Most women with womb cancer have surgery to remove the womb. The operation you have depends on how far the cancer has grown.
Your doctor may not be able to tell you the exact stage of your cancer until after your operation. During surgery, your surgeon (gynaecological oncologist) examines other organs around the womb to see if there are signs of cancer spread, and takes samples of tissue (biopsies) to send to the lab to check for cancer cells.
Most women have their womb, fallopian tubes and ovaries removed. Your doctor might also remove some lymph nodes from your pelvis.
Surgery to remove your womb
Your surgeon removes your womb and cervix. This is called a total hysterectomy. They usually remove both fallopian tubes and ovaries at the same time. This is called a bilateral salpingo oophorectomy (BSO).
If your cancer has already spread to your cervix (stage 2 womb cancer), your surgeon may also remove the:
- tissues holding your womb in place
- top of your vagina
- lymph nodes around your womb
This operation is called a radical hysterectomy. Some women with stage 3 womb cancer also have this type of hysterectomy, depending on how far the cancer has spread.
Your surgeon may also remove the sheet of fatty tissue in your abdomen (the omentum). This is called an omentectomy. They are more likely to do this for serous carcinomas.
In younger women, removing both ovaries will bring about the menopause. Menopausal symptoms include hot flushes and night sweats. In the longer term it can cause bone thinning (osteoporosis). So in some cases, your surgeon may consider leaving one or both of your ovaries in place.
Checking for cancer outside the womb
During the operation, your surgeon usually takes samples of areas where the cancer could have spread. This information helps them to make decisions about treatment after surgery.
Your surgeon may take biopsies from the lining of your abdomen and pelvis. They may also put fluid into your abdomen and then remove it. They send the fluid to the lab to check for cancer cells. This is called peritoneal washing.
Your surgeon may also remove some or all the lymph nodes around your womb and at the back of the abdomen to check for cancer cells.
Women with early stage womb cancer (stage 1 and 2), and some stage 3 cancers, may have keyhole surgery to remove their womb. Keyhole surgery is called laparoscopic surgery. Surgeons use a laparoscope to do it. This is a narrow telescope that lights and magnifies the inside of your body, which your surgeon can see on a TV screen.
Your 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 usually less than a centimetre long.
Keyhole surgery results in very little scarring afterwards. There is likely to be less blood loss during the operation compared to traditional open surgery, and recovery time is less. 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 hospitals, the surgeon may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery or da Vinci surgery.
During the surgery, a robotic machine is beside you. It has 4 arms. One arm 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 magnified view of the operating area.
Treatment after surgery
Most women only need surgery to treat their endometrial cancer. You might need other treatment if you have high grade or stage 3 or 4 womb cancer.
Treatment after surgery helps to reduce the chance of the cancer coming back. You might have chemotherapy or radiotherapy or a combination of both.
Surgery for advanced womb cancer
If your cancer has already spread to another part of your body at diagnosis, you don’t normally have surgery. But in some cases of advanced cancer your specialist may suggest removing as much of the cancer as possible, if they think this will slow down its growth and help with symptoms. 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
After surgery, you may have chemotherapy, radiotherapy or hormone therapy, or a combination of treatments.
Surgery for womb cancer that has come back
If womb cancer comes back within the pelvis, it may be possible to try and cure it with surgery. 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).
Your surgeon removes any pelvic organs that contain cancer cells, or are very near to the cancer.
This can include:
- your womb (unless you've 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. This type of surgery is called pelvic extenteration.
If the surgeon removes your bladder, you will need to have a bag to collect your urine (urostomy). Similarly, if they remove your rectum, you’ll need a bag to collect your poo (stools or faeces). This is called a colostomy. Your doctor and specialist nurse will talk to you before your operation about what to expect and support you.
As this 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. 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).