of complications and you are able to drink fluids on your own, the catheter in your bladder and IV will be removed. 
  • To promote healing, eat a balanced diet rich in fresh fruits and vegetables. Depending on how much blood loss occurred during surgery, you may require a daily iron supplement.
  • Try to avoid constipation by eating high-fiber foods, drinking plenty of water, and if necessary, using stool softeners.
  • Shower instead of taking a bath for at least the first two weeks after your surgery.
  • Keep your incision sites clean and dry.
  • Do not douche or put anything in your vagina, such as a tampon, until your doctor tells you otherwise. Speak to your doctor about when you may resume having sexual intercourse.
  • Take daily walks as tolerated.
  • Avoid heavy lifting for four to six weeks.
  • Ask your practitioner whether any type of physical therapy or nutritional counseling may be helpful to speed your recovery.
Call Your Doctor if Any of the Following Occurs:
  • Signs of infection, including fever and chills
  • Persistent or heavy vaginal bleeding or discharge, or foul-smelling vaginal discharge
  • Severe pain
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Problem with urination or bowel movements
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Pain and/or swelling in your feet, calves or legs, sudden shortness of breath or chest pain

References

American Cancer Society website. Available at: http://www.cancer.org/ .

Bast R, Kufe D, Pollock R, et al, eds. Cancer Medicine. 5th ed. Hamilton, Ontario: BC Decker Inc; 2000.

National Cancer Institute website. Available at: http://www.nci.nih.gov/ .

Rakel R. Bope E, ed. Conn's Current Therapy. 54th ed. St. Louis, MO: WB Saunders; 2002: 1094-1096.

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