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Surgery to remove womb cancer

If you have stage 1 womb cancer, you will have a hysterectomy to remove your womb, and usually your ovaries and fallopian tubes.

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.

If you have stage 3 womb cancer, your doctor may suggest surgery. You will need to have a radical hysterectomy. After surgery, you will probably have radiotherapy. Your doctor may also discuss hormone therapy or chemotherapy.

If you have stage 4 womb cancer, you may not be offered surgery because it will not cure the cancer. But your specialist may suggest removing as much of the cancer as possible to slow down the growth of the cancer.

Sometimes it is possible to try to cure womb cancer with surgery, even when it has come back. If the cancer is only within your pelvis, you may have surgery to remove organs in the pelvis 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 all stages. The amount of surgery you have will depend on how far the cancer has grown – the stage of the cancer.

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 have to examine other body tissues around the womb to see exactly how much needs to be taken away. Most women will just have their womb 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 want to remove your womb (including the cervix). This is called a hysterectomy. Usually the ovaries and fallopian tubes are removed at the same time. This is called bilateral salpingo oophorectomy – BSO for short. The surgeon removes the tubes and ovaries as well as the womb because cancer cells often spread to the ovaries very early on.

During the operation, your surgeon will need to take 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. You may have biopsies taken 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. Researchers published the results of a trial in January 2009 which looked at whether routinely removing all the lymph nodes helped women with stage 1 womb cancer live longer. The trial was called ASTEC. The researchers found that the women who had their lymph glands removed didn't live any longer than those who didn't have them removed. This means that they no longer recommend routinely removing all of the lymph nodes if you have stage 1 womb cancer.

You may also hear your surgeon talk about the omentum, or omentectomy. The omentum 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. Your surgery will take place while you are asleep (under general anaesthetic) and you will need to stay in hospital for about a week after the operation. Then you will need to rest at home for several weeks. We have more information about having your womb cancer operation.

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 quickly growing (high grade) your surgeon will probably suggest you have both ovaries removed and take hormone replacement therapy (HRT) to stop menopausal symptoms.

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 (faster growing), or a stage 1B cancer. If you had lymph nodes removed and they had no cancer cells inside them, then you are not likely to have radiotherapy.

 

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 tube has small surgical instruments that the surgeon operates from outside the body. There is an eyepiece so they can see what they are doing. The surgeon removes your womb through your vagina. The laparoscope goes in through about 3 or 4 very small incisions in your tummy (abdomen) so there is 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. Research so far seems to show that keyhole surgery is as safe and works as well as conventional hysterectomy at removing the cancer. The National Institute for Health and Clinical Excellence (NICE) approved laparoscopic hysterectomy in September 2010. This type of operation needs to be carried out by surgeons who have had specialist training and so is not available in every hospital.

 

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 your specialist may suggest radiotherapy. This is to help stop the cancer from coming back. You are more likely to be offered this extra treatment if you have a high grade (faster growing) cancer and cancer cells were found in your lymph nodes.

 

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 will probably have some radiotherapy. This 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 or chemotherapy. This will depend on how far the cancer has spread and the grade of the cancer cells. 

You may be asked to consider taking part in a clinical trial where doctors are testing a new treatment for this stage of womb cancer.

 

Surgery for stage 4 womb cancer (advanced 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 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 on surgery to relieve symptoms.

 

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 or 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: 5 November 2013