Contents. Overview. Removing the womb (hysterectomy) Overview

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1 This information is an extract from the booklet Understanding womb (endometrial) cancer. You may find the full booklet helpful. We can send you a free copy see page 9. Overview Contents Overview Removing the womb (hysterectomy) What else may be done When the cancer has spread outside the womb Before the operation After the operation Going home Early menopause Possible long-term complications Getting support Surgery is the main treatment for womb cancer. Your operation will be carried out by a surgeon who is experienced in treating gynaecological cancers. After the operation, your surgeon can tell you more about the stage of the cancer. The stage of womb cancer describes how far the cancer has grown and if it has spread from where it started. Removing the womb (hysterectomy) Usually you will have a total hysterectomy. This involves removing the womb and the cervix. The fallopian tubes and both ovaries are also removed (called a bilateral salpingooopherectomy). A hysterectomy can be carried out in different ways. Your surgeon will advise you on which type of hysterectomy is suitable for you. Questions about cancer? Ask Macmillan Page 1 of 9

2 Laparoscopic hysterectomy (or keyhole hysterectomy) The surgeon makes small cuts in your tummy and inserts small surgical instruments and a laparoscope (a telescope with a camera on the end). This allows the surgeon to see pictures on a screen. The womb and ovaries are removed through the vagina and then the top of the vagina is sewn up. Women recover faster from this type of hysterectomy and it involves a shorter stay in hospital. But it s not suitable for everyone. Abdominal hysterectomy The surgeon makes a cut (incision) across your tummy above the pubic hair, or sometimes downwards from your belly button to the pubic hair. We have more information about different types of hysterectomy. What else may be done During your operation, the surgeon will check organs nearby to find out more about the stage of the cancer. This includes putting some fluid into your tummy (abdomen), then removing it so that it can be tested for cancer cells. Doctors sometimes call this abdominal or peritoneal washing. Removing lymph nodes You may have some or all of the lymph nodes (see illustration below) close to the womb (pelvic nodes) and at the back of the tummy (para-aortic nodes) removed. This allows them to be checked for cancer cells. Your surgeon will talk to you about the benefits and disadvantages of removing lymph nodes. Knowing if the cancer has spread to the lymph nodes helps your specialist decide if you need further treatment. Page 2 of 9 Questions about cancer? Ask Macmillan

3 Pelvic lymph nodes Lymph nodes in the pelvis Bladder Urethra Lymph nodes in the groin Womb Cervix Vagina When the cancer has spread outside the womb If the cancer has spread to organs close by, such as the bladder or bowel, you ll usually have an operation to remove as much of the cancer as possible. This helps to control the cancer and may make the treatment you have after surgery more effective. Very rarely, if the cancer is widespread in the pelvic area, surgery to remove the bladder and the bowel, as well as the womb, may be done. This is a major operation called pelvic exenteration. Speak to one of our cancer support specialists on for more information on pelvic exenteration. If the cancer has spread to the liver or lungs, surgery is not usually possible. Very occasionally, an operation to remove a secondary tumour that s contained in one area may be done. This would only be done if the cancer elsewhere in the body is under control. Questions about cancer? Ask Macmillan Page 3 of 9

4 Before your operation Before your operation, you will have some tests to prepare you for surgery. These tests are usually done a few days or weeks beforehand at a pre-assessment clinic. A member of the surgical team and a specialist nurse will discuss the operation with you. Make sure you tell them any questions or concerns that you have. You ll usually be admitted to hospital the morning of your operation. The doctor who gives you your anaesthetic (the anaesthetist) will normally visit you. You ll be given special elastic stockings (TED stockings) to wear during and after the operation to prevent blood clots forming in your legs. If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection. It will also help your wound to heal after the operation. Your GP can give you advice and you may find it helpful to read our booklet on Giving up smoking. Some hospitals follow an enhanced recovery programme. This aims to reduce the time you spend in hospital, speed up your recovery and involve you more in your own care. For example, you may be given information about diet and exercise before surgery, and any arrangements needed for you to go home may be put in place. Your doctor will tell you if an enhanced recovery programme is suitable for you and if it s available. After your operation How quickly you ll recover will depend on the type of operation you have and the extent of the surgery. If you re in an enhanced recovery programme, you ll be encouraged to get out of bed on the evening of the operation, if possible. Your drip, which gives fluids into your vein, will be removed soon after surgery and you ll be able to start drinking and eating again. Page 4 of 9 Questions about cancer? Ask Macmillan

5 Back in the ward After your operation, you ll be given fluids into a vein in your hand or arm. This is called a drip or an intravenous infusion. Once you re eating and drinking normally again, it s taken out. You ll usually have a tube (catheter), which is put in during the operation, to drain urine from your bladder. This can be taken out a few hours after your surgery, but in some people it may need to stay in for longer. If you have a wound drain (a fine tube in the wound draining fluid into a small bottle), it s usually taken out after a few days. Pain After your operation, you ll have some pain and discomfort, which should be controlled with painkillers. Depending on the extent of your surgery, you may need a strong painkiller for the first day or two after your operation. You may be given painkillers as injections into a muscle (given by the nurses), or through a pump known as a patientcontrolled analgesia (PCA) pump. The pump is attached to a fine tube (cannula), which is placed in a vein in your arm. It allows you to release painkillers directly into your blood by pressing a button. The machine is set so you always get a safe dose and can t have too much. You may be given painkillers through an epidural infusion for the first few days. A fine tube is inserted in your back, into the space just outside the membranes surrounding your spinal cord. A local anaesthetic and other painkilling drugs are given by infusion (drip) into this space using an electronic pump. The drugs work by numbing the nerves in the operation area, giving you continuous pain relief. It s important to let the nurses or doctor know if your painkillers aren t working for you. They can increase the dose or prescribe a different painkiller. Painkillers can cause constipation, so you may be offered laxatives. Tell your nurse if you have any problems going to the toilet. Questions about cancer? Ask Macmillan Page 5 of 9

6 Your wound You ll have a dressing covering your wound, which may be left undisturbed for the first few days. After this, you ll usually have the dressings changed if there s any leakage from the wound. If necessary, you can have any stitches or staples removed after you ve gone home. This will be done by a district nurse or at your GP surgery. Always let your doctor know if your wound becomes hot, painful or starts to leak fluid these are signs of infection. If something doesn t feel right after your operation, go to your doctor immediately. They will be more than happy to see and help you. It s better to catch something like an infection early, than let it get hold. Joan Getting moving After your operation, you ll be encouraged to start moving about as soon as possible. This is important for your recovery as it helps prevent chest infections and blood clots. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse can help you do these exercises. Going home If you ve had laparoscopic (keyhole) surgery, you can usually go home 1 4 days after your operation. You may be ready to go home between 2 8 days after an abdominal hysterectomy. Your nurse will give you advice on looking after yourself so that your wound heals and you recover well. You ll be given an appointment to come back to the outpatient clinic to see the surgeon. They will examine you and check the wound. You ll also be given information about the results of the operation and advised if you need further treatment. Page 6 of 9 Questions about cancer? Ask Macmillan

7 When you get home How quickly you recover will depend on the operation you ve had. It s important to take things easy for a while. Try to get plenty of rest and eat well. If you re having any problems, it s important to contact your doctor or specialist nurse. It s really important to not overdo things and allow yourself time to heal. I took things slowly, followed the advice from health professionals about not lifting anything heavy and took gentle exercise everyday. To start with, that was a walk to the end of the road and I found that very quickly I built up my strength. Daloni Physical activity You ll be advised to avoid strenuous physical activity or heavy lifting for about three months after a hysterectomy and six weeks after laparoscopic surgery. Your physiotherapist or specialist nurse will give you advice about this. Try to do some light exercise, such as walking, that you can gradually increase. This will help you build up your energy levels and feel better. Some women find driving uncomfortable after their operation. It s probably a good idea to wait for a few weeks before driving again. Some insurance policies give specific time limits, so check this with your insurance company. Don t drive unless you feel you have full control of the car. Hygiene Try to have a shower or bath every day to keep your wound clean. It s common to have a reddish brown vaginal discharge for up to six weeks after a hysterectomy. Use sanitary pads rather than tampons to reduce the risk of infection. Questions about cancer? Ask Macmillan Page 7 of 9

8 Sex Your surgeon will usually advise you not to have sex for at least six weeks after your operation. This allows the wound to heal properly. After that, you ll be able to return to your usual sex life. But it s not unusual to need more time before you feel ready, especially if you re having other treatment as well. Our booklet Sex and cancer information for women has more detailed information. Early menopause For younger women who haven t reached the menopause, a hysterectomy and removing the ovaries will cause the menopause. This means you will get menopausal symptoms. Some common symptoms of the menopause are hot flushes and sweats, vaginal dryness, low sex drive, bone thinning and emotional symptoms such as; mood swings, anxiety, problems concentrating or remembering things. Possible long-term complications Most women have no long-term complications after surgery. But having other treatments as well as surgery may increase the risk of problems. Rarely, women have bladder or bowel problems after a hysterectomy because of damage to the nerves during the operation. If you have had the pelvic lymph nodes removed, there s a risk of developing swelling (lymphoedema) in one or both legs. This is a build up of lymph fluid in the tissues. Lymphoedema isn t common, but if you have radiotherapy as well as surgery there s more risk. There are things you can do to reduce your lymphoedema risk. This mainly involves protecting the skin on your legs and feet. Infection can trigger lymphoedema, so it s important to avoid damage to the skin. If you get swelling in your foot or leg, always get it checked by your doctor or nurse. Our booklet Understanding lymphoedema has more detailed information. Page 8 of 9 Questions about cancer? Ask Macmillan

9 Getting support It s not unusual to feel anxious after surgery. You may feel your recovery is taking longer than you expected or you may be worried about having further treatment. It s often helpful to talk about your feelings with your family and friends. Your nurse specialist or our cancer support specialists can also give you support. You can contact our cancer support specialists on to talk, or for information about local support groups. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding womb (endometrial) cancer, or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN APRIL 2015 Planned review in 2017 Questions about cancer? Ask Macmillan Page 9 of 9

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