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Hysterectomy and bilateral salpingo-oophorectomy

Endometrial cancer is usually treated by removing the uterus and cervix. The operation is called a total hysterectomy. In most cases, a woman will also have a bilateral salpingo-oophorectomy, which means her fallopian tubes and ovaries are also removed. Women’s ovaries are removed during surgery because the cancer may have spread, or because ovaries produce oestrogen, a hormone which may cause cancer to grow.

If you are premenopausal and feel concerned about how surgery will affect your fertility, see ‘Effects on fertility’, below, for more information.

Depending on the size and type of cancer you have, the surgeon may also remove some other parts of your body. For example, sometimes a small part of the upper vagina and ligaments supporting the cervix are removed if the cancer has spread to this area. The lymph glands in your pelvis may also be removed. Your gynaecologic oncologist will discuss this with you before the operation.

If the doctor has not confirmed the type of cancer you have or how far it has spread, these operations may help to determine this. A hysterectomy also gives your surgeon an opportunity to examine the other organs in your abdomen for signs that the cancer has spread (metastasised).

In a hysterectomy or bilateral salpingo-oophorectomy, a cut is usually made from the pubic area to the belly button. Occasionally a cut is made along the pubic line. Once the abdomen is open, the surgeon washes out the area with fluid. This fluid will be sent to a pathologist, who will check it for cancer cells.

If appropriate, the operation may be performed as a laparoscopic procedure (keyhole surgery). This means that the surgeon makes a small cut in the abdomen and uses a thin telescope to see inside the abdomen. The uterus (and any other organs) are cut away and removed through the vagina.

Removing lymph nodes

If the cancer has spread into the muscular wall of the uterus, this increases its risk of spreading to the abdominal lymph nodes. You and your doctor may decide to remove some lymph nodes in your pelvic region. Removal of lymph nodes is called a lymphadenectomy.

Your surgeon may use extremely small titanium clips to seal the lymph vessels when the nodes are removed. These should not have long-term effects on your body.

If you do have cancer in your lymph nodes, your doctor may advise additional therapy.