Types of surgery for womb cancer

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 examines other organs around the womb to see if there are signs of cancer spread. They can also take samples of tissue (biopsies) to send to the lab to check for cancer cells. The surgeon is called a gynaecological oncologist. This means they specialise in cancers affecting women's reproductive organs. 

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 simple or 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. This sheet is the omentum. The operation is called an omentectomy. You are more likely to have this if you have a type of womb cancer called serous carcinoma.

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 looks for signs of cancer spread. They take 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 to check for cancer cells. They check the lymph nodes:

• around your womb
• at the back of the abdomen

For an early cancer that is only in the womb, you might have a sentinel node biopsy (SLNB). This test finds the first lymph node or nodes to which a womb cancer may spread. The doctor then checks to see if this lymph node contains cancer cells.

How you have the operation

There are different ways your surgeon can do the operation. The most common way is to have keyhole surgery but some need to have open surgery. You will need a general anaesthetic with both types of surgery.

Keyhole surgery

You may have keyhole surgery if you have early womb cancer. This is stage 1 and 2 womb cancer. It is sometimes possible for people with stage 3 cancer to have surgery in this way, but less common.

Keyhole surgery is also called laparoscopic surgery. Surgeons use a laparoscope to do it. The surgeon makes up to 5 cuts in your tummy. The laparoscope connects to a fibre optic camera which shows pictures of the inside of the body on a video screen. The surgeon then uses the other incisions to insert the other instruments into your body.

So you will have 4 to 5 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. The recovery time is less than it would be after open surgery.

Surgeons who have had specialist training need to do the surgery. This means that it may not be available in every hospital.

Robotic surgery

In some 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 using a machine that controls the robotic arms. The surgeon has a 3D magnified view of the operating area. 

Open surgery

You may have open surgery if your womb is large and can't be removed easily. You may have open surgery if you have an advanced cancer.

Your surgeon may make a cut into your tummy (abdomen). After this surgery you will have one scar on your tummy afterwards. You may have a wound that runs vertically, up and down your lower abdomen. This is called a mid line incision. Or you may have a wound that runs from right to left across your lower abdomen (your bikini line). This is called a transverse incision. Your surgeon will talk to you before your operation about the type of cut they are likely to do and why.

Treatment after surgery

Most women with early cancer only need surgery to treat their endometrial cancer. You might need other treatment if you have intermediate risk or high risk 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 your specialist may suggest removing as much of the cancer as possible. They might suggest this 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 other treatments. This might include one or more of the following treatments:

• chemotherapy
• radiotherapy
• hormone therapy
• immunotherapy
• targeted treatment

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. The pelvis is the lower part of your abdomen. It contains the womb, bladder, and back passage (rectum). You can usually only have this if the cancer grows back in the middle of the pelvis. 

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 on where the cancer had grown back. This type of surgery is called pelvic exenteration.

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 a 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 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) rather than womb cancer.