Primary treatment of early stage operable cervical cancer

Treatment of endometrial cancer with cervical involvement

In special circumstances where cancer has come back after primary radiation



A radical hysterectomy is a surgical procedure that entails the removal of the uterus as well as the tissue and ligaments on the sides of the uterus and the cervix that hold it in place, and a portion of the vagina. The pelvic lymph nodes and occasionally the lymph nodes going further up the abdomen to the level of the kidneys are also removed. A radical hysterectomy is generally only done when cancer is present.

Alternatives to a radical hysterectomy

In early stage cervical cancer one may opt for or better be suited to receive primary radiation therapy or in very rare cancer types chemotherapy and or radiation therapy may be indicated. Generally radical hysterectomy has less lifelong complications then doing radiation therapy and has the potential to preserve a young womens ovarian function. The other benefit to a radical hysterectomy and lymphnode dissection is that in appropriately selected individuals the treatment may be definitive. Nonetheless, the decision to have a hysterectomy must be an informed decision made with your gynaecologic oncologist.

1What is removed during this surgery?

During a radical hysterectomy, the uterus, cervix, fallopian tubes, surrounding tissues and ligaments, and the top part of the vagina usually removed. In addition the surgeon usually also performs a bilateral pelvic lymph node dissection, removing the lymph nodes in the pelvis and some of the lymph nodes around the aorta.

The ovaries are usually spared in young women who will benefit from ovarian function unless there is a risk or likelihood the cancer may spread to the ovaries. In some instances where additional radiation is anticipated an ovary mat be hitched to the abdominal side wall under the rib cage so that it wont be damaged by radiation. If the ovaries are removed in post menopausal women or in patients with high risk cancer types then it is referred to as a radical hysterectomy and bilateral salpingectomy-oophorectomy.

Fertility sparing techniques are very occasionally indicated in young women who have not yet completed their families. These include radical trachelectomy and pelvic lymph node dissection. This is the procedure whereby the cervix and surrounding tissues along with the vagina and lymph nodes are removed while preserving the body of the uterus and ovaries for future child baring. This is only indicated for very small cancers and certain cancer types and may be performed via the vagina or via the abdomen. Fertility and successful pregnancy is not guaranteed after this operation and pregnancies have a high preterm birth rate.

Menopause after hysterectomy

If your ovaries are removed prior to you have gone through natural menopause, surgical removal of your ovaries may result in severe menopausal symptoms such as hot flushes, sleep disturbance and vaginal dryness, as well as an increased risk of developing osteoporosis. In such cases, Dr Bryant may advise hormone replacement therapy (HRT) in the form of a cream, a patch or a pill, to treat these symptoms. Hormone replacement therapy (HRT) may be started shortly after the surgery.

Routes of hysterectomy

Which type of approach taken during surgery will depend on the overall health of the patient. Generally there are two approaches to a radical hysterectomy. These include:

  1. Through the abdomen (Abdominal radical hysterectomy)
  2. Via laparoscopy also known as keyhole surgery (Laparoscopic radical hysterectomy)

1Abdominal radical hysterectomy

An abdominal radical hysterectomy is an open surgery during which the uterus and lymph nodes are removed through an incision in the middle or lower abdomen.

Currently internationally the open approach is the preferred method as there is some evidence to suggest that there is an increased risk of cancer returning if done through the minimally invasive approach. The mechanisms behind this are not fully understood and we await on going research.

The disadvantages of this type of surgical method is that there tends to be more blood loss and a longer recovery period when compared to minimally invasive techniques. It also requires a longer hospital stay and recovery period. Some disadvantages/complications to make note of include:

  1. Wound complications such as infection or hernia
  2. More nerve and tissue damage and ultimately more pain then minimally invasive routes
  3. More blood loss than minimally invasive techniques

In view of the nature of the surgery one will need an indwelling urinary catheter for 7 – 10 days

Hospital stay up to 10 days

Blood thinning medication for up to 1 month post operatively

Return to work/full function > 6 weeks

2Laparoscopic radical hysterectomy

It is possible for your surgeon to perform a radical hysterectomy through minimally invasive, laparoscopic surgery, however this route has recently been questioned globally due to an increase in the recurrence of cancer.

As Dr Bryant follows an evidence-based approach, she will only advise this route if she finds it suitable and effective.  There may be some instances where a combined laparoscopic and vaginal approach is indicated but this is not routine practice. Using only a few tiny cuts or holes in the abdomen, a camera can be passed into the abdomen. The abdomen is then filled with gas so that your surgeon can get a better look at the pelvic organs. Small instruments are passed through the other holes/ports, and the operation is performed using those instruments. The uterus and lymph nodes are removed through the vagina.

Since the incisions made during this surgery are significantly smaller than those made during open surgery, the benefits of this route of surgery include a shorter hospital stay as well as a lower risk of infection and blood loss.

The disadvantages of this operation are that it may take longer to perform than the open surgery. There is also an increased risk of injury to the urinary tract and bowel. Again, as mentioned, laparoscopic surgery has recently been associated with cancer recurrence globally.

Hospital stay 1 – 2 days

Return to work 4 -6 weeks

Complications and safety

While various type of hysterectomies are commonly performed by Dr Bryant, there are risks for any surgery. The risk of complications increases with more complex cases such as cancer.  Complications that may occur after a radical hysterectomy include:

  • Infection of the wound
  • Fever
  • Bleeding - resulting in the need for blood transfusion or a second operation
  • Blood clots - precautions are taken for this during surgery, but that still doesn't eliminate the risk completely and blood thinners are recommended after the operation
  • Problems with your airway, breathing and heart that can be related to the anaesthesia given
  • Death

Other complications may only become apparent days after surgery. These include:

  • Injury to the bladder or ureters
  • Injury to bowel
  • Leaking urine from fistulae from urinary tract
  • A bowel blockage from scar tissue

These complications may require further surgery.

Complications specific to this operation may include

  • Permanent damage to the bladder resulting in the need to self catheterise or drain out your own urine. This is as a result of the radical nature of the operation and damage to the nerves that supply the bladder. This is rare and account for less than 3% of cases. Newer surgical techniques to avoid this are done by Dr Bryant when possible.
  • Lymphoedema – this is the chronic swelling of one or both limbs as a result of removal of the lymphatic glands. It very rarely occurs in patients but when it does may be debilitating. Regular lymphatic massage is used to help control the condition and some experimental operations using lymphatic grafts (lymph nodes taken from else where) are transplanted into the limb to assist with lymph drainage.

What to expect after surgery

You will be admitted on the day of the surgery unless otherwise indicated. Your nurse will fit your stockings which will help reduce your risk of blood clots.

After your surgery you will be given pain medication in the ward. Your physiotherapist will assist you with walking as soon as possible and you will also be prescribed blood thinning medication for a few weeks. This is done to minimize your risk of developing blood clots.

After a laparoscopic surgery; you can take fluid and feeds a couple of hours after the operation. If you had abdominal surgery you may only eat the next day.

You will have a urinary catheter in for up to 10 days. Your physiotherapist will also assist you with exercises and instruct you on postoperative activity. You will come for a check-up in 2 – 6 weeks to have your wound checked and stitches removed.

Pain is to be expected for the first few days, and pain medication will be prescribed. One may also experience some mild bleeding and discharge for a couple of weeks.

A persistent yellow discharge that may be copious has been described. This may take a few weeks to settle and is cause by the leakage of lymphatic fluid.

Constipation is a common side-effect after a radical hysterectomy, but medication can be prescribed to relieve this. You may also have difficulty passing urine, but this should resolve with time. Some women experience profound emotional changes after this surgery and may experience symptoms of depression; these usually subside without intervention.

Important recovery facts

  • Give yourself time to rest
  • Follow the instructions of your physiotherapist and do your prescribed exercises daily
  • Refrain from heavy lifting for the next 4 – 6 weeks
  • Do not push anything into your vagina and refrain from sexual intercourse for 6 weeks

Adjuvant therapy and follow up

At your post op check up Dr Bryant will discuss your histology results with you. Unfortunately surgery is not always a definitive treatment for your cancer and you may need to be sent for further therapy such as radiation therapy alone or chemotherapy and radiation.

Some of the factors that will predict this is if the cancer has spread to the lymph glands that are removed or into the surrounding tissues.

If you do not require adjuvant therapy you will need routine gynaecological exams and cancer screening. You will need to be assessed up to 3 monthly in the first year after your surgery there after the time intervals extend to 6 monthly and then yearly. Dr Bryant may also need to begin your hormone replacement therapy, but this will be discussed with you at your follow-up appointment.


Why does Dr Bryant perform a radical hysterectomy?

Dr Bryant performs a radical hysterectomy to treat an early stage of cervical cancer.

Am I still at risk of cancer after a radical hysterectomy?

All cancers can reoccur once diagnosed. You will have routine oncological follow-ups to look out for recurrence.

Is it normal to put on weight after a radical hysterectomy?

Women who are premenopausal and have undergone a radical hysterectomy are more likely to gain weight.

We are a referral practice that specialises in female pelvic surgery

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