Surgery to remove the womb (radical hysterectomy)

A radical hysterectomy is an operation to remove the cervix, tissues around the cervix, womb, fallopian tubes and top part of the vagina. It might also include removal of the ovaries.

You will also have lymph nodes removed in the area between the hip bones (the pelvis). This is called a pelvic lymphadenectomy.

When you might have a radical hysterectomy

Doctors usually offer a hysterectomy to women with stage 1A2 to 1B2 cancers and rarely for stage 2A cancer.

What happens?

You have the operation while you are asleep (under general anaesthetic). During the operation, your doctor will remove:

• the cervix
• your womb 
• all the tissues around the cervix
• fallopian tubes
• the top part of the vagina
• in some people, the ovaries

This is called a radical hysterectomy.

Your surgeon might also remove all the lymph nodes around the womb.

Some women with very early cervical cancer (stage 1A to 1A2) may have just the following removed:

• the cervix
• the womb
• the fallopian tubes

This is called a simple hysterectomy.

Ovaries

If you haven’t been through the menopause (pre menopausal) and depending on the type of cervical cancer, your doctor will generally leave the ovaries. Removing them would put you into an early (premature) menopause. In this case, you might need to take hormone replacement therapy (HRT). This prevents menopausal symptoms and the effects of menopause on your bones and other body organs.

If you have been through menopause, your doctor will also remove the ovaries.

Removing lymph nodes

During the operation, your doctor will remove the lymph nodes in your pelvis. The lymph nodes are part of the lymphatic system. Cancer cells can first travel to the nearest lymph nodes if they break away from a tumour. So, your doctor removes them and checks for cancer cells.

How you have a radical hysterectomy

Your doctor (gynaecological oncologist) will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have.

Having a general anaesthetic means you won’t be able to eat or drink for several hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your nurse will give you instructions about this.

The anaesthetist inserts a small plastic tube (a cannula) into a vein in your arm or hand. This is used to give you fluids and medications. Once you’re asleep from the general anaesthetic, a tube to drain urine (catheter) is inserted into your bladder.

Your doctor can do a hysterectomy and lymph node removal in different ways. Many women have keyhole surgery. The methods of doing surgery include:

An abdominal hysterectomy

The surgeon cuts into the tummy (abdomen).

A vaginal hysterectomy

The womb and cervix are removed through the vagina. An incision is made at the top of the vagina.

Further treatment

Your doctor sends the tissue they remove, including the lymph nodes, to the laboratory. This is to check that they have removed all of the cancer in the cervix and to see if there are any cancer cells in the lymph nodes.

Your specialist will offer you more treatment if there is a risk that cancer cells have been left behind or if there is any sign that the cancer has spread. Treatment is usually with chemotherapy and radiotherapy (chemoradiotherapy).

After surgery

You will be in hospital for between 5 and 7 days. And recovering at home afterwards for at least another month or so.

Problems after surgery

There are risks with any type of surgery, but most women don’t have problems after a hysterectomy. Your doctor ensures the benefits of having the surgery outweigh any possible risks.