UTERINE CANCER SYMPTOMS, DIAGNOSIS & TREATMENTS

What are uterine cancer symptoms?

The symptoms of the different anatomical cancers described above are not all the same and have even led to confusion in some women that have delayed treatment. It is very important to be aware of the different symptoms and your level of risk. Arranging once or twice-yearly gynaecological check-ups and knowing which tests are available and which cancers they apply to can significantly lower the risk of undetected, later-stage cancer.

Most uterine cancer is first diagnosed when post-menopausal women or older women who have never have children are invited to be screened by a gynaecologist. Unlike many types of cancer, symptoms of uterine cancer begin at early stages with abnormal vaginal bleeding that does not coincide with the normal menstrual cycle or that occurs after the menopause. Vulvar cancer is associated with itching or pain, thickened skin, wart-like growths or open sores. Cervical cancer symptoms include irregular bleeding, vaginal discharge and pelvic pain. Ovarian cancer is more likely to produce abdominal bloating, pelvic and lower back pain, low energy and urinary and bowel movement changes.

If you are reading this page, you may have been diagnosed with uterine (U), ovarian (O), cervical (C) or vulvar (V) cancer due to the presence of one or more symptoms. The list of common symptoms below also lists the initials of the corresponding cancer types. These symptoms are also present in non-cancerous pathologies that include infection, hormonal imbalances, pregnancy and even irritable bowel syndrome.

• Irregular bleeding that does not correspond with the menstrual cycle (U) (C)

• Abdominal bloating (O)

• Pain during sexual intercourse (C) (U)

• Unusual vaginal discharge (C) (U)

• Pelvic or lower back pain (O) (C) (U)

• Bowel movement and urinary changes (O) (U)

• Itchy vulva (V)

• Open sores or warts on the vulva (V)

• Loss of appetite and unexplained weight loss (U) (O) (C) (V)

• Fatigue (U) (O) (C) (V)

National screening programs for the detection of cervical cancer in the general population are common in the form of a Pap smear that removes cervical cells with a swab. A pap test does not test for uterine, ovarian or vulvar cancers. Vulvar diagnostic tests include checking the skin for lumps and growths. Ovarian and uterine cancers require transvaginal ultrasound where a probe is inserted into the vagina to create an image on a screen. If abnormalities are detected using any of these methods, further testing by way of medical imaging or tissue biopsy is necessary. These diagnostic measures will be discussed further on. 

Can I prevent uterine cancer?

Not many uterine, cervical, ovarian or vulvar cancers run in families; however, if a family member has had colon cancer this may increase your risk of uterine and ovarian cancer types, as does hereditary non-polyposis colorectal cancer (HNPCC). Increased risk of uterine cancer in those who have had colon, breast or ovarian cancer has been reported. This may also be linked to earlier cancer treatment with drugs such as tamoxifen or in response to repeated radiation therapy.

The most common non-familial risk factor for cervical and vulvar cancer is infection with the human papilloma virus (HPV). This is not the case with uterine or ovarian cancer. Vaccination of teenage girls and boys is a highly effective preventive measure for these two cancer types. If you are HPV-positive, a biannual appointment with a gynaecologist and annual Papanicolaou test (Pap test) will pick up abnormal cells in the cervix at an early stage. For ovarian and uterine cancer, a blood test called the CA125 test may indicate both malignant and benign abnormalities; a positive result certainly does not indicate cancer but can provide a reason to test further.

Endometrial hyperplasia and vulvar intraepithelial neoplasia increase the risk of developing uterine and vulvar cancer respectively. Removal of these areas of overgrowth with minimally invasive treatments can be an effective preventive measure.

Obesity is linked to a wide range of cancers, especially those linked to hormone imbalances. Fat tissue produces oestrogen, causing long-term hormonal imbalance. Women with a BMI of 28 or more might want to arrange more regular screening appointments from a younger age, lose weight and eat foods low in animal (saturated) fats. Post-menopausal women are at a higher risk of uterine and ovarian cancer, and those taking hormone replacement therapy also very slightly increase their risk of developing ovarian and uterine cancer. Additionally, women with diabetes may be up to 25% more likely to develop ovarian and uterine cancers and should try their best to manage the disease with regular blood glucose monitoring, the correct medication and healthy lifestyle changes.

Many risks can be diminished through taking the combined contraceptive pill for more than 10 years, use of a progestin-secreting intrauterine device (IUD), pregnancy, breastfeeding, combined oestrogen and progesterone hormone replacement therapy and surgical removal of the ovaries in women who no longer wish to have children.

While CT scans and X-rays can detect a range of illnesses, they also emit large amounts of radiation and can cause damage to cell DNA. This damage can lead to cancer. MRI scans do not use radiation but electromagnetic energy and are therefore much safer; however, they are not as cost-efficient as radiation-emitting machines and hospitals tend to limit their use. A less expensive option is ultrasound that uses soundwaves to produce an image. Arranging your own diagnostic MRI scans at a private hospital can be a good idea.

It is also important to mention that people who regularly travel on long-haul (high altitude) flights can be exposed to higher radiation levels and should opt for the MRI scan (or ultrasound) rather than a CT scan or X-ray whenever possible.

How are uterine cancers diagnosed?

Whether you are experiencing symptoms, present with risk factors or simply want increased peace of mind, all gynaecologists follow the same diagnostic pathways when ruling out gynaecologic cancers. Before any gynaecological diagnostic test it is a good idea to empty your bladder and bowels. Do not use a tampon if you are menstruating - you can temporarily replace it with a sanitary towel. Some diagnostic tests will ask you to reschedule your appointment if menstruating. If this time coincides with your appointment, let the doctor know at least 24 hours beforehand so your trip is not wasted

Your first visit will include giving information about your general health and family history, details of pregnancies, miscarriages or plans for children, blood tests to check for hormonal and CA125 levels, clinical observation of the breasts and lower abdomen, ultrasound of the lower abdomen, an ultrasound-assisted transvaginal examination and a colposcopy. C

Discolouration, growths or lumps detected in the breasts, vulva, vagina, cervix, uterus or ovaries, blood tests pointing to abnormal hormonal levels, or positive Pap test results will requre a second new appointment. For breast diagnostics, please visit the breast cancer page.

The next step after detection of abnormality may be another colposcopy where a small amount of tissue will be taken from the vagina, cervix or lower womb (biopsy). Fine-needle aspiration under ultrasound guidance inserts a thin needle into the lower abdomen under local anaesthetic to remove multiple samples of ovarian tissue. In the upper womb, alternative biopsy procedures such as dilation and curettage (D&C) or hysteroscopy may be required. These latter procedures are described in more detail further on as they are also treatment methods. Biopsy samples are tested for cancer spread and staging, cell type and the presence of receptors for oestrogen, progesterone and certain proteins. This  information will enable your oncologist to select the most effective treatment pathway.

Medical imaging will also be prescribed. These diagnostic methods include CT, PET or Dotatate PET and MRI scans.

Vulvar biopsies can be taken under a local anaesthetic in the gynaecologist’s office. Changes to the vulva can be detected by way of the Toluidine blue dye test. This involves applying a blue dye to the tissue of the vulva and using a special light that shows up unusual cells. A biopsy of this tissue can then be immediately taken.

During a vulvar biopsy the visible area of abnormal tissue is often completely excised. This can be a curative procedure and is also the approved treatment for benign lumps and warts of the vulva. Such abnormalities can be removed by laser, application of extreme cold (cryotherapy) or a scalpel.

An alternative diagnostic test of the womb is the fluid-contrast ultrasound or FCUS. This is a full pelvic ultrasound that measures the thickness of the endometrium and shows any changes in texture due to benign or malignant growths. A thin catheter is inserted into the uterus using a colposcope. Sterile saline is slowly administered through the catheter before imaging commences. The injected fluid makes visualization of abnormalities much easier. 

How are gynaecologic cancers treated?

Treatments for uterine, ovarian, cervical and vulvar cancers vary and will be discussed separately at first, with the various surgeries and non-surgical treatments described in a more generalised manner further on.

Practically all womb, ovary, vulva and cervix cancer cases require surgery. For younger women, this can be a life-changing and upsetting event as it is sometimes no longer possible to have children. Finding the right balance between disease and future family life makes these situations particularly challenging. A highly experienced and knowledgable gynaecologist with an empathic approach and the ability to listen is essential for the best possible outcome.

How is ovarian cancer treated?

Nearly all ovarian cancer is treated surgically. Before and/or after surgery, chemotherapy is prescribed. Only inoperable ovarian cancer uses chemotherapy as a first-line treatment to control cancer growth. Unlike the other cancer types described here, ovarian cancer is rarely treated with radiotherapy.

Localized ovarian cancer is removed during a salpingo-oophorectomy (surgical removal of the ovaries and fallopian tubes) either on one side (unilateral) or both sides (bilateral). A unilateral operation in combination with chemotherapy and other treatments can significantly affect your fertility but it may still be possible to have children. 

If the cancer has spread or is of a type that is more likely to spread, the womb and close-lying lymph nodes may also be removed during a laparoscopic or robotic-assisted hysterectomy with lymphadenectomy. An additional omentectomy removes the fatty flap of tissue that covers the intestines. A combination of staging and observable cancer removal may be advised – this operation type is known as a debulking.

Chemotherapy treatment for ovarian cancer can be neoadjuvant (before surgery) or adjuvant (after surgery). When cancer is diagnosed, up to 4 cycles of chemotherapy may significantly shrink the tumour before it is surgically removed. This pre-surgical treatment requires anywhere between 8 to 12 weeks. Adjuvant chemotherapy is often given in higher doses for shorter lengths of time - common drug combinations are carboplatin and paclitaxel. Remission rates increase with additional targeted therapy in the form of bevacizumab. Many different combinations of pharmaceuticals are possible.

How is uterine cancer treated?

Nearly all uterine cancer is treated by way of a hysterectomy. Before and/or after surgery, radiotherapy and possibly chemotherapy is prescribed. Only inoperable cancer implements chemotherapy as a first-line treatment to control cancer growth.

Localized uterine cancer requires a laparoscopic or robotic-assisted hysterectomy with or without lymphadenectomy (removal of the lymph nodes). Where cancer has spread into the cervix, a radical hysterectomy removes the uterus, cervix and upper part of the vagina. Woman who are close to or have reached the menopause will also undergo a bilateral salpingo-oophorectomy. An additional omentectomy removes the fatty flap of tissue that covers the intestines. Combination staging and cancer surgery may be advised – this operation type is known as a debulking.

For recurrent uterine cancer, total pelvic exenteration in which the ovaries, uterus, cervix, vagina and sometimes the bladder and/or lower bowel (rectum) are removed is performed. This is a complex surgery with an option to undergo vaginal reconstruction at a later date. Due to the rarity of this procedure, it is not discussed any further in this article. If this treatment course has been advised to you, request your free Second Opinion and we will put you in touch with gynaecologists experienced in complex abdominal and gynaecological surgeries.

Radiotherapy is more likely to be advised after hysterectomy or in inoperable cases of endometrial cancer. MRI-guided external beam radiation or vaginal brachytherapy are the most common approaches. 

Chemotherapy treatment for uterine cancer is only used for later stages and can be neoadjuvant (before surgery) or adjuvant (after surgery). It does not replace radiotherapy but can be an additional therapy for those in otherwise good health. In combination with surgery and radiotherapy, 3 cycles of chemotherapy may help to kill any remaining cancerous cells. This requires approximately 9 weeks. Common chemotherapy drug combinations are carboplatin and paclitaxel or cisplatin and doxorubicin. HER2-positive uterine cancer remission rates increase with additional targeted therapy in the form of trastuzumab. Many different combinations of pharmaceuticals are possible. You can discuss complete treatment pathways with all accommodation, transportation, home nursing care, catering and follow-ups by contacting a member of the Remedazo team or speak to experienced oncologists during your free Second Opinions.

How is cervical cancer treated?

All earlier stage cervical cancer is treated surgically. Advanced forms are treated with radiotherapy with or without chemotherapy. 

Localized early-stage cervical cancer can be treated with a large-loop excision of the transformation zone (LLETZ). Transformation zone refers to a location with changed cell types (cancer or benign lesions). This procedure is performed under a local anaesthetic using a colposcope in the gynaecologist’s office. 

If cancer has spread or is of a type that is more likely to spread, surgery under a general anaesthetic is required in the form of a laparoscopic trachelectomy (removal of the cervix and upper vagina), a laparoscopic trachelectomy with simple hysterectomy (removal of cervix, upper vagina and uterus) or a radical hysterectomy (removal of cervix, upper vagina, uterus, lymph nodes and ovaries).

Pelvic exenteration is used to treat recurrent cervical cancer. In this complex surgery, the ovaries, uterus, cervix, vagina and sometimes the bladder and/or lower bowel (rectum) are removed. There is an option to undergo vaginal reconstruction at a later date. Due to the rarity of this procedure, it is not discussed any further in this article. 

Radiotherapy is occasionally advised after surgery or in advanced cases of cervical cancer. MRI-guided external beam radiation and vaginal brachytherapy is a common combination approach that lasts for up to 8 weeks.

Chemotherapy treatment for cervical cancer can be neoadjuvant (before surgery) or adjuvant (after surgery). It is often combined with radiotherapy. When cancer has been diagnosed up to 4 cycles of chemotherapy, a course that takes 9 to 12 weeks, may significantly shrink the tumour. Adjuvant chemotherapy is usually administered in higher doses for shorter lengths of time; commonly used cytotoxic drugs are cisplatin, topotecan, carboplatin and paclitaxel. Remission rates increase with additional targeted therapy in the form of bevacizumab. Many different combinations of pharmaceuticals are possible.

How is vulvar cancer treated?

Nearly all vulvar cancer is treated surgically, as is VIN. Before and/or after surgery for advanced stage vulvar cancer, chemotherapy is usually prescribed. Radiation therapy may be used to shrink tumours before surgery or destroy remaining cancer cells afterwards.

Localized vulvar cancer requires a partial vulvectomy where the tumour and surrounding tissue are removed. This can be done under a local anaesthetic with or without sedation and performed using lasers or a scalpel. Larger tumours or those which may spread will require the removal of larger areas of tissue for which a general anaesthetic is advised. Radical vulvectomy removes the entire vulva but is rarely performed; newer methods (modified vulvectomy) allow surgeons to remove larger areas with the same treatment outcomes but significantly more positive psychological outcomes. In some cases, a lymphadenectomy (removal of the regional lymph nodes) is necessary. 

Chemotherapy treatment for vulvar cancer can be neoadjuvant (before surgery) or adjuvant (after surgery). When cancer is diagnosed, up to 4 cycles (9 to 12 weeks) of chemotherapy may significantly shrink the tumour. Adjuvant chemotherapy is usually given in low doses over a longer period of time and is almost always combined with radiotherapy.  The most common chemotherapy drugs for the treatment of advanced or metastatic vulvar cancer are cisplatin, fluorouracil, capecitabine, carboplatin and paclitaxel. Remission rates increase with additional targeted therapy in the form of cetuximab and erlotinib.

Why do I need uterine cancer treatment?

Treatment is necessary for any type of cancer to try to prevent cancerous cells from travelling to other organs via the surrounding blood and lymph vessels. When treated at an early to mid-stage, gynaecologic cancers can be cured; even advanced cancers can be kept under control for long periods of time with rapidly increasing treatment options. New therapies and procedures are continuously enhancing advanced uterine, ovarian, cervical and vulvar cancer remission and survival rates.

How do I prepare for uterine cancer treatment? What can I expect?

Approximately 2 to 4 weeks before surgical cancer treatment or other therapy pathways you will be asked to supply the results of your blood tests and copies of any diagnostic and imaging results (ultrasound, CT, MRI, biopsy and/or PET). This means we can see how your cancer is progressing and will help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders and your overall state of health.

You will need to undergo an MRI, PET or CT scan and possibly a bone scan – if these have not yet taken place - which will help us to see if cancer has spread to other organs.

Approximately 2 weeks before your treatment you will need to ask your home doctor to take blood for a preoperative or pre-treatment blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For some procedures, blood-thinning and other medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.

Gynaecologic cancer treatment

The information below covers all available treatments for gynaecologic cancers at Remedazo. Breast cancer treatment can be found here. If you would like information on any therapy not covered in this section, please do not hesitate to contact us.

Surgical cancer treatment

When the results of a biopsy are positive for uterine cancer and this cancer has not spread to areas far from the original tumour, surgical removal is always the first-line treatment. Surgery methods and results range from minimally invasive to life-changing.

Dilation and curettage

This minor surgery dilates the cervix to allow the gynaecologist access to the inner lining of the uterus. D&C is the most common procedure for the removal of benign lesions, tissue for biopsies, placement and removal of intrauterine devices, and expulsion of tissue left behind after miscarriage or childbirth.

Depending on the amount of tissue that is to be removed and your personal preference, a D&C may be carried out with a local anaesthetic injected directly into the cervix with a little sedation, a spinal anaesthesia or a light general anaesthetic. This is an outpatient procedure carried out in a gynaecological position. Cramps may be felt for up to 48 hours  afterwards and light bleeding is expected. You will need to avoid having a bath, swimming and sexual intercourse for 3 to 4 days after a D&C.

Hysteroscopy

If the gynaecologist wants to observe the lining of the womb, hysteroscopy is the procedure of choice. This is a diagnostic or therapeutic operation that inserts a light and camera into the womb via the vagina in a gynaecological position. Without accompanying procedures, hysteroscopy can be carried out in the gynaecologist’s office with a little local anaesthetic and sedation. When combined with a laparoscopy or dilation and curettage, the procedure will take place in the operating theatre. With an accompanying laparoscopy, the outside of the uterus, fallopian tubes and ovaries can also be observed via an endoscope placed through an incision in the navel. A general anaesthetic is required for any laparoscopic procedure. The combined D&C and hysteroscopy can be performed under sedation with local anaesthesia, spinal anaesthesia or general anaesthesia.

The timing of this operation is often important. For the best view of the inner lining of the womb, hysteroscopy should take place approximately 1 week after menstruation in non-menopausal women. This is sometimes difficult to arrange, especially if you suffer from irregular periods. In such cases, Remedazo will place you on a stand-by list to ensure you are promptly seen by your specialist gynaecologist of choice at exactly the right time.

Salpingo-oophorectomy

Localized ovarian cancer is removed via a salpingo-oophorectomy (surgical removal of the ovaries and fallopian tubes) either on one side (unilateral) or both sides (bilateral). After your general anaesthesia, your doctor will also carry out a D&C and remove endometrial tissue for further testing. If he or she wants to view the inside of the womb, a hysteroscopy (see above) will also take place.

As this is a laparoscopic procedure, your choice of specialist can also observe the outside of the womb. A simple salpingo-oophorectomy takes 40 minutes to 1 hour.  When carried out as a robotic-assisted procedure surgery will take approximately 90 minutes. For both procedures you will probably need to stay in the hospital overnight.

A bilateral salpingo-oophorectomy means you will no longer be able to have children. A unilateral operation in combination with chemotherapy and other treatments may significantly affect your fertility but it can still be possible for you to have children. 

After bilateral ovary removal, you will have reached the menopause. The pros and cons of hormone replacement therapy according to your personal medical history can be discussed during your free online Second Opinion.

Vulvar excision

Removal of a cancerous or benign lump with or without a margin of healthy tissue is usually a curative procedure and can be carried out in the gynaecologist’s office under a local anaesthetic and perhaps a little sedation. 

For localised benign tumours, laser ablation under local anaesthetic is the treatment of choice.

Vulvectomy

Removal of a layer of or a section of the vulva to ensure the excision of cancerous cells is a possible treatment course for vulvar cancer in cases where vulvar excision is considered insufficient.

A skinning vulvectomy removes the upper layer of vulvar skin in the presence of precancerous cells (vulvar intraepithelial neoplasia). Removal of the entire top layer of the vulvar skin is only recommended in women with multiple precancerous lesions. A skin graft may be necessary and the operation is carried out by a gynaecologic oncologist or plastic surgeon. This is surgery that requires a general or spinal anaesthetic with a hospital stay of 3 to 4 days. A urinary catheter protects the area from bacteria and is removed just before discharge from hospital. 

A simple vulvectomy removes all of the vulva, although often leaves the clitoris intact. A modified radical vulvectomy may sound more invasive than a simple vulvectomy but this is not necessarily true. A modified radical procedure removes anywhere from a third to nearly all of the vulva and some of the surrounding lymph nodes and tissue. Skin grafts are often necessary. Both surgery types are carried out under general or spinal anaesthesia and involve hospital stays of 4 to 6 days. A urinary catheter protects the area from bacteria and is removed just before discharge from hospital.

Hysterectomy

Removal of the womb is performed using abdominal, laparoscopic or transvaginal techniques. Hysterectomy is not only performed for cancer but also for the treatment of fibroids (benign growths), severe and recurrent endometriosis and pelvic inflammatory disease. Hysterectomy in these cases is considered a last resort; this is rarely the case after a uterine, ovarian and occasionally cervical cancer diagnosis.

When both ovaries are removed without hysterectomy, very little oestrogen is produced and a women becomes infertile. Hormone replacement therapy may be advised to avoid (early) menopause side effects. When only the uterus is removed, the body still produces oestrogen and so the menopause will not be entered as a result of surgery; reaching the menopause will be the result of natural ageing. It is potentially possible to harvest your eggs for surrogate-assisted pregnancy but without a womb, it is not possible to be pregnant yourself. When the uterus and both ovaries are removed you enter the menopause and are unable to produce eggs, making this operation a psychologically challenging one for women of all ages.

You may have been advised to undergo one of four different hysterectomy procedures:

• Subtotal or partial hysterectomy (uterus)

• Total hysterectomy (uterus and cervix)

• Hysterectomy and bilateral salpingo-oophorectomy (uterus and both ovaries)

• Radical hysterectomy (uterus, both ovaries, cervix, part of the vagina, lymph nodes and supporting ligaments)

Removal of the ovaries is sometimes a prophylactic (preventive) part of a hysterectomy. If you do not have cancer of the ovaries but have been advised to undergo this additional treatment this may be due to the type of uterine cancer. Your gynaecologist should inform you as to why he or she recommends a prophylactic excision.

An abdominal hysterectomy requires a horizontal or vertical incision above the pubic hairline or running from under the navel to just aabove the pubic hairline. Many women opt for a laparoscopic operation to avoid a 15 to 22 cm scar, although this may not be possible when a tumour is large as the uterus must be removed via a sufficiently large incision. An abdominal hysterectomy requires a 1 to 3 night hospital stay and up to 8 weeks of rest until the lower abdominal muscles have healed. Until this point, heavy lifting and activities that involve significant bending should be avoided.

A vaginal hysterectomy removes the uterus through the vagina and requires a shorter hospital stay (0 to 1 day) as recovery is much quicker. No muscles are damaged during this operation and you will be able to return to your normal activities within 2 to 4 weeks; however, sometimes the emotional and psychological effects of such surgery require more time. This type of procedure can only be carried out if the womb is not particularly large. More commonly, a laparoscopically-assisted vaginal hysterectomy (LAVH) helps the surgeon remove a larger womb by cutting it into smaller sections and allows easier separation of the womb from the body. This procedure has the same recovery times of a vaginal hysterectomy and three 1.5 – 2.5 cm scars (one of these inside the navel, the other two to the lower left and right of the navel). Your gynaecologist must have significant laparoscopy skills in order to perform this operation.

Laparoscopic hysterectomy can be performed with the surgeon standing beside you and manually manipulating special instruments known as trocars while watching progress on a screen or as a robotic-assisted procedure where he or she sits at a distance and uses magnified 3-D imagery and hand controls to manipulate previously-positioned robotic arms. Both procedures require specialist surgeons. Remedazo partners with numerous, carefully-selected laparoscopy-specialised surgeons; these include renowned gynaecologists and surgical oncologists.

Advances in robotic surgery now allow two different procedures. These are robotic multiport hysterectomy (RMPH) and robotic single-site hysterectomy (RSSH). The latter involves the use of multiple instruments through a single incision in the navel and requires new and significant laparoscopy skills. However, more recent reports do not recommend either surgery as a sole technique for cancer treatment. This is because, in order to remove the uterus through these tiny scars, it needs to be disected into smaller pieces when still in the abdomen. This can lower the risk of cancer spread. Your surgeon will therefore perform a vaginal hysterectomy and keep the womb intact. This means your eligibility for either procedure depends on a broad groups of factors including your weight, medical history, age and current health level, your cancer type, location and size, and the size of your womb. You can discuss eligibility with surgeons experienced in RMPH and RSSH for free with Remedazo.

Conventional laparoscopy involves 3 to 4 incisions of 2 to 3 cm in length. Robotic multiport procedures require 5 incisions of between 2 to 4 cm and, as already mentioned, RSSH involves a single incision inside the navel. 

Sexual intercourse should be avoided for at least 6 weeks after any type of hysterectomy. You will need to use sanitary pads as bloody discharge is possible for as long as a month after this procedure. 

It is no longer possible to become pregnant after a hysterectomy. Your menstrual cycle will stop and you may wish to start hormone replacement therapy once you have recovered from surgery. Younger women may wish to preserve their fertility or save eggs. Speak to an experienced and empathic gynaecologist during one of your three free Second Opinion sessions.

 Debulking

Debulking is an operation in which the surgeon attempts to remove as much visible cancerous tissue as possible from areas into which it has spread. Some cancers may show up in multiple areas causing symptoms (or not) and your surgeon may prefer to use this hands-on approach rather than resect areas indicated on medical imaging results. In simpler terms, this means a larger incision (laparotomy) that allows the surgeon to access to a wider area, personally visualise areas of abnormal cell growth and remove it as he or she finds it. Biopsies may be taken for further testing unless the cancer is known to be advanced. A number of surgeons are prepared to use robotic-assisted surgical techniques.

Debulking surgery is often called initial cytoreductive surgery and you may need a further operation according to this procedure’s biopsy results. Debulking is also used to increase comfort in cases of metastatic cancer. It can keep more advanced cancers under control but may involve significant tissue removal.

A laparotomy involves a large incision through the abdomen and an epidural catheter that is inserted before you are anaesthetised for postoperative pain control. A general anaesthetic is always necessary. Hospital stays of at least 3 days and up to 6 days are normal.

After a gynaecological debulking procedure that nearly always removes the ovaries and womb, you will have reached the menopause. The pros and cons of hormone replacement therapy according to your personal medical history can be discussed during your free Second Opinion.

Peri-operative uterine cancer surgery care

Minor surgical procedures carried out in the gynaecologist’s office need little preparation. Make sure you go to the toilet within the hour before a procedure and remove tampons if inserted. If your procedure will take place in the operating theatre, the following information will apply.

You will be admitted to your chosen clinic on the day of the procedure. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting.

From midnight of the day before your surgery, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least one week before surgery; stopping smoking beforehand improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted. If your operation is planned to proceed under a local or spinal anaesthetic you might still be asked to refrain from eating or drinking before surgery. This means that if you find the surgery or situation too uncomfortable, the anaesthetist has the option to administer a general anaesthetic that will increase your comfort.

Approximately thirty minutes before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.

Preoperative gynaecologic cancer surgery preparation requires:

• An intravenous line

• A blood pressure cuff placed on the upper arm

• The completely painless placement of electrodes to the chest to measure heart activity

• A finger or ear sensor to measure oxygen levels in the blood

• A general, local or spinal anaesthetic.

• A urinary catheter (placed after you are asleep) to prevent the contamination of wounds during surgery (24 hours) or to protect vulvar incisions (5 – 6 days).

• For debulking, robotic-assisted or extensive surgery you will need an arterial catheter and perhaps a second intravenous line. 

• For some laparotomy procedures, an epidural catheter will be inserted for postoperative patient-controlled pain medication administration.

At the surgeon’s signal, you will be anaesthetised.

What happens after uterine cancer surgery? What can I expect? 

You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Where a spinal anaesthetic has been given you will remain in the recovery room until you can move both legs. For epidural catheters, your patient-controlled pain pump will be started while you are still in the recovery area. All patients remain in the recovery ward until they are fully responsive and any pain is well under control. If you have undergone a procedure under local anaesthetic you can return to your chosen accommodation the same day.

When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward. Pain medication is given as standard but postoperative pain, even for debulking and more radical procedures, is easy to control due to epidural catheters and intravenous medications. Only the most extensive debulking or laparotomy procedures give cause for a night or two in a medium or intensive care facility. This also applies to some longer robotic-assisted laparoscopies.

Your intravenous catheter will continue to administer fluids for up to 24 hours and any drains will be removed by a trained nurse or doctor within 2 days. Urinary catheters placed for hysteroscopy are removed before you leave the recovery room. For other procedures, the urinary catheter stays in place for 24 hours. In the case of vulvectomy, urinary catheters will be removed after 4 to 5 days as urine coming into contact with healing wounds is not only likely to cause infection but can cause much discomfort.

The majority of gynaecologic cancer patients are out of bed within 4 hours of exiting the recovery room. Average hospital stays for localised cancers range from 0 to 2 days. More invasive surgeries with or without laparotomy may mean a hospital stay of 2 to 5 days.

Upon discharge from hospital you will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further treatment. In most instances you will be able to travel within 2 days of discharge. You will need to wear compression stockings when travelling and perhaps split longer journeys into shorter trips.

Long-term postoperative care includes the removal of laparoscopic or abdominal stitches after 5 to 8 days. This can be done by your general practitioner at home if you are not attending further treatment sessions. Full recovery from minor surgery only requires a few short days. For laparoscopic and robot-assisted surgeries expect to rest for 1 to 3 weeks. Larger incisions such as those of a laparotomy or skin grafts such as in vulvectomy require 2 to 4 weeks to recover. Further radiotherapy or chemotherapy is prescribed after the majority of gynaecological cancer procedures.