Uterine Sarcoma: Surgery

Surgery is the main treatment for uterine sarcoma. It's usually done by a gynecologic oncologist. This healthcare provider is a specialist who has had extra training in the diagnosis and treatment of female cancers. The goal is to remove all of the cancer. In most cases, this means removing the uterus (hysterectomy). In some cases, the ovaries, fallopian tubes, part of the vagina, and other tissues near the uterus may also be removed. After the uterus is removed, you will no longer be able to become pregnant.

Types of surgery used to treat uterine sarcoma

The type of surgery done depends on the type of uterine sarcoma, how big it is, and how far it has spread. Your age and overall health are also considered. The main kinds of surgery done for uterine sarcoma include: 

• Simple hysterectomy

• Bilateral salpingo-oophorectomy

• Radical hysterectomy

• Lymph node removal

Simple hysterectomy

The surgeon takes out your uterus and cervix. The cervix is the lower part of the uterus that connects to and opens into the vagina. Your surgeon may also take out some nearby lymph nodes to check them for cancer. A hysterectomy may be done in any of these ways:

• Total abdominal hysterectomy. The surgeon makes a cut (incision) that goes across the lower part of your abdomen (called a bikini incision). Or the incision may go from about your pubic bone to your belly button (called a vertical or midline incision). 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 your recovery may be easier.

• Laparoscopic-assisted hysterectomy. The surgeon makes small cuts in your belly (abdomen). A long, thin tool called a laparoscope is put in through 1 cut. It has a camera and light on the end. This tool lets the surgeon see your uterus, fallopian tubes, and ovaries. The surgeon puts other tools in through other cuts to detach your uterus. The uterus is then removed through a small cut at the top of your vagina. The surgeon can also check and remove some lymph nodes through the laparoscope.

• Robotic hysterectomy. This is a lot like laparoscopic-assisted hysterectomy. But robotic technology is used to magnify the area and control the surgical tools. This helps the surgeon be more precise. 

Bilateral salpingo-oophorectomy

This surgery may be done along with the hysterectomy. The surgeon takes out both ovaries and both fallopian tubes. Most women with uterine sarcoma also need this surgery. The surgeon takes these organs out at the same time as the hysterectomy is done. Taking out your ovaries removes the main source of hormones that can make certain kinds of cancer cells grow.

Radical hysterectomy

This surgery is not often done but may be used for women whose cancer has spread to the cervix or the tissue around the uterus called the parametrium. It might also be done if you have certain types of uterine sarcoma. If you have this surgery, your surgeon will likely make a cut through your belly (abdominal incision). But it can be done through the vagina or using a laparoscope. In some places, newer robotic technology can be used to do the surgery.

During this surgery, the surgeon takes out these organs:

• Uterus

• Tissues next to the uterus (the parametria and uterosacral ligaments)

• Cervix, which connects your vagina to your uterus

• Upper part of your vagina

• Some nearby lymph nodes, for most women

• Both ovaries and fallopian tubes, for some women

Lymph node removal

If your healthcare provider thinks there's a risk that the cancer has spread, the surgeon will likely take out lymph nodes near your uterus. This lets your healthcare team check the lymph nodes for cancer cells. Cancer cells found in the lymph nodes means that cancer has spread outside the uterus. This information helps your healthcare provider plan any other treatment you might need. Lymph nodes are often removed at the same time as the hysterectomy.

Fluid removal during surgery

During any of these procedures, your surgeon may also do a pelvic washing. This is when Saltwater (saline) is used to wash out your abdomen and pelvis. The fluid is then collected and sent to a lab where it's checked to see if there are cancer cells in it. This helps your healthcare providers plan your treatment.

Risks of surgery for uterine sarcoma

All surgery has risks. The risks of uterine sarcoma surgery depend on the type of surgery done and can include:

• Excess bleeding

• Infection

• Damage to nearby organs

• Bulging of organs under the incision (hernia)

• Medical complications, such as heart attack, stroke, pneumonia, or blood clots

• Menopause, if bilateral salpingo-oophorectomy is done

• Swelling in the legs (lymphedema) if lymph nodes are removed

Your risks depend on your overall health, the exact type of surgery you need, how it's done, and other factors. Talk with your healthcare provider about which risks apply most to you.

It's important you know that you will not be able to get pregnant or carry a baby after a hysterectomy.

Making a decision

Your healthcare team will talk with you about the surgery choices that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:

• What type of surgery will be done?

• What will be done during surgery?

• Will lymph nodes be removed?

• What are the risks and possible side effects of the surgery?

• How long will I need to be in the hospital?

• When can I return to my normal activities?

• Will the surgery leave scars and what will they look like?

• How will surgery affect my sex life?

Getting ready for your surgery

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, prescription medicines, vitamins, herbs, and other supplements. It also includes marijuana and street drugs. This is to make sure you’re not taking anything that could affect the surgery or the anesthesia. After you have discussed all the details with the surgeon, you will sign a consent form that says that the healthcare provider can do the surgery.

You’ll also meet the anesthesiologist or nurse anesthetist. You can ask questions about the anesthesia and how it will affect you. On the day of your surgery, an anesthesiologist or a nurse anesthetist will give you medicine to put you to sleep. The medicine, called anesthesia, also makes sure that you won’t feel pain during the surgery. The anesthetist or anesthesiologist checks you during the surgery to be sure you stay healthy and comfortable.

After your surgery

You may have to stay in the hospital for several days, depending on the type of surgery you had. For the first few days after surgery, you will likely have pain from the incisions. Your pain can be controlled with medicine. Talk with your healthcare provider about your choices for pain relief. Some people don’t want to take pain medicine. But it can help your healing. If you don’t control pain well, for example, you may not want to cough or get up very often, which you need to do as you recover from surgery.

If you have a radical hysterectomy, you will likely have a urinary catheter for a few days. This a soft tube put through your urethra and into your bladder. Your urine flows into a bag outside your body. In some cases, you may go home with the catheter still in.

It's normal to take a few weeks to feel better after surgery. Here are some of the things you may experience during your recovery:

• Pain at the incisions

• Tiredness

• Vaginal discharge or slight bleeding

• Trouble urinating or having bowel movements

• Vomiting

Your healthcare team can treat you for these problems and help you learn how to cope with them.

Follow-up care

You may need radiation or chemotherapy or both after you heal from surgery. Your healthcare provider will talk with you about this or any other treatments that could help reduce the risk of the cancer coming back.

When to call your healthcare provider

Let your healthcare provider know right away if any of the following occur:

• Bleeding

• Redness, swelling, or fluid leaking from the incision

• Changes in bladder function or trouble passing urine

• Nausea or vomiting

• Constipation or diarrhea

• Incision opens up or the edges pull apart

• Increase in pain

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Chills

• Swelling, pain, warmth, or redness in your leg

• Chest pain or trouble breathing

Before you leave the hospital or surgical center, make sure you know how to check for signs of a serious problem. The type of procedure you have will determine how long it takes for you to return to normal activities after surgery. Make sure you know when to call your healthcare provider after surgery and know how to reach them any time.