Advanced search
 

 

Treatment | Surgery | Hysterectomy and oopherectomy

These FAQs about hysterectomy have been answered by women who have been through this surgery because of gynecologic cancer. For more information about hysterectomy, please visit our Web Resources page and Our Stories by cervical, endometrial, uterine, and ovarian cancer survivors treated with hysterectomy surgery.

 What are the different types of hysterectomies, and when are they used? How is the recovery time different for each?

 Why do some women go home from the hospital after a hysterectomy with a catheter?

 Is a horizontal or a vertical incision better for an abdominal hysterectomy ?

 Is a vaginal hysterectomy an option for cancer patients?

See also:

Preparing for hysterectomy:

 What questions should I ask my doctor about having a hysterectomy to treat my cancer?

 What can I do to make my hospital stay more comfortable?

 Why is bowel preparation necessary for abdominal surgery?

After hysterectomy:

 I've heard that some women get depressed after a hysterectomy. Is it true?

 Will I have problems with sex after a hysterectomy?

 What are the different types of hysterectomies, and under what circumstances are they used? How is the recovery time different for each?

 Georgia P., Massachusetts, USA: I had a TAH/BSO for my endometrial cancer, which means, in laymen's terms, that I had my cervix, uterus, ovaries and fallopian tubes removed. These initials stand for Total Abdominal Hysterectomy/Bilateral Salpingo-Oophorectomy. Removing the ovaries and fallopian tubes during a total hysterectomy is considered a TAH/BSO.

There are several hysterectomy options, including the removal of the uterus through the vagina (vaginal hysterectomy) and, more commonly used after a cancer diagnosis, the removal of the reproductive organs through an abdominal incision. The abdominal incision can be vertical or horizontal. For the best visual access to the entire area, the vertical incision is often the choice of a gynecological or surgical oncologist.

Reading more about hysterectomies (see sources below) I found that by definition, a "total hysterectomy" includes a) removal of the uterus, and b) severing (and removal of) the cervix and upper portion of the vagina (vaginal cuff). This causes shortening of the vagina, diminished elasticity and reduced lubrication. These books also noted that when they remove the cervix, a large portion of the uterovaginal plexus (interwoven network of blood vessels and nerves) goes too. Since most of the nerve supply to the uterus is concentrated in the cervical area, some sensory information the brain receives may be affected.

Lymph node dissection (or sampling) is another procedure used during hysterectomy to examine the lymph nodes for cancer; usually a quick visual and fast pathological examination will be done during surgery, followed by more comprehensive laboratory testing of the tissues.

Finally, a more extreme procedure is the radical hysterectomy which not only removes the cervix, but also any surrounding area affected by cervical cancer; the goal being clean margins (removing diseased tissue and a thin layer of non-diseased tissue, to insure removing all visible cancer).

The books which provided me with this information were:

Sex, Lies and the Truth about Uterine Fibroids: A Journey from Diagnosis to Treatment to Renewed Good Health by Carla Dionne, Exec. Director of the National Uterine Fibroids Foundation. Web site: http://www.uterinefibroids.com

For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life by Jennifer Berman, M.D., and Laura Berman, PH.D. Web site: Network for Excellence in Women's Sexual Health http://www.newshe.com/

 Karen, Alberta, Canada: I had a total abdominal hysterectomy (TAH) for stage 1A cervical cancer when I was thirty. They removed part of the top of the vagina as well (I think they called it a "vaginal cuff"). As my type of cancer is unlikely to spread to the ovaries, and as there is no history of ovarian problems in my family, and considering my age, my doctor suggested that I keep my ovaries to avoid a surgical menopause. I was in the hospital for one week due to complications - transfusions due to blood loss, and a fever. I continued to breastfeed my nineteen month old baby through my hospital stay, and also through the recovery period. I was told to avoid lifting for six weeks. I'm sure I was given more instructions than that, but that is the one thing that I was most worried about as I had two small children, and my husband could not take six weeks off work.

up arrow

 I need to have a hysterectomy to treat my cancer. What questions should I ask my doctor about my surgery?

 Carol F., Pennsylvania, USA: I know there are many, many more questions, but these are the ones that came immediately to mind:

1. Does your doctor have a specialty in Gynecologic Oncology?

2. What type of hysterectomy will I have? (radical, total, abdominal, vaginal, etc.) What are the pros and cons of each for my particular cancer?

3. How many times has your doctor done this type of procedure?

4. What is the doctor's experience with complications? What should you expect? (It's never fun to think that things can go wrong, but you need to know.)

5. Do you anticipate that I will need transfusions? If so, can family donate blood?

6. Is there anything you can do for me pre-surgically to help with anxiety (assuming that's a problem)?

7. How long will the surgery take?

8. Are you going to remove my ovaries? Do I have a choice? What are the pros and cons.?

9. Will I have a "Foley" catheter? This is a means of draining the bladder giving it time to rest while you recover. And, you can go home with it, if necessary. Actually, it sounds unpleasant, but is really, really helpful, as it allows you and your bladder time to get much needed rest.

10. Do you use drains and how do you decide? (I didn't have these, but I know some of the ladies have.)

11. Are you going to do "frozen sections" of nodes during the surgery and from where will the nodes be taken? What happens if one or more of these nodes is found to be positive?

12. Will this cause me to be at risk for lymphedema? If so, what steps can I take to avoid it?

13. What kind of impact will this surgery have on my bladder/bowel?

14. What happens to my vagina? How will the surgery effect me and my relationship with my husband?

15. What kind of pain relief will I have? There are various choices available.

16. How long will I be in the hospital? And, if I need to stay longer, how can that be arranged?

And, don't be afraid to seek a second opinion with another doctor before making a final decision.

up arrow

 I've heard that sometimes women go home from the hospital after a hysterectomy with a catheter. Why?

 Jax, Massachusetts, USA: While I didn't need to go home with the catheter, my gyn-oncologist told me it might be necessary. He explained that there is a lot of tugging, pulling, pushing and yes, cutting going on during the operation. Some bodies require a bit longer of an adjustment time before the bladder begins working on its own.

 Lola, Utah, USA: I went home with a supra pubic catheter.

I was told that the bladder needed time to stay empty and heal. I know they cut my bladder open at the top, like a top hat, and then closed it back up. The catheter afforded me the ability to stay in bed with the big bag to store urine - I liked not having to get up at night. I did get an infection from mine. The area around the catheter became very red and sore initially. I called and told the nurse, and she said it was normal to have redness and irritation there. But this was very sore, and then swollen. The day I went for my appointment, I could hardly walk. My right labia was swollen and red. It was twice the size of the left. My doctor could not understand why I waited so long!

 Karen, Alberta, Canada: With my total abdominal hysterectomy, I only had a catheter for about three or four days in the hospital. However, I had very little bladder sensation for several weeks after the surgery. I was advised to make sure I urinated regularly.

up arrow

 Which is better for an abdominal hysterectomy - a horizontal or a vertical incision?

 Georgia P., Massachusetts, USA: Speaking from an endometrial cancer point of view, a vertical incision is usually the most often used, in order to enable the surgeon to view the entire abdominal area and "stage" the cancer. Since endometrial cancer can invade the walls of the uterus, spreading to other organs, there is a need to inspect the organs in the entire pelvic and abdominal area, sample the lymph nodes and fluids, and manually inspect the intestines and bowels. This requires a good visual field and gives the patient the most reassurance that staging is accurate.

 Katie, California, USA: I had an horizontal incision for Stage 1B cervical carcinoma. As a surgical neophyte, I didn't even consider the angle of the incision...I just wanted the cancer out and assumed that the appropriate type of incision would be used. During surgery, grossly positive lymph nodes were encountered, and the hysterectomy wasn't completed. I ended up having an exploratory laparotomy, bilateral salpingo-oophorectomy (BSO), and pelvic and para-aortic lymphadenectomy through that horizontal incision.

 Karen, Alberta, Canada: With my early stage cancer, a horizontal incision was the preferred medical option. There was some talk about having a vaginal hysterectomy instead, but it was felt that the abdominal route was necessary because of the cancer.

up arrow

 Is a vaginal hysterectomy an option for cancer patients?

 Karen, Alberta, Canada: I asked my doctor about having a vaginal hysterectomy instead of an abdominal one; vaginal hysterectomy is a faster and less serious surgery, and the recovery time is much quicker and easier. My doctor did not recommend it - he said he preferred the abdominal approach so that he could take a better look around. However, as my cancer was diagnosed at a very early stage, he felt that a horizontal "bikini line" incision was adequate, and that he didn't need to do a larger, vertical incision.

Since then, though, I have heard of other women with early cancer having a vaginal hysterectomy - so I know that some doctors will consider it. As always, the more questions you ask, the better - and it's always a good idea to get a second medical opinion (and even a third), if that's what it takes to get all your questions answered.

up arrow