Hysterectomy for ovarian cancer

Surgery Overview

A hysterectomy is the removal of your uterus . The goal of the initial surgery is to remove all visible ovarian cancer. Surgery confirms the diagnosis and stages the cancer, and it is also the initial treatment for the cancer. Your long-term outcome (prognosis) is improved when you are under the care of an experienced gynecologic oncologist. His or her expertise can help determine the best treatment choices at the time of this initial surgery.¹

Surgery for ovarian cancer usually includes:

• A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
• Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal cavity, to look for cancer cells.
• Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
• Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
• Removing and checking the fatty tissue (omentum) attached to some of the abdominal organs, to see if the cancer has spread.
• An appendectomy, which removes your appendix.

Your long-term outcome (prognosis) depends on the type and stage of your cancer, your age, your overall health, and the amount of cancer remaining after surgery.

What To Expect After Surgery

You will probably stay in the hospital for 1 to 4 days after a hysterectomy. After you leave the hospital, getting some rest and following your doctor's instructions usually will help any problems that you have after surgery go away over time. About 4 to 6 weeks after the hysterectomy, your doctor will examine you in his or her office. You may be able to return to doing some of your normal activities, including having sexual intercourse, in about 6 to 8 weeks. Some light vaginal bleeding or spotting is expected for up to 6 weeks following a hysterectomy. After having a hysterectomy, you will not be able to become pregnant.

Chemotherapy, which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Chemotherapy is usually started 1 to 4 weeks after surgery.

After a hysterectomy, call your doctor if you have:

• Chest pain, a cough, or difficulty breathing.
• Bright red vaginal bleeding that soaks two or more pads in an hour or forms large or painful clots.
• Pain or tenderness, swelling, or redness in your legs, especially in the back of your calves.
• A fever of 100 °F (38 °C).
• Pain that is not relieved by your pain medicine.
• Difficulty passing a stool, especially if you have not had a normal bowel movement for 3 to 5 days, or if you have mild pain or swelling in your lower abdomen.
• Difficulty passing urine, pain or burning when you urinate, blood in your urine, or cloudy urine.
• Pain, discomfort, or bleeding during intercourse.
• Hot flashes, sweating, flushing, or a fast or pounding heartbeat.

Why It Is Done

Ovarian cancer develops in one ovary but can spread to the other ovary, the uterus, and the other abdominal organs as well. The goal of the initial surgery is to remove all visible cancer. The surgery confirms the diagnosis and stages the cancer.

How Well It Works

For women with early-stage (stage IA, grade 1) ovarian cancer and low risk of the cancer progressing, surgery may be the only treatment needed. These include women whose surgery showed no tumor cells in the abdomen or in the capsule surrounding the ovary. But studies have shown an increase in survival and a reduced risk of cancer returning in women who receive chemotherapy for this early-stage cancer.^{2, 3}

Risks

Most women do not have complications after a hysterectomy. But complications that may occur include:

• Fever. A slight fever is common after any surgery.
• Difficulty urinating or not being able to control your urine (urinary incontinence).
• Continued heavy vaginal bleeding. Some vaginal bleeding for 4 to 6 weeks following a hysterectomy is expected. But call your doctor if bleeding continues to be heavy.
• The formation of scar tissue (adhesions).

Other complications may include:

• Infection.
• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus).
• Injury to other organs, such as the bladder or bowel.
• A collection of blood at the surgical site (hematoma).

You may develop other physical problems after a hysterectomy. In some women, the pelvic muscles and ligaments that support the vagina, bladder, and rectum may become weak. The weakness may cause bladder or bowel problems, such as cystocele, urinary incontinence, or rectocele. Kegel exercises may help strengthen the pelvic muscles. And some women need other treatments, including additional surgery.

Vaginal dryness may develop from the removal of your ovaries and the loss of the hormones (estrogen and progesterone) that the ovaries make. If sexual intercourse is painful because your vagina is dry, use a vaginal lubricant such as K-Y jelly, Astroglide, or Replens, or a polyunsaturated vegetable oil that does not contain preservatives. Do not use petroleum jelly (for example, Vaseline) as a lubricant because it increases the risk of vaginal irritation and infection.

Your doctor will tell you how long you should wait after surgery before having sexual intercourse. If you have pain during intercourse, changing positions may help make intercourse less painful. If you continue to have difficulty during intercourse after a hysterectomy, talk with your doctor.

What To Think About

You may have emotional concerns when faced with surgery to remove your reproductive organs. These emotions may be based on your beliefs about the importance of your uterus, your fears about your cancer treatment, and your concerns about the effect on your sexual relationships.

You may also experience a wide variety of emotions about your cancer diagnosis. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

Talk with your doctor about your specific fears and anxieties concerning your surgery and treatment.

The hospital or surgery center may send you instructions on how to get ready for your surgery, or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will likely stay in the recovery area for 1 to 4 hours, and then you will be moved to a hospital room. In addition to any special instructions from your doctor, your nurse will explain information to help you during your recovery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. National Comprehensive Cancer Network (2007). Ovarian cancer. Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.

2. Karlan BY, et al. (2005). Ovarian cancer, peritoneal carcinoma, and fallopian tube carcinoma. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., vol. 1, pp. 1364-1397. Philadelphia: Lippincott Williams and Wilkins.

3. Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.

Credits