Cancer of the uterus, precisely termed endometrial cancer, is the most common form of gynecologic cancer. It is considered as the fourth most common cancer among women—after breast, cervical and lung.
“The cancer usually develops after menopause,” notes The Merck Manual of Medical Information.
Studies done in the United States showed that if endometrial cancer is detected early, nearly 90 percent of women who have it survive at least five years, and most are cured. “The prognosis is better for women whose cancer has not spread beyond the uterus,” the Merck manual informs. “If the cancer grows relatively slowly, the prognosis is also better.”
Hysterectomy, the surgical removal of the uterus, is the mainstay of treatment for women who have endometrial cancer. “If the cancer not has spread beyond the uterus, removal of the uterus plus removal of the fallopian tubes and ovaries almost always cures the cancer,” the Merck manual points out.
Aside from endometrial cancer, hysterectomy is also recommended to women with cancer of the cervix and ovaries. Most doctors claim that only 10 percent of hysterectomies are performed for cancer.
In most instances, doctors may suggest hysterectomy to women who experience uterine fibroids that cause pain, bleeding, or other problems; uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal; endometriosis; abnormal vaginal bleeding; chronic pelvic pain; and adenomyosis or thickening of the uterus.
In 1994 a study conducted in the US followed in a span of 12 months approximately 800 women with similar gynecological problems (pelvic pain, urinary incontinence due to uterine prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids and painful intercourse). About half of those who were studied had a hysterectomy while the other half didn’t undergo such operation.
The study found that a substantial number of those who had a hysterectomy had “marked improvement in their symptoms following hysterectomy,” as well as “significant improvement in their overall physical and mental health” one year out from their surgery.
The researchers came up with this conclusion: for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness.
Doctors use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and a woman’s overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.
In webMd.com article, reviewed by Dr. Kecia Gaither, two approaches of hysterectomy were mentioned: a traditional or open surgery and surgery using a minimally invasive procedure (MIP). The former, called abdominal hysterectomy, is the most common approach to hysterectomy, accounting for about 65 percent of all procedures.
To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.
“On average, a woman spends more than three days in the hospital following an abdominal hysterectomy,” the webMd.com feature note. “There is also, after healing, a visible scar at the location of the incision.”
Interestingly, there are several approaches that can be used for an MIP hysterectomy. The webMd.com feature cites the following:
Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly or, in the case of a single site laparoscopic procedure, one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina.
Robot-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.
“Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy,” the feature says. “In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.”
Like most treatments, hysterectomy has side effects. “After a hysterectomy, menstruation stops,” the Merck manual says. “However, a hysterectomy does not cause menopause unless the ovaries are also removed.
Removal of the ovaries has the same effects as menopause, so hormone therapy may be recommended.”
Many women anticipate feeling depressed or losing interest in sex after a hysterectomy. “However, hysterectomy rarely has these effects unless the ovaries are also removed,” notes the Merck manual.
In addition, removal of the uterus renders the patient unable to bear children (the same thing happens when the ovaries and fallopian tubes are removed). These consequences, the surgical risks and the long-term effects are the reasons why the surgery is only recommended when other treatment options are not available or have failed.
By the way, before a woman undergoes hysterectomy, she has to have a pelvic examination, Pap smear, and a diagnosis first. Prior to having a hysterectomy for pelvic pain, women usually undergo more limited (less extensive) exploratory surgery procedures (such as laparoscopy) to rule out other causes of pain. Prior to having a hysterectomy for abnormal uterine bleeding, women require some type of sampling of the lining of the uterus (biopsy of the endometrium) to rule out cancer or pre-cancer of the uterus. This procedure is called endometrial sampling.
In addition, pelvic ultrasounds and/or pelvic computerized tomography (CT) tests can be done to make a firm diagnosis. In a woman with pelvic pain or bleeding, a trial of medication treatment is often given before a hysterectomy is considered.