Uterine Cancer: Surgery

The treament for most women with endometrial cancer is surgery. Surgery typically consists of hysterectomy (removal of the uterus). Because the incidence of endometrial cancer is increasing in younger women, however, some fertility-sparing options are becoming more common.

Hysterectomy

The treatment for most women with endometrial cancer is surgery. Surgery typically consists of hysterectomy (removal of the uterus) often in conjunction with removal of the ovaries and fallopian tubes (salpingo-oophorectomy, and sampling of the pelvic and para-aortic lymph nodes (lymphadenectomy). The lymph nodes within the pelvis and the abdomen are often removed to ensure there has not been spread of the cancer beyond the uterus.  

Hysterectomy for endometrial cancer can be performed by a variety of different methods. Traditionally hysterectomy is performed through an incision on the abdomen (either a vertical or transverse incision). This type of hysterectomy, known as an abdominal hysterectomy, is still frequently performed in women in whom it is suspected that cancer has spread outside of the uterus.

More recently minimally invasive surgical procedures have been developed to perform hysterectomy and are now the preferred surgical approach in women with an apparent early cancer. During minimally invasive surgery a video camera is inserted into the abdomen and the abdomen filled with gas to facilitate the surgery. As opposed to one large incision, minimally invasive procedures are performed through multiple small incisions on the abdomen.

Minimally invasive hysterectomy can be performed either laparoscopically in which the surgeon directly controls the instrumentation or through a robotic-assisted approach in which a surgical robot is utilized to maneuver the instrumentation. The gynecologic oncologists at Columbia University are nationally leaders in the development and evaluation of minimally invasive surgery for uterine cancer and other gynecologic conditions.

Some women with endometrial cancer also have significant concurrent medical problems that make surgery unsafe and possibly not the best option for treatment. For these women treatment with radiation, sometimes in combination with chemotherapy, may be considered.

Fertility-sparing surgery

For some women endometrial cancer is diagnosed before the completion of child bearing. In some cases, these very early endometrial cancers uterine-preserving treatment with hormonal therapy may be appropriate. Similarly, for young women who have completed child bearing but are still remote from menopause, occasionally the ovaries can be preserved to avoid menopausal symptoms. The gynecologic oncologists at Columbia University have performed extensive, large scale studies examining the safety of these fertility conserving surgeries in young women with endometrial cancer.