Helen F. Graham Cancer Center
Uterine Cancer and Treatment
When a woman faces a medical condition that affects her uterus, the hollow, muscular organ that holds and feeds a fertilized egg, the emotional impact can often be as challenging as the physical. These conditions include, but are not limited to, cervical and uterine cancers such as endometrial cancer, uterine fibroids, uterine prolapse, excessive bleeding and endometriosis.
Treatment options are as varied as the conditions themselves, depending on individual circumstances. A woman's age, health history, surgical history and diagnosis (benign or cancerous), all factor into the recommended course of action.
For endometrial cancer, also known as uterine cancer and more common among women after menopause, standard treatment options include hormone therapy, radiation therapy, chemotherapy and hysterectomy (surgical removal of the uterus). Three of these—radiation therapy, chemotherapy and hysterectomy—are also used to treat cervical cancer.
Physicians perform hysterectomy—the surgical removal of the uterus—to treat a wide variety of uterine conditions. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.
There are various types of hysterectomy that are performed depending on the patient's diagnosis:
- Supracervical hysterectomy: removes the uterus, leaves cervix intact.
- Total hysterectomy: removes the uterus and cervix.
Radical hysterectomy or modified radical hysterectomy: a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread).
Approaches to hysterectomy
Surgeons perform the majority of hysterectomies using an "open" approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6–12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.
A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient's condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.
In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.
While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy—including reduced risk for complications, a shorter hospitalization and faster recovery—there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
- A narrow pubic arch (an area between the hip bones where they come together).
- Thick adhesions due to prior pelvic surgery, such as C-section.
- Severe endometriosis.
- Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes.
With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.
Christiana Care Helen F. Graham Cancer Center
4701 Ogletown-Stanton Road, Newark, DE 19713 directions