Goal of Surgery for Uterine Sarcoma
Surgery continues to be the most important initial treatment for uterine sarcomas of all types. The goals of surgery are to remove the effected organ (uterus) and to determine if the cancer has spread. If cancer is found before it spreads outside the uterus, surgery by itself may be the only treatment needed. During surgery, the uterus is removed. This is called a hysterectomy. The surgeon may also take out these organs.
- Fallopian tubes
- Ovaries
- Some lymph nodes near your uterus
Surgery is the most common treatment for uterine sarcoma and endometrial cancer. If you haven’t yet reached menopause, taking out the entire uterus means that you’ll no longer be able to bear children. In some cases, it may be possible to remove only the part of the uterus that contains the tumor. This may allow you to bear children. Whether this is possible depends on the type, size, and location of the tumor. If you’ve already reached menopause, taking out your uterus does not have a serious effect on your health or sexual function.
Some uterine sarcomas (carcinosarcoma, stromal sarcoma) have a greater chance of spreading to lymph nodes in the pelvis and abdomen. Women with either of these types of sarcomas frequently have the lymph nodes removed at the time of hysterectomy. The removal of the uterus, ovaries, fallopian tubes, and lymph nodes is called a staging procedure. A pathologist checks the removed organs for the presence of tumor cells. Finding cancer has spread outside of the uterus is important and usually means that additional treatment after surgery will be needed.
Preparing for Surgery for Uterine Cancer
How you prepare for surgery is basically the same whether you have uterine sarcoma or endometrial cancer. Once cancer has been found, the decision to have surgery is usually made within 1 to 2 weeks. If you also have heart disease, your surgeon may ask your heart doctor to give approval before the surgery.
You’ll meet with your surgeon ahead of time to talk about the procedure. At that time, you can ask any questions and bring up any concerns you may have. You may want to ask about the possible side effects of the surgery. You can talk with your doctor about the risks. You can ask your doctor when you can expect to get back to your normal activities. Your doctor can tell you if the surgery will leave scars and what they may look like.
The surgery is likely to be done by a gynecologist who specializes in cancer, called a gynecologic oncologist. Compared with a general gynecologist, these doctors have received additional formal training in surgery (such as removing lymph nodes), and managing cancer treatment. Before surgery, the surgeon will go over your health records. This is done to make sure you’re not taking medications or have another health problem that could affect the surgery. After you have discussed all these details, you will sign a consent form (permission slip) that gives the doctor permission to do the surgery. You may get instructions to follow before surgery.
You’ll meet an anesthesiologist or nurse anesthetist before surgery. This is the person who will give you medicine during the surgery to make you sleep. You can ask questions about the anesthesia and how it will affect you.
What Happens During Surgery for Uterine Sarcoma?
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 feel pain during the surgery. The anesthetist or anesthesiologist monitors you during the surgery to be sure you stay healthy and comfortable.
Here are the main kinds of surgery done for uterine sarcoma.
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. The doctor will do the hysterectomy in one of 3 ways.
- Abdominal hysterectomy. The surgeon makes a cut that runs from about your pubic bone to your belly button. 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 or have serious health problems.
- 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 a small cut at the top of your vagina.
Bilateral Salpingo-Oophorectomy
The surgeon takes out both ovaries and both fallopian tubes. Most women with uterine sarcoma also need this surgery. The surgeon removes these organs at the same time as the uterus and cervix. Taking out your ovaries removes the main source of hormones that can make certain kinds of cancer cells grow. Cancers can spread to the ovaries or tubes, and their removal is part of the staging procedure which classifies how the cancer has spread or not.
Lymph Node Removal
If you have some types of uterine sarcoma, the surgeon will likely take out lymph nodes near your uterus. This allows your healthcare team to check for spread of cancer cells. Cancer cells found in the lymph nodes means that cancer has spread, and that you will likely need additional treatments after surgery. Lymph nodes can be removed during the hysterectomy procedure, or if not done initially, can also be removed at another time. Both the hysterectomy and lymph node surgery can be done using an open approach (incision on your abdomen, laparotomy) or by laparoscopy (minimal invasion surgery with small incisions). Your doctor will discus which approach is best for you.
Radical Hysterectomy
This surgery is not done as often for uterine sarcoma. This surgery is for women whose cancer has spread to the cervix or the tissue around the uterus, called the parametrium.
The surgeon takes out these organs.
- Uterus
- 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
What to Expect After Surgery for Uterine Cancer
What you feel like after surgery is basically the same whether you are being treated for endometrial cancer or uterine sarcoma. After surgery, you may have to stay in the hospital for a few days. How long you stay depends on which kind of surgery you had. Here’s an overview of how you might feel after surgery.
- For the first few days, you are likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your doctor or nurse about your options for pain relief. Some people are reluctant to take pain medication, but it can actually help your healing. If you don’t control pain, for example, you may not want to cough or turn over. These actions help you recover from surgery.
- You may need a urinary catheter for a little while to empty your bladder. The catheter is a thin tube that goes up to your bladder, allowing it to drain. Whether you use a catheter or not, you may have problems urinating after surgery. Such problems could include frequent urination, your bladder filling quickly, and some pain with urination.
- You may feel tired or weak for a while. The amount of time it takes to get better after surgery is different for each person.
- You may have bleeding, abdominal discomfort, and vaginal discharge for up to 6 weeks after surgery.
- You may have constipation from using painkillers, from not moving much, or from not eating or drinking much. Talk with your doctor or nurse about ways to limit constipation.
- You will no longer have monthly periods after a hysterectomy.
- If your ovaries were taken out, and you were still having periods (pre-menopausal) you may have menopausal symptoms. These can include hot flashes, vaginal dryness, and vaginal thinning.
- You may feel that your sexuality is affected by the surgery. You may grieve if you will no longer be able to have children. It is important that your partner and doctor understand your concerns. Be better prepared for these changes by discussing these issues with your doctor and loved ones before the surgery.
After surgery, a pathologist studies samples from your uterus and lymph nodes to learn more about your cancer. Your doctor uses the information from these samples and from any earlier tests to recommend any further treatment. This may include radiation, chemotherapy, or hormone therapy.
