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What Happens During Surgery for Endometrial Cancer?

Three surgeons in a surgery suite

Surgery is the primary treatment for women with endometrial cancer. Your surgery should be done by a gynecologic oncologist. This doctor is a specialist who has done extra training in the diagnosis and treatment of gynecologic cancers. 

On the day of your surgery, an anesthesiologist or a nurse anesthetist will give you medication to put you to sleep. The anesthesia also ensures that you won’t remember or feel pain during the surgery. The anesthetist or anesthesiologist monitors you during the surgery to be sure you stay healthy and comfortable.

There are different kinds of surgery done to manage endometrial cancer.

Simple hysterectomy

The surgeon takes out your uterus and cervix, the top of the vagina that connects to the uterus. Your doctor may also take out some nearby lymph nodes to check them to see if the cancer has spread. This is important to determine the surgical stage and making postoperative treatment decisions. The doctor will do the hysterectomy in one of three ways:

  • Abdominal hysterectomy. The surgeon makes an incision (cut) that goes from the belly button down to the pubic bone (about 3 inches to 4 inches). The surgeon takes out your uterus and cervix through this opening.

  • Vaginal hysterectomy. The surgeon takes out the uterus and cervix through the vagina. You’ll need a small cut at the top of your vagina. This method is more difficult for the surgeon to do than an abdominal cut, but it may be easier to recover from. That’s particularly true if you are overweight. Lymph nodes may also be removed by using laparoscopic surgery.

  • Laparoscopic hysterectomy. The surgeon makes small incisions in your abdomen. The surgeon places a tool called a laparoscope into one incision. It has a camera attached to a telescope. This tool lets the surgeon see your uterus, fallopian tubes, and ovaries. The surgeon places other instruments through other incisions to detach your uterus. The uterus is then removed through your vagina. The surgeon can also check some lymph nodes through the laparoscope. Laparoscopic hysterectomy may be performed using a robotic system controlled by the surgeon. This robotic technique offers improved visualization, precision, and control during the operation. Since the introduction of the robotic technology, more patients have been able to undergo a minimally invasive surgical procedure for the treatment of endometrial cancer and thus avoid a large incision. 

Bilateral salpingo-oophorectomy

The surgeon usually takes out both ovaries and both fallopian tubes in women diagnosed with endometrial cancer. Most women with uterine sarcoma have this done. The age of the woman plays a role in the decision to take out the ovaries. The surgeon removes these organs at the same time as the uterus and cervix. In some younger women with early stage endometrial cancers, the ovaries may not need to be removed. 

Lymph node removal

If you have endometrial cancer, the surgeon will likely take out lymph nodes from your pelvis and higher up in your abdomen. This allows your health care team to check for cancer cells. It also helps the surgeon know whether tissue outside the uterus needs to be removed. Cancer cells found in the lymph nodes may mean that cancer has spread. This information helps your doctor plan any further treatment you might need. Lymph nodes can be removed during a hysterectomy. They can also be removed at another time using a laparoscope or via robotic technology. This procedure is called laparoscopic, or robotic lymph node sampling.

Radical hysterectomy

This type of surgery is not done as often for endometrial cancer. This surgery is for women whose cancer has spread to the cervix or the tissue around the uterus called the parametrium. The radical hysterectomy may be performed through a traditional abdominal incision or through minimally invasive approaches, such as laparoscopy or robot-assisted surgery. 

The surgeon removes the following:

  • Uterus

  • Tissues next to the uterus called the parametrium and uterosacral ligaments 

  • Cervix, which is the area that connects your vagina to your uterus

  • The upper part of your vagina

  • Some nearby lymph nodes in most women

  • Both ovaries and fallopian tubes in most women