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What Happens During Surgery for Endometrial Cancer?

Three surgeons in a surgery suite

On the day of your surgery, an anesthesiologist or a nurse anesthetist will give you medication to put you to sleep. The anesthesia also ensures that you won’t feel pain during the surgery. The anesthetist or anesthesiologist monitors you during the surgery to be sure you stay healthy and comfortable.

Here are the main kinds of surgery done for endometrial cancer.

Simple hysterectomy

The surgeon takes out your uterus and cervix, the top of the vagina that connects to the uterus. Your doctor may also take out some nearby lymph nodes to check them to see if the cancer has spread. The doctor will do the hysterectomy in one of three ways:

  • Abdominal hysterectomy. The surgeon makes an incision (cut) that goes from the belly button down to the pubic bone (about 3-4 inches). The surgeon takes out your uterus and cervix through this opening.

  • Vaginal hysterectomy. The surgeon takes out the uterus and cervix through the vagina. You’ll need a small cut at the top of your vagina. This method is more difficult for the surgeon to do than an abdominal cut, but it may be easier to recover from. That’s particularly true if you are overweight. Lymph nodes may also be removed by using laparoscopic surgery.

  • Laparoscopic hysterectomy. The surgeon makes small incisions in your abdomen. The surgeon places a tool called a laparoscope into one incision. It has a camera attached to a telescope. This tool lets the surgeon see your uterus, fallopian tubes, and ovaries. The surgeon places other instruments through other incisions to detach your uterus. The uterus is then removed through your vagina. The surgeon can also check some lymph nodes through the laparoscope. Laparoscopic hysterectomy may be performed using a robotic system controlled by the surgeon.

Bilateral salpingo-oophorectomy

The surgeon takes out both ovaries and both fallopian tubes. Most women with uterine sarcoma have this done. The age of the woman also plays a role in the decision to take out the ovaries. The surgeon removes these organs at the same time as the uterus and cervix. Taking out your ovaries removes the main source of hormones that can make certain kinds of cancer cells grow.

Lymph node removal

If you have endometrial cancer, the surgeon will likely take out lymph nodes near your uterus. This allows your health care team to check for cancer cells. It also helps the surgeon know whether tissue outside the uterus needs to be removed. Cancer cells found in the lymph nodes may mean that cancer has spread. This information helps your doctor plan any further treatment you might need. Lymph nodes can be removed during a hysterectomy. They can also be removed at another time using a laparoscope. This procedure is called laparoscopic sampling.

Radical hysterectomy

This type of surgery is not done as often for endometrial cancer. This surgery is for women whose cancer has spread to the cervix or the tissue around the uterus called the parametrium, and involves an abdominal incision.

The surgeon removes the following:

  • Uterus

  • Tissues next to the uterus called the parametrium and uterosacral ligaments 

  • Cervix, which is the area that connects your vagina to your uterus

  • The upper part of your vagina

  • Some nearby lymph nodes in most women

  • Both ovaries and fallopian tubes in most women

FYH

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