Surgeries for Endometrial Cancer

The main treatment for endometrial cancer is surgery to take out your uterus. Doctors call this a hysterectomy. Your care team will help you choose the type for you based on your age, health, and how far the cancer has spread.

Most surgeons now use small cuts and a camera to do the procedure. That’s called minimally invasive or laparoscopic surgery. It usually means less pain and a faster recovery than open surgery, which uses a larger cut in your lower belly (laparotomy).

Types of hysterectomies include:  

Simple or total abdominal hysterectomy. This is the most common. Your doctor makes a cut in your belly and removes the uterus and cervix. They may also take out nearby lymph nodes to check if the cancer has spread.  

Vaginal hysterectomy. Your doctor removes the uterus through your vagina. It’s less common because it’s harder to see and check nearby areas for cancer.  

Radical hysterectomy. Your doctor removes the uterus, cervix, upper vagina, and surrounding tissue. They usually only do this if the cancer has spread beyond the uterus or into the cervix.

Most people with endometrial cancer also have their ovaries and fallopian tubes taken out during a hysterectomy. Doctors call this a bilateral salpingo-oophorectomy, or BSO for short.

Why take them out? Cancer can spread to these areas. Even if it hasn’t, a BSO lowers the risk it could later. Ovaries also make estrogen, which can help some types of endometrial cancer grow. Taking them out helps cut off that fuel.

Total hysterectomy and BSO is standard for most people with endometrial cancer, especially after menopause. If you’re younger and have early-stage, low-risk cancer, you might be able to keep one or both ovaries. Your doctor will talk through what’s best for you.

If you haven’t gone through menopause yet, this surgery will bring it on right away. Your care team will help you manage that shift.

Lymph nodes act like tiny filters for your immune system. They can also catch and hold cancer cells.

During surgery for endometrial cancer, doctors often check these nodes as part of staging – a process that shows how far the cancer has spread and what treatment you may need next.

There are a few ways to do this:

Lymph node sampling. Your surgeon takes out just a few nodes from spots where cancer is most likely to spread. This gives your doctor important details without putting you through a bigger surgery.

Lymph node dissection. This involves taking out many lymph nodes from the pelvis and around the aorta (a big blood vessel in your belly). It provides more detail than sampling but comes with a higher risk of complications, like long-term swelling in the legs (lymphedema).

Sentinel lymph node mapping. This newer method uses a special dye to find the first nodes that drain the uterus. If those are cancer-free, the rest likely are, too. It’s less invasive and is now common in early-stage cases. 

Pelvic washing is a test your doctor may do during surgery to check for hidden cancer cells. Before removing your uterus, they rinse the pelvic area with a saltwater-like fluid. Then they send that fluid to the lab.

If the lab finds cancer cells in the fluid, it could mean the cancer might spread later – even if everything else looks OK. These results don’t change your stage, but they can help guide your treatment plan.

Doctors often include pelvic washing when they check lymph nodes. The test is quick, low-risk, and gives your team more information. 

Tumor debulking means your surgeon removes as much visible cancer as possible. Doctors usually do this when the tumor is big or cancer has spread beyond the uterus (called metastatic or stage IV endometrial cancer).

The goal is to lower the amount of cancer in your body. This gives treatments like chemo a better chance to work. It may also ease symptoms and slow cancer growth.

During debulking, your doctor may remove cancer from places like the ovaries, bladder, bowel, or the lining of your belly (called the peritoneum). They may also remove lymph nodes at the same time.

This is a more involved surgery than a standard hysterectomy, but your team may suggest it if they think it’ll help you feel better. 

Most people only need a hysterectomy, ovary and fallopian tube removal, and lymph node checks. But if the cancer has spread more widely, your doctor may suggest other surgeries.

These can include:

Omentectomy or omental biopsy. This surgery removes some or all of the omentum, a fatty layer in the belly. Doctors usually only do this if you have a high-grade or serious type of cancer, which can spread here early on.  

Bowel or bladder resection. Your surgeon may take out parts of these organs if they find cancer in them. This is less common and usually only done when cancer is advanced.  

Diaphragm or peritoneal stripping. Doctors may remove cancer from the lining of the belly (peritoneum) or diaphragm. This is only done in certain advanced (stage IV) cases.

Fertility-sparing surgery. Doctors may try to preserve the uterus and/or ovaries. This option needs close follow-up. It’s only done after a careful review and for people with early-stage, low-risk cancer. 

Depending on your surgery, you might go home the same day or stay in the hospital for a few days – sometimes up to a week. Most people feel better in three to six weeks, but everyone heals at their own pace.

In the first 24 hours, try to:

• Move around.
• Ask if you should wear compression socks.   
• Stay hydrated. 
• Eat a light snack or meal.

Once you get home:

• Have a trusted person stay with you for a few days. 
• Try to get out of bed for several hours each day. 
• Expect to be unusually tired for a few weeks.
• Take pain meds as prescribed. 
• Eat and drink normally. 
• Use a heating pad for belly pain. 
• Avoid intense exercise until your doctor says it's OK.

If you get a hysterectomy, you can’t put anything in your vagina for six to 12 weeks. Your doctor will let you know when it’s safe to have sex again. 

After surgery, your body needs time to adjust. Here’s what you might notice – and when to reach out for help.

It’s normal to have:

• Low energy or feel wiped out for a few weeks
• Hot flashes, night sweats, or vaginal dryness (if your ovaries were removed)
• Mild bloating and belly pain
• Soreness near your surgical cuts
• Changes in sex, like less interest or more discomfort
• Trouble peeing, especially after more complex surgery

These symptoms usually get better with time. But if they’re hard to deal with or stick around too long, tell your doctor. Many of these issues are treatable.

Call your doctor or get medical help right away if you have: 

• Heavy bleeding 
• Fever or chills
• Shortness of breath
• Bad pain that doesn’t go away or gets worse
• Swelling in your legs or belly
• Signs of infection (redness, pus, warmth, or pain at the cuts made during surgery)
• Trouble peeing or pooping

Once you’re healed, you’ll likely see your doctor every three to six months for a few years. These checkups help spot cancer early and give you a chance to talk about how you’re doing.  

After surgery, your care team may suggest more treatment, like radiation or chemo.  Or you might just need regular checkups for the next few years. Everyone’s plan is a little different, and your doctor will talk you through what’s ahead.

No matter what comes next, you won’t have to face it alone. Your team is there to help you recover and move forward, one step at a time.