Surgical Procedures: Surgical Staging for Endometrial Cancer

Endometrial cancer can spread to other parts of the body through the lymph and blood systems. The stage of your cancer describes how extensive the cancer is, if and how far it has spread, and what treatment course is recommended. Two staging systems are used in staging endometrial cancer:

• The FIGO staging system (International Federation of Gynecology and Obstetrics). 
• The American Joint Committee on Cancer TNM staging system. 

Both staging systems use the letters TNM to describe the cancer::

• T: The size and local invasiveness of the tumor.
• N: Which, if any, lymph nodes are involved.
• M: If it has spread to other more distant areas of the body.

Terms such as local, regional or distant metastasis may be used to describe the cancer. 

• 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 (belly), omentum (fatty tissue covering the abdominal organs) and to organs like the lung, liver, bone, and/or brain.

It is often 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. The ovaries may be removed. 
• Radical Hysterectomy: Removal of the uterus, cervix, tissue surrounding the cervix, and the upper part of the vagina. The fallopian tubes, ovaries, 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 in the abdomen to remove the uterus.
• Vaginal: An incision is made in the upper vagina.
• Laparoscopic: Uses a laparoscope (a lighted tube with a camera) to see the pelvic organs. Small incisions are made 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?

“Debulking” removes as much of the cancer as is safely possible. This is done to reduce the amount of cancer before starting radiation or chemotherapy.

What is recovery like?

Recovery from surgery for endometrial cancer will include a stay in the hospital. How long you are there depends 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 talk with you about any changes you will need to make in your activity level.

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.