Surgical Procedures: Surgical Staging for Endometrial Cancer

Author: OncoLink Team
Last Reviewed: January 19, 2018

Endometrial cancer spreads to other parts of the body through the lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread, and what treatment course will be recommended. Two staging systems are used to determine the stage of your cancer, the FIGO staging system (International Federation of Gynecology and Obstetrics) and the American Joint Committee on Cancer TNM staging system. Both of these staging systems will provide your healthcare team with information on the extent of the tumor (T), spread to the lymph nodes (N) and distant metastasis (spread) (M).

When evaluating the stage of endometrial cancer, terms such as local, regional or distant metastasis may be used. Local spread includes spread of the cancer to the cervix and other areas of the uterus. Regional metastasis describes disease spread to lymph nodes that are nearby in the pelvis and along the aorta (para-aortic lymph nodes). Distant metastasis includes disease spread to distant lymph nodes, upper abdomen, omentum (fatty tissue covering the abdominal organs) and to organs like the lung, liver, bone, and/or brain.

Often, it is recommended that women with stage I-III endometrial cancer have surgery. Often, a total hysterectomy with removal of the ovaries is suggested. Lymph nodes may also be removed. In some cases, chemotherapy and/or radiation may be used instead of surgery.

There are many types and methods of hysterectomy:

  • Total Hysterectomy: Removal the uterus and the cervix. In some cases, the ovaries and fallopian tubes will not be removed and will stay in place. 
  • Radical Hysterectomy: Removal of the uterus, cervix, tissue surrounding the cervix, and the upper part of the vagina. The fallopian tubes and lymph nodes may/may not also be removed.
  • Bilateral Salpingo-oophorectomy (BSO): Removal of the ovary and fallopian tube. During a bilateral procedure, both the left and right ovary and tube are removed. A unilateral procedure only removes one side.

A hysterectomy can be done in different ways:

  • Abdominal: An incision is made into the abdomen to remove the uterus.
  • Vaginal: An incision is made in the upper vagina, and the uterus is removed.
  • Laparoscopic: A laparoscope, a lighted tube with a camera, which allows the pelvic organs to be seen, is used. This procedure uses small incisions in the abdomen where the tools are inserted. 
  • Robotic: The surgeon controls a robotic arm to perform the surgery through small incisions.

What does debulking mean?

In some cases, a debulking procedure is used. “Debulking” removes as much of the cancer as is safely possible. This is done to reduce the amount of cancer, before radiation or chemotherapy.

What is recovery like?

Recovery from surgery for endometrial cancer will include a stay in the hospital for one to many days, depending on the type of hysterectomy you have had. You may have a bladder catheter in place for one to two days to drain your bladder of urine. You may need to go home with the catheter in place.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

Your healthcare provider will discuss your particular activity restrictions.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

  • Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

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