Hysterectomy for womb cancer

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1 Gynaecology Oncology Service Hysterectomy for womb cancer April 2014 Great Staff Great Care Great Future INTRODUCTION This leaflet has been produced to provide you with general information about your operation. Most of your questions should have been answered by this leaflet It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you. WHAT IS A HYSTERECTOMY? A hysterectomy is a commonly performed and generally safe surgical procedure. This can be carried out in a number of ways and your surgeon will discuss the most appropriate type of hysterectomy for you. The different procedures are: Total abdominal hysterectomy and bilateral salpingo-oopherectomy (BSO).This is when the womb (uterus), neck of the womb and both fallopian tubes and ovaries are removed. This operation may be performed through either a bikini style incision or through an up and down cut in the tummy. Laparoscopic assisted vaginal hysterectomy (LAVH) and BSO. This operation is carried out through three or four tiny keyhole incisions in your abdomen to help remove the uterus, tubes and ovaries through the vagina. The end result of these approaches is the same (the removal of your womb, ovaries and fallopian tubes). It is just a question of which method is most suitable for you.

2 WHY DO I NEED A HYSTERECTOMY? You have been diagnosed with cancer of the womb. The most common cancer of the womb is known as endometrial cancer, this is in the lining of the womb. There are other types of womb cancer that affect the muscle of the womb these are known as sarcomas. The aim of the operation is to remove all of the cancer. If there is any evidence that the cancer has spread, or if the results of the operation suggest that you may be at an increased risk of recurrence of the cancer (your cancer returning), you may be offered further treatment such as radiotherapy and/or chemotherapy. This will be discussed with you when all your results are available. Are there any alternatives to surgery? There are alternatives to surgery but these vary from patient to patient. The treatment options will depend on the stage of your disease. The medical team will discuss this with you. Surgery is the best way of treating the cancer but you may be offered radiotherapy /chemotherapy. What happens if I have no treatment? Your wishes about treatment will be respected at all times by your medical team. If you choose not to have treatment, your cancer will progress and your health is likely to deteriorate. At this time you may wish for us to transfer your care to the Palliative Care Team, who will discuss with you what will happen next and help you to manage your symptoms and support you. Whatever you may be feeling try talking about it with someone who specialises in dealing with this condition (such as your consultant or the Gynaecological Clinical Nurse Specialist). They will listen, answer any questions you may have and can put you in touch with other professionals or support agencies if you wish. Some useful contact numbers are also listed within this leaflet. CAN THERE BE ANY COMPLICATIONS OR RISKS? All surgical procedures carry with them a small chance of complications and a hysterectomy is no different in this respect. Every care will be taken to minimise the risks and the potential complications include: Infection - The risk of this is reduced by giving antibiotics around the time of the surgery. The infection may occur in the pelvis, bladder, chest or in the incision site. Any more extensive infection is usually easily treated with antibiotics. Occasionally an abscess may form which may require surgical drainage under anaesthetic. Bleeding - This may occur during the operation or rarely afterwards and may be sufficient to require a transfusion or another operation.

3 Occasionally, if blood collects in the pelvis it may need to be drained surgically under anaesthetic. Deep vein thrombosis and pulmonary embolism - In association with hysterectomy, it is possible for clots of blood to form in the deep veins of the legs and pelvis. If this does occur a deep vein thrombosis is diagnosed. It may cause pain and swelling in the legs and can be treated with drugs. However, in rare cases, it is possible for this clot to break away and be deposited in the lungs or heart causing a pulmonary embolus or heart attack. The risk of developing a DVT is low as precautions are taken to help minimise the risk. Moving around as soon as possible after your operation can help to prevent this. We will give you special surgical stockings (known as TEDS ) to wear whilst you are in hospital, and injections to thin the blood. Further treatment may be needed such as: returning to theatre to stop bleeding to the bladder or bowel antibiotics to treat an infection a blood transfusion to replace lost blood If any further treatments are needed this will be explained to you by the medical team looking after you. HOW DO I PREPARE FOR THE HYSTERECTOMY? Please read this information leaflet and also the Gynaecology Oncology Enhanced Recovery patient information. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this operation. WHAT HAPPENS AFTERWARDS? For more information on afterwards read the Gynaecology Oncology Enhanced Recovery information for patients. When can I have sex? After a hysterectomy or vaginal surgery you may not feel physically or emotionally ready to start having sex again for a while. We normally advise women not to have sexual intercourse for six weeks until you have had a follow up appointment at the hospital or with your GP. Follow up You will be reviewed in out-patients about three weeks following your surgery when the consultant should be able to give you the results from your surgery. This may be done at your local hospital.

4 USEFUL CONTACTS AND SUPPORT AGENCIES Macmillan Cancer Support - specialist advice and support through Macmillan nurses and doctors and financial grants for people with cancer and their families 89 Albert Embankment, London, SE1 7UQ The Daisy Network PO Box 183, Rossendale, BB4 6WZ They provide a support network for women who experienced a premature menopause. Womb Cancer Support The Lymphoedema Support Network St. Luke s Crypt, Sydney Street, London, SW3 6NH Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Gynaecology Clinical Nurse Specialists are happy to speak to you at any time. If they are not there, an answer phone is available. (01482) If you need to speak to someone urgently, the staff on Ward 14 at Castle Hill Hospital will be happy to help. Contact details Gynaecology Outpatients Women and Children s Hospital (01482) Women s Health Outpatients Castle Hill Hospital (01482) Ward 14 Castle Hill Hospital (01482) Northern Lincolnshire and Goole Hospitals NHS Trust Gynaecology Clinical Nurse Specialist (01724) Page through Switch Board or ask for extension 5904 Scarborough Hospital Gynaecology Clinical Nurse Specialist Page through Switch Board (01723) Office (01723) Oncology/ Haematology Department (01482) Entrance 1 Castle Hill Hospital

5 Information on Gynaecology Services at Hull and East Yorkshire Hospitals NHS Trust: WHAT HAPPENS AFTERWARDS? GENERAL ADVICE AND CONSENT Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with your doctor. You will be asked to sign a consent form and you should be satisfied that you have received enough information before going ahead. Consent to treatment Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information. For a hysterectomy you will be given both verbal and written information and after having time to ask questions, you will be asked to sign a consent form to show you have received enough information and you understand it. The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means: you must be able to give your consent you must be given enough information to enable you to make a decision you must be acting under your own free will and not under the strong influence of another person How much do I need to know? Some people want to know as much as possible about their condition and possible treatments; others prefer to leave decisions to the experts. No one providing healthcare will force information on you, for example, about the risks of treatment if you do not want to know. Remember, the person in the best position to know what matters most is you. INFORMATION ABOUT YOU As part of your care, when you come to the hospital, information about you is shared between members of a healthcare team, some of whom you may not meet. It may be used to help train any staff involved in your care. Information we collect may also be used after you have been treated to help us to maintain and improve the quality of our care, to plan services, or to research into new developments. We may pass on information to other health organisations to help improve the quality of care provided by the NHS generally.

6 All information is treated as strictly confidential, and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you. Under the Data Protection Act (1998), Hull and East Yorkshire Hospitals NHS Trust is responsible for maintaining the confidentiality of any information we hold on you. This leaflet was produced by the Gynaecology Oncology Department, Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in April Ref: HEY600/2014