Surgery for Endometrial Cancer

The main treatment for endometrial cancer is to remove the entire uterus, including the cervix, as well as the ovaries (pair of female reproductive organs that produce eggs and hormones) and the fallopian tubes (two hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization). This procedure is called a hysterectomy, and it may be simple or radical.

• Simple hysterectomy (total hysterectomy) - The surgeon removes the uterus and cervix but not the structures next to the uterus (parametria and uterosacral ligaments) or the pelvic lymph nodes (bean-shaped structures, which help fight infection). The uterus is removed through a surgical incision in the front of the abdomen or through the vagina. This operation is usually combined with bilateral salpingo-oophorectomy (see below).

If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using laparoscopy, a method of examining the inside of the abdomen and pelvis through a tube (laparoscope) inserted into a very small surgical incision, the operation is called a total laparoscopic hysterectomy.

• Radical hysterectomy - Like a simple hysterectomy, this operation removes the entire uterus. But unlike simple hysterectomy, the tissues next to the uterus (parametria and uterosacral ligaments) and the upper part (about 1 inch) of the vagina next to the cervix are also removed. This operation is usually combined with bilateral salpingo-oophorectomy (see below).

If you have endometrial cancer, you will most likely be treated with a hysterectomy unless you have very early-stage cancer (Stage IA) and you want to have children. If so, it might be possible to treat you with other therapies. However, once you have finished having children, you should consider having your uterus, tubes, and ovaries taken to reduce the risk of recurrence.

Other surgical procedures may be done during or after a simple or radical hysterectomy.

• Bilateral salpingo-oophorectomy (BSO) - The surgeon removes both ovaries and both fallopian tubes (the hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization). A BSO is usually performed during a hysterectomy.
• Laparoscopic lymph node sampling - The doctor controls small surgical instruments through a tube (laparoscope). This procedure lets the surgeon remove lymph nodes without making a large incision in the abdomen. This technique can shorten the time needed for the patient to recover from surgery.
• Pelvic and para-aortic lymph node dissection - The surgeon removes lymph nodes from the pelvis and the area next to the aorta (the main artery from the heart) to find out if they contain cancer cells that have spread from the endometrial tumor. This procedure is usually done through the incision in the abdomen that was made for the simple or radical hysterectomy. The lymph nodes may also be removed by laparoscopic surgery in women who have had a vaginal hysterectomy.

This content has been reviewed and approved by Myo Thant, MD.