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Surgery to remove womb cancer

If you have stage 1 womb cancer, you will have an operation to remove your womb (hysterectomy), and usually both your ovaries and fallopian tubes. Some women will have radiotherapy once they have recovered from the operation.

If you have stage 2 womb cancer, your surgeon will also remove the tissues holding your womb in place, the top of your vagina, and all the lymph nodes around your womb. This operation is called a radical hysterectomy or Wertheim’s hysterectomy. You are likely to have radiotherapy after surgery. Some women may also have chemotherapy.

If you have stage 3 womb cancer, your doctor may suggest surgery, depending on how far your cancer has spread. You are likely to have a radical hysterectomy. After surgery, you may have radiotherapy or chemotherapy, or both. Your doctor may also discuss hormone therapy.

If you have stage 4 womb cancer, you may not be offered surgery because it will not cure the cancer. But in some cases, your specialist may suggest removing as much of the cancer as possible to slow down the growth of the cancer. You may then have chemotherapy, radiotherapy or hormone therapy, or a combination of treatments.

If your cancer has come back after treatment, it is sometimes still possible to try to cure womb cancer with surgery. If the cancer is only within your pelvis, you may have surgery to remove the cancer and any organs that contain cancer cells, or are very near to the cancer such as the bladder and rectum. This operation is called pelvic exenteration.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating womb cancer section.

 

 

Who has surgery for womb cancer?

Most women with womb cancer will have surgery to remove it. There are different operations for the different stages of womb cancer. The amount of surgery you have will depend on how far the cancer has grown.

Your surgeon may not be able to tell you the exact stage of your cancer until after your operation. So when you go for surgery, you may know that you will have your womb removed, but may not be sure what else will be done. During the operation, the surgeon will examine other body tissues around the womb to see exactly how much they need to take away. Most women will just have their womb, fallopian tubes and ovaries removed, possibly with some lymph nodes taken from around the womb as well.

During the operation, the surgeon may put fluid into your abdomen and pelvis. They then send the fluid to the laboratory to be tested for cancer cells. Doctors call this peritoneal washings or peritoneal lavage.

In some situations, it can be possible to operate to remove womb cancer that has come back after it was first treated. This major surgery is called pelvic exenteration.

 

Surgery for stage 1 womb cancer

If you have a stage 1 cancer, your surgeon will remove your womb (including the cervix). This is called a hysterectomy. Usually they remove both ovaries and fallopian tubes at the same time. This is called bilateral salpingo oophorectomy – BSO for short.

If you are a younger woman who has not yet reached the menopause, your surgeon may be willing to leave one of your ovaries in place. Removing both your ovaries will bring about an early menopause. Whether you have one or both ovaries removed depends on how likely the cancer is to spread from the womb to your ovaries. If you have a cancer that is thought to be quite fast growing (high grade) your surgeon will probably suggest you have both ovaries removed and take hormone replacement therapy (HRT) to stop menopausal symptoms.

During the operation, your surgeon will take samples (biopsies) of areas where the cancer could have spread. This will give the exact stage of your cancer and help your specialist to decide if you need more treatment after your operation. They may take biopsies of the

  • Lymph nodes in your pelvis
  • Tissue lining your abdomen and pelvis

Your surgeon may talk about lymph node sampling rather than lymph node biopsies because lymph nodes are usually removed whole. Knowing whether the lymph nodes contain cancer cells or not helps your doctor decide which treatment you need.

To try to reduce the risk of the cancer coming back some surgeons used to remove all the lymph nodes around the womb. The ASTEC trial looked at whether routinely removing all the lymph nodes helped women with stage 1 womb cancer live longer. The researchers found that the women who had their lymph nodes removed didn't live any longer than those who didn't have them removed. This means that doctors no longer recommend routinely removing all of the lymph nodes if you have stage 1 womb cancer.

You may hear your surgeon talk about the omentum. This is a sheet of fatty tissue inside the abdomen. It is sometimes removed along with the womb, as it can be a site of cancer spread. But this is not common. Removing the omentum is called an omentectomy. 

You have your surgery under general anaesthetic, and you may need to stay in hospital up to a week after the operation. Then you will need to rest at home for a month or so. We have more information about having your womb cancer operation.

After surgery, your specialist may suggest radiotherapy. This is to help stop the cancer coming back. You are more likely to have this if you have a high grade cancer, a type 2 cancer such as serous or clear cell womb cancer, or a stage 1B cancer.

 

Keyhole surgery

Some women have keyhole surgery for early womb cancer (stage 1 womb cancer). Doctors call this laparoscopic surgery because they use a laparoscope to do it. This is a bit like a telescope. It is connected to a camera that shows the inside of the body on a TV screen. The surgeon usually makes a number of small cuts through your skin. They put the laparoscope and other small instruments through these to carry out the surgery. So you will end up with 3 or 4 small wounds, each a centimetre or so long.

keyhole%20hysterectomy

As well as very little scarring afterwards, keyhole surgery has other advantages. There is likely to be less blood loss during the operation and it takes less time to recover. But the surgery takes longer so you spend more time under anaesthetic. It needs to be carried out by surgeons who have had specialist training and so may not be available in every hospital.

In a few specialist hospitals, the surgeon may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery. They may be more likely to use this for more difficult operations.

During the surgery, a robotic machine is beside you. It has 4 arms. One holds a camera and the others hold the surgical instruments. The surgeon carries out the operation by using a machine that controls the robotic arms. The surgeon has a 3D view of the operating area that they can magnify many times, so gives them good detail.

 

Surgery for stage 2 womb cancer

If you have stage 2 womb cancer, the cancer has already spread to your cervix. As well as having your womb, cervix, fallopian tubes and ovaries removed, your surgeon will remove

  • The tissues holding your womb in place
  • The top of your vagina
  • The lymph nodes around your womb

This operation is called a radical hysterectomy. You may also hear it called Wertheim’s hysterectomy after the doctor who first performed it. It is a major operation and you may be in hospital for a couple of weeks and recovering at home afterwards for at least a month.

Diagram showing parts of the body removed with a radical hysterectomy

We have more information about having your womb cancer operation.

After surgery you are likely to have radiotherapy. This is to help stop the cancer from coming back. Some women with high risk womb cancer, such as type 2 endometrial cancer, may also have chemotherapy.

 

Surgery for stage 3 womb cancer

If you have stage 3 womb cancer your specialist may suggest surgery, depending on how far your cancer has spread. It is likely you will need to have a radical hysterectomy to remove as much of the cancer as possible. There is information on this page in the stage 2 section about what a radical hysterectomy involves.

After surgery you may have radiotherapy or chemotherapy, or both. This treatment is to kill off any cancer cells left behind after surgery and to help stop the cancer from coming back. Your doctor may also discuss hormone therapy. This will depend on how far the cancer has spread and the grade of the cancer cells. 

 

Surgery for stage 4 womb cancer

If your cancer has already spread to another part of the body by the time it is diagnosed your specialist may not offer you surgery. This is because the surgery will not cure the cancer. But in some cases your specialist may suggest removing as much of the cancer as possible if they think this would help to slow down the growth of the cancer. This is called debulking surgery. Having surgery will depend on

  • Your general health
  • How fast the cancer is likely to grow
  • How far the cancer has spread

There is more about this in the section about surgery to relieve symptoms. After surgery, you may have chemotherapy, radiotherapy or hormone therapy, or a combination of treatments.

 

Surgery for womb cancer that has come back

Sometimes it is possible to try to cure womb cancer with surgery, even when it has come back. Usually, this is done when womb cancer grows back in the middle pelvis after it has been treated with radiotherapy or surgery. The pelvis is the lower part of your abdomen. It contains the womb, bladder and back passage (rectum).

If the cancer is all inside your pelvis, you may be able to have surgery to remove all the cancer. Your surgeon will remove any pelvic organs that contain cancer cells, or are very near to the cancer. This can include

  • Your womb (unless you have already had it removed)
  • Your bladder
  • Your rectum

You would not necessarily have all these organs removed. It would depend where the cancer had grown back. If your bladder is removed, you will need to have a bag to collect your urine (urostomy). Similarly, if your rectum is removed, you will have to need a bag to collect your stool (faeces). This is called a colostomy.

Removing the organs mentioned above is called pelvic exenteration. As it is such major surgery, surgeons only suggest it when there is a good chance that it will cure the cancer. So your surgeon will check very carefully beforehand that the cancer has not spread to your lymph nodes or to any other body organ. If it has, this treatment is not suitable for you because it will not cure you. If the cancer is in your lymph nodes, there is too high a risk that there is cancer growing somewhere else in your body, even if it is too small to be seen.

Pelvic exenteration operations are more often done for cancer of the neck of the womb (cervix). So there is detailed information about pelvic exenteration in our cervical cancer section.

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Updated: 4 October 2014