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Gynecology |
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Hysterectomy (Uterus Cancer)
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What is Hysterectomy (Uterus Cancer)?
A hysterectomy is the removal of a woman's uterus. In some
case, the ovaries and fallopian tubes are also removed.
How is it conducted?
A hysterectomy is removal of the uterus and sometimes other
reproductive organs via surgical extraction. Patients with cancer of the
uterus, endometriosis, fibrosis, or severe menstrual irregularities can benefit
from a hysterectomy.
There are many types of hysterectomies, but the two primary
categories are abdominal and vaginal. In an abdominal hysterectomy, an incision
is made either horizontally, from the naval to the pubic area, or vertically
along the bikini line. Vaginal hysterectomies involve internal access of the
uterus through the vagina.
A partial hysterectomy is removal of the uterus. Whole hysterectomy refers to
extraction of the uterus and cervix, and radical hysterectomy is the removal of
part of the upper vagina, lymph nodes, uterus, and cervix. A patient's doctor
will consider the reasons behind the surgery to determine the best procedure
for each patient.
What should I do if I am told I need a hysterectomy?
- talk to the doctor about options, and ask if there are other treatments
available.
- consider getting a second opinion.
- ask about possible complications of a hysterectomy.
- be aware that every woman and every situation is different. One treatment
choice might be good for one woman and not the other.
What are other alternatives to a hysterectomy?
If cancer has been diagnosed, a hysterectomy might be the
only option. But if uterine fibroids, endometriosis or uterine prolapse has
been found, the following are other treatments that can be tried first.
- Drug therapy; certain medications that may lighten or
correct uterine bleeding that is not regular, also medications to help with
endometriosis.
- Endometrial ablation; this procedure might ease symptoms of heavy or
irregular uterine bleeding. A doctor uses electricity, heat or cold to destroy
the lining of the uterus and stop uterine bleeding.
- Uterine artery embolization; this treatment of fibroids involves blocking the
blood supply to tumors, which makes the fibroids shrink over time reducing pain
and heavy bleeding.
- Myomectomy; treatment of fibroid tumors, surgically removing the tumors while
leaving the uterus intact. (There is a risk that tumors may return).
- Vaginal pessary; for the treatment of pelvic organ prolapse, an object is
inserted into the vagina to hold the womb in place. It is used as a temporary
or permanent form of treatment.
Why do women have hysterectomies?
Hysterectomies are used to treat fibroids, endometriosis,
uterine prolapse, cancer, persistent bleeding and chronic pelvic pain.
What are the different types of hysterectomies?
Abdominal hysterectomy; involves a 3.9 - 5.9 inch incision
in the abdomen. The incision could be horizontal (under the pubic hair line) or
vertical (between the pubis and navel). This makes it easier for the surgeon to
easily reach the uterus and fallopian tubes. This leaves a visible scar and
requires several days' hospital stay.
Vaginal hysterectomy; involves a small incision in the rear
of the vagina, where the uterus is removed. This procedure is mostly used in
cases of uterine prolapse. It does not leave a visible scar and requires only a
short hospital stay.
Vaginal hysterectomy with laparoscope; involves between 2
and 4 small incisions into the abdomen in which a laparoscope is inserted.
Using the laparoscope, the surgeon disconnects the uterus and then removes it
following the same procedure as vaginal hysterectomy. It requires a short
hospital stay and small visible scars.
Why would I consider a subtotal (partial)
hysterectomy rather than a total hysterectomy?
A subtotal is often faster and associated with fewer
surgical complications and a more rapid return to normal activities. Also,
there is evidence to suggest that with a subtotal, there is less disruption of
the pelvic floor, therefore resulting in less pelvic prolapse reducing the need
for additional surgery in the future. The cervix may also play a role in female
orgasm, which is why many women request a subtotal hysterectomy.
What are the main short-term risks an complications
of a hysterectomy?
- serious infections may occur requiring a return to the
hospital and treatment with antibiotics.
- urinary problems from a kidney or bladder infection to urinary incontinence
(greater risk for radical hysterectomies).
- hemorrhaging that may require blood transfusions.
- severe reactions to the anesthesia.
- intestinal problems if intestines were damaged during surgery; some women may
have to undergo another operation to remove any obstruction blocking their
intestines.
What are the main long-term risks and complications
of a hysterectomy?
- Prolapse; which is the descent of an organ down-wards.
When the uterus is removes, other organs, such as intestines and bladder can
descend toward the bottom and lead to problems of constipation and/or urinary
incontinence. These types of prolapse may also lead to pain during sexual
penetration.
- Menopause; when the ovaries are removed during a hysterectomy it sharply
reduces the quantity of hormones circulating in the blood. Following this type
of surgery, women who are not menopausal will experience surgical or sudden
menopause. Menopausal symptoms are then felt. Main menopause symptoms are heat
flashes; vaginal dryness; fatigue; night sweats, irritability; insomnia;
migraines; increased risk of osteoporosis and heart disease.
Note: even if the ovaries are not removed, some women may be
menopausal following their hysterectomy. In these cases, menopause is caused by
a decrease in the amount of blood being fed into the ovaries preventing them
from producing enough hormones.
- Sadness/mourning may occur with some women, losing their
uterus is a sad and upsetting event. Self-image as women may be affected
following the operation. They become depressed and experience a period of
mourning, especially if they had wanted to become pregnant one day in the
future. The emotions experienced after a hysterectomy can also have a
physiological cause. Removing the ovaries causes a drop in the hormone levels,
which can provoke behavioral changes: irritability, crying fits, insomnia, etc.
If this is your case, support from friends, family, a health professional or a
support group can help you go through this period of change and adaptation.
It is important to mention that, for some women hysterectomy
will be a positive experience since the benefits far outweigh the complications
from the operation.
Can I have other another surgery performed at the
time of a laparoscope hysterectomy?
Yes. Women may elect to have another elective surgery
performed in combination such as liposuction, gallbladder removal and breast
implants.
How long does it take to recover from a
hysterectomy?
Recovering from a hysterectomy usually takes 1 to 2 days in the hospital
for post surgery care;
For abdominal, complete recovery usually takes 4 to 8 weeks,
being able to gradually increase your activities.
For vaginal or laparoscope, most women are able to return to
normal activity in 1 to 2 weeks.
For both procedures, by the 6th week, most women should be
able to take tub baths and resume sexual activities.
What are the post operative cares?
Immediately following surgery, a hysterectomy patient will
experience bleeding and discharge. Pads should be worn and changed regularly to
deter infection. Medication may be prescribed for pain, and patients will be
tired after surgery. Patients should abstain from heavy lifting for 6 weeks.
Light activities can resume in 2 to 4 weeks.
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