Surgery
for radical hysterectomy - Information for patients and carers
Radical Hysterectomy - Information for patients and carersContents
If you have recently been diagnosed with cancer of the cervix
or uterus, it is normal to experience a wide range of emotions.
For some women, it can be a frightening and unsettling time.
Whatever you may be feeling at present, try talking about it with
someone who specialises in dealing with this condition such as
your consultant or the gynaecological cancer nurse specialist. They
will listen, answer any questions you may have and can put you
in touch with other professionals or support agencies if you wish.
Some useful contact numbers are also listed at the back of this
booklet.
This booklet has been written to help
answer some of the questions you may
have about radical hysterectomy.
What is a radical hysterectomy and
why is it necessary?
Women with cancer of the cervix (neck of the womb) or uterus (womb)
may be off ered a radical hysterectomy. This is diff erent from a ‘simple’
hysterectomy because not only are the cervix, uterus and fallopian tubes
removed, but also the top 2-3 cm of the vagina and the tissues around
the cervix. The pelvic lymph glands will also be removed at this time
because the cancer can spread to these glands fi rst (please see diagram).
The doctor will discuss with you whether it is necessary to remove your
ovaries as well.
The aim of the operation is to remove all of the cancer. If there is
any evidence that the cancer has spread, or if the results of the
operation suggest that you may be at increased risk of recurrence
of the cancer (your cancer returning), you may be offered further
treatment such as radiotherapy or chemotherapy. This will be
discussed with you when all of your results are available.
Agreeing to treatment
Consent to treatment
The doctors and nurses will discuss the treatment that has been
recommended for you and will explain how it will aff ect you. Once you
have had all your questions and concerns answered to your satisfaction,
we will then ask you to sign a consent form giving your permission for
the operation to proceed.
What are the benefits of this operation?
The aim of the operation is to remove all the cancer and so that we can
assess the extent of the disease. This is known as staging. This will enable
the team to know whether further treatment is recommended.
Are there any alternatives to this operation?
Yes, but these vary from patient to patient. The cancer team will discuss
the options available to you. The options will depend on the stage of
your disease. For some women the options are:
- Radiotherapy is as effective as surgery in women with cervical
cancer. This tends to be off ered to women with a larger tumour or
women who are not medically fi t enough to have major surgery. Chemotherapy is often given in combination with the radiotherapy.
- Radical trachelectomy is surgery which can be carried out if the
tumour is very small and is defi nitely confi ned to the cervix. It should
be considered only if you have a strong desire to maintain your
fertility.
What happens if I have no treatment?
Your wishes about treatment will be respected at all times by your
medical team. If you choose not to have treatment, your cancer will
progress and your health is likely to deteriorate.
At this time you may wish for us to transfer your care to the Palliative
Care Team, who will discuss with you what will happen next and help
you to manage your symptoms and support you.
Are there any risks?
As with any operation there are risks but it is important to realise that the
majority of women do not have complications.
There can be risks associated with having a general anaesthetic and
major abdominal surgery. The risks include:
- Bruising or infection in the wound. Internal bruising and infection
may also occur. A blood transfusion is often needed to replace blood
lost during the operation. Very occasionally, there may be internal
bleeding after the operation, making a second operation necessary.
- Blood clots in the leg or pelvis (deep vein thrombosis or DVT). This
can lead to a clot in the lungs (pulmonary embolus). Moving around
as soon as possible after your operation can help to prevent this.
We will give you special surgical stockings (known as ‘TEDS’) to
wear whilst you are in hospital and injections to thin the blood. The
physiotherapist will visit you and show you some leg exercises to help
prevent blood clots.
- Your bladder and bowels may take some time to begin working
properly after your operation. Some women have loss of feeling in the
bladder that may take some months to get better. During this time, you may need to take special care to empty your bladder regularly.
Occasionally, a hole may develop in the bladder or in the tube
bringing urine to the bladder (ureter). If this happens it is generally
identified at the time of surgery. If not, it results in leakage of urine
into the vagina. The hole may close without surgery, but another
operation may be necessary to repair this.
Are there any long term complications?
The skin around the wound is usually numb for several months until
the small nerves damaged by the incision grow back. Sometimes the
numbness may aff ect the tops of the legs or the inside of the thighs. This
should get better in 6-12 months.
There is a small risk of swelling, called lymphoedema, of the legs or lower
abdomen. If this occurs please tell your GP or cancer team. Normally,
lymphatic fluid circulates throughout the body draining through
the lymph glands. The pelvic lymph glands are removed during the
operation to prevent the spread of cancer cells. The lymphatic system
may then become blocked, resulting in a build up of fluid in one or
both legs or in the genital area. Preventative measures can be taken to
reduce the risk of it developing and you will be given information about
this. However, if you do develop lymphoedema the problem can be
treated and you will be referred to a specialist to manage the swelling.
Some women have problems emptying the bladder after surgery.
This usually settles with time but a small number will have long term
problems. Occasionally it is necessary to show you how to put a catheter
tube into the bladder to make sure it is emptying completely. This does
not mean wearing a catheter permanently and is known as intermittent
self catheterisation. It aff ects only about 1 in 50 of women having radical
hysterectomy.
Will this operation affect my fertility?
At any age, having your womb and/or ovaries removed can affect the
way you feel about yourself. A hysterectomy will prevent you carrying
a pregnancy in the future, and removing your ovaries will bring on an
early menopause. The loss of fertility can have a huge impact if you
have not started or completed your family and you have an operation
that takes that choice away. You may want to make sure that you have
explored all your options. It is important that you have the opportunity
to discuss this and how you feel about it with the gynaecological cancer
nurse specialist before your operation. She or he will continue to offer
you support when you are recovering from the operation. Advice is also
available from the specialist fertility team.
Will my ovaries continue to produce eggs?
Yes, if you still have your ovaries after the operation. As you will have had
a hysterectomy, you will not menstruate (have periods) each month and
so the eggs will be absorbed harmlessly by your body.
Will I need Hormone Replacement Therapy
(HRT)?
You may need HRT if you have both your ovaries removed and have
not already been through the menopause. HRT is available in many
forms – as an implant, patches (similar to a nicotine replacement patch),
tablets, gels, sprays and vaginal creams. There are also alternative
ways of managing the potential symptoms. Please discuss the options
available to you either with the gynaecological oncology team before
you are discharged from hospital, or with your GP. You can also contact
the gynaecological cancer nurse specialist for further information or
advice.
The operation
What is removed during my operation?
- Cervix (neck of the womb)
- Uterus (womb)
- Fallopian tubes
- Top 2-3 cm of the vagina
- Pelvic lymph glands
- In some cases, the ovaries
Will I have a scar?
Yes, although it will fade. The surgeon will either make an incision (cut)
across your tummy just above your pubic hair or a vertical incision down
your tummy, see diagram. The wound will be closed together using
either sutures (stitches) or clips.
There will be an internal scar at the top of your vagina where your cervix
has been removed. This will heal over time.
Is there anything I should do to prepare for my operation?
Yes. Make sure that all of your questions have been answered to your
satisfaction and that you fully understand what is going to happen to
you. You are more than welcome to visit the ward and meet the staff
before you are admitted to hospital. Just ask the gynaecological cancer
nurse specialist to arrange this for you.
If you are a smoker, it would benefi t you greatly to stop smoking or cut
down before you have your operation. This will reduce the risk of chest
troubles as smoking makes your lungs sensitive to the anaesthetic. If you
need further information about stopping smoking please contact your
GP or the NHS Smoking Helpline on 0800 169 0 169. A specialist adviser
is available everyday from 7am to 11pm.
You should also eat a healthy diet. If you feel well enough, take some
gentle exercise before the operation as this will also help your recovery
afterwards. Your GP, the practice nurse at his/her surgery or the doctors
and nurses at the hospital will be able to give you further advice.
Before you come into hospital for your operation, try to organize things
ready for when you come home. If you have a freezer, stock it with easyto-prepare food. Arrange for relatives and friends to do your heavy work
such as changing your bedding, vacuuming and gardening and to look
after your children if necessary. You may wish to discuss this further with
the gynaecological cancer nurse specialist.
If you have any concerns about your fi nances whilst you are
recovering from your operation, you may wish to discuss this with the
gynaecological cancer nurse specialist. You can do this either before you
come into hospital or whilst you are recovering on the ward.
What tests will I need before my operation?
Tests will be done to ensure that you are physically fi t for surgery and
help your doctor to choose the most appropriate treatment for the type
and extent of your disease. Recordings of your heart (ECG) may be taken
as well as a chest x-ray. An MRI or CT scan of your pelvis and abdomen
will be needed. A blood sample will also be taken to check that you are
not anaemic and to identify your blood group in case you need a blood
transfusion.
You will also have the opportunity to ask the doctor and the
gynaecology cancer nurse specialist any questions that you may have. It
may help to write them down before you come.
Why do I need to attend the pre-operative
clinic?
Before your admission to hospital, you will be asked to attend the
pre-operative clinic to make sure that you are fi t for the operation.
During this visit the staff will discuss your operation with you and what
to expect afterwards. You will have the opportunity to ask any questions.
Your temperature, pulse, blood pressure, respiration rate, height, weight
and urine are measured to give the nurses and doctors a base line
(normal reading) from which to work.
When will I come in for my operation?
You will be admitted to the ward the day before your operation. The
ward administrator or one of the nurses will greet you and show you to
your bed. If your bed is not ready, you will be given a seat on the ward
until it becomes available.
You will meet the ward nurses and doctors involved in your care. The
anaesthetist may visit you to discuss the anaesthetic and to decide
whether you will have a ‘pre-med’ (tablet or injection to relax you) before
you go to the operating theatre. Any further questions you have can
also be discussed at this time.
What happens on the day of my operation?
You will not be allowed to have anything to eat or drink (including
chewing gum or sweets) for a number of hours before your operation.
Each hospital has slightly diff erent fasting times and the ward staff will
tell you more about this.
Before going to the operating theatre, you will be asked to take a bath
or shower and change into a theatre gown. All make-up, nail varnish,
jewellery (except your wedding ring), dentures and contact lenses must
be removed.
After the operation
What happens after my operation?
After your operation you will wake up in the recovery room before
returning to the ward. You may still be very sleepy and be given oxygen
through a clear face mask to help you breathe comfortably immediately
after your operation. To allow your abdomen to recover from surgery
you will not have anything to eat or drink except for a few sips of water
until the next day. An intravenous infusion also known as a ‘drip’ will be
attached to your hand or arm to give you fl uids and prevent dehydration
for the next 24-48 hours.
You may also have a drain (tube) in your wound which is inserted during
your operation. This is so that any blood or fl uid that collects in the area
can drain away safely and will help to prevent swelling. The drain will be
removed when it is no longer draining any fluid which could take several
days.
During your operation a catheter (tube to drain urine away) will be
put into the bladder. As the bladder is positioned close to the cervix,
uterus and vagina, where the surgery has taken place, the catheter will
allow the area to recover and heal. The catheter will need to stay in for
approximately 5-10 days. Once it has been removed we need to make
sure that you have emptied your bladder completely. We can do this by
inserting another small catheter or by scanning your bladder to see if it is
completely empty.
Occasionally, the catheter will need to remain in place for a little longer
or you may need to insert the catheter at regular intervals (known as ‘intermittent self catheterisation’) to enable your bladder to return to
working normally. This varies from woman to woman and will not
necessarily prevent you from going home. If needed, a district nurse can
visit you at home to help you care for your catheter.
You may also have trouble opening your bowels or have some
discomfort due to wind for the fi rst few days after the operation. This
is temporary and we can give you laxatives and painkillers if you need
them.
How will I feel after my operation?
You can expect to be extremely sleepy or sedated for the first few hours.
This will allow you to rest and recover. Please tell us if you are in pain
or feel sick. We have tablets/injections that we can give you as and
when needed, so that you remain comfortable and pain free. You may
have a device that you use to control your pain yourself. This is known
as a PCA (Patient Controlled Analgesia) and the staff will show you how
to use it. Alternatively, an epidural may be inserted in your back for pain
relief. The anaesthetist will discuss these choices (PCA or an epidural)
with you before surgery.
You may have some vaginal bleeding or a bloodstained discharge but
this does not usually last for more than a few days. The wound will have
a dressing on it to keep it clean and dry. Depending on the type of
incision used, the sutures or clips will be removed 5-10 days later.
We will encourage you to do gentle leg and breathing exercises to help
your circulation and prevent a chest infection.
Is it normal to feel weepy or depressed
afterwards?
Yes. It is a very common reaction to your operation. Also sometimes
being away from your family and friends can make you feel weepy. If
these feelings persist or develop when you leave hospital, the advice
and support of your friends, family, GP, or gynaecological cancer nurse
specialist may help. There are also a number of local and national
support groups. (See page 21).
Leaving hospital and coping at home
When can I go home?
You will usually be in hospital between 5 and 14 days, depending on the
type of operation you have had, your individual recovery, how you feel
physically and emotionally and the support available at home. This will
be discussed with you before you have your operation and again whilst
you are recovering.
When can I get back to normal?
It is usual to continue to feel tired when you go home. It can take up to 3
months to fully recover from this operation, sometimes longer, especially
if you need further treatment following surgery. However, your energy
levels and what you feel able to do will usually increase with time. This
is individual, so you should listen to your body’s reaction and rest when
you need to. This way, you will not cause yourself any harm or damage.
Avoid lifting or carrying anything heavy (including children and
shopping). Vacuuming and spring-cleaning should also be avoided for
at least 6 weeks after your operation.
Rest as much as possible, gradually increasing your level of activity.
Continue with gentle activities such as making cups of tea, light dusting
and washing up. Generally, within 3 months you should be able to
return to your normal activities but you can discuss this further on your
return to the follow-up clinic.
When can I start to drive again?
We advise you not to drive for at least 6 weeks after your operation.
However, this will depend on the extent of your surgery and your
individual recovery. You will be able to discuss it further with your doctor
at your follow-up appointment.
We advise you to contact your car insurers for advice on driving
following major abdominal surgery.
When can I return to work?
This will depend upon the type of work you do, how well you are
recovering and how you feel physically and emotionally. It also depends
on whether you need any further treatment, such as radiotherapy, after
your operation.
Most women need approximately 2-3 months to recover but remember
that the return to normal life takes time. It is a gradual process and
involves a period of readjustment and will be individual to you. You can
discuss this further with your doctor, gynaecology cancer nurse specialist
or GP.
What about exercise?
It is important to continue doing the exercises shown to you by the
physiotherapist for at least 6 weeks after your operation. Ideally, you
should carry on doing them for the rest of your life, particularly the pelvic
floor exercises. Avoid all aerobic exercise, jogging and swimming until
advised, to allow the muscles cut during your operation to heal. The
physiotherapist or gynaecological cancer nurse specialist will be happy
to give advice on your individual needs.
When can I have sex?
After a radical hysterectomy for cancer, you may not feel physically or
emotionally ready to start having sex again for a while. We normally
advise women not to have sexual intercourse for 6 weeks following
surgery.
During this time, it may feel important for you and your partner to
maintain intimacy, despite refraining from sexual intercourse. However,
some couples are both physically and emotionally ready to resume
having sex much sooner and this can feel like a positive step. If you have
any worries or concerns, please discuss them with the gynaecological
cancer nurse specialist.
It can be a worrying time for your partner. He or she should be
encouraged to be involved in discussions about the operation and how
it is likely to aff ect your relationship afterwards.
If you do not have a partner at the moment, you may have concerns
either now or in the future about starting a relationship after having a
radical hysterectomy.
Please do not hesitate to contact the gynaecological cancer nurse
specialist if you have any queries or concerns about your sexuality,
change in body image or your sexual relationship either before or after
surgery.
Follow up treatments and
appointments
Will I need to visit the hospital again after
my operation?
Yes. It is very important that you attend any further appointments
arranged.
If the histology (tissue analysis) results from your surgery are not
available before you are discharged home, an early appointment for
the outpatient clinic will be made to discuss the results and any further
treatment options if necessary.
You will need to attend for regular follow-up appointments once your
treatment is complete. These follow up appointments will be arranged
for every 3-6 months for the fi rst 2 years, then every 6 months up to 5
years, and then every year up to 10 years after your operation. At these
appointments you will be seen by a member of the cancer team. This
may be a doctor or gynaecology cancer nurse specialist who works
closely with your consultant.
After your first follow up appointment, your subsequent appointments
will be at your local hospital if no further treatment is necessary.
Will I need further treatment?
You may need further treatment if cancer is found in the lymph glands or
close to the edge of the tissue removed. If the histology show that you
need further treatment, an appointment will be made with the clinical
oncology team to discuss this with you.
Should I continue to have cervical smears?
No, cervical smear tests are not necessary after this operation, as your
cervix will have been removed.
Why do I need to be followed up in the
clinic for so long after my operation?
By having frequent appointments during the fi rst 2 years any problems
can be detected early. On occasion, cervical cancer may return and
if this should happen it is usually within the fi rst 2 years after your
first treatment. These appointments are not only to look for medical
problems, a diagnosis of cancer can aff ect any aspect of your life. You
can discuss these issues with your gynaecology cancer nurse specialist.
What symptoms should I report or be
worried about?
If you have any of the following symptoms, please contact your
gynaecology cancer nurse specialist, GP, or hospital for an earlier
appointment:
- Bleeding or discharge from the vagina
- Lower tummy pain lasting for 2-3 weeks particularly if it keeps you
awake at night
- Swelling in one or both legs
After you have had treatment for cancer it can be a worrying time.
Please remember that you will have the same aches and pains that you
have always had. If you develop a new health problem, this may not be
related to your cancer and its treatment.
Staging of cervical cancer explained
The STAGE of a cancer describes its size and extent.
- Stage 1. The cancer cells are found only in the cervix.
- Stage 2. The cancer has spread into nearby organs and tissue, such as
the upper vagina or tissue next to the cervix.
- Stage 3. The cancer has spread further to the lower part of the vagina,
nearby lymph nodes, and / or tissue at the sides of the pelvis.
- Stage 4. The cancer has spread to the bladder or bowel and / or outside
the pelvic area. This stage includes cancer that has spread to the lungs,
liver or bone although these are less common.
Staging of womb cancer explained
The STAGE of a cancer describes its size and extent
- Stage 1 The cancer cells are contained within the lining of the womb or
the muscle of the womb.
- Stage 2 The cancer has spread to the cervix.
- Stage 3 The cancer has spread to the vagina, through the womb to the
outer edge of the womb and/or the lymph nodes.
- Stage 4 The cancer has spread to the bladder or bowel and / or outside
the pelvic area.
Grading of cancer explained
Tumour cells arise from normal cells within the body. If the tumour cells
are very similar to normal cells then the tumour is described as being
well differentiated or grade 1. If there is less similarity then the tumour
is described as being moderately differentiated or grade 2. If the
tumour bears little resemblance to the normal cell then the tumour is
described as being poorly diff erentiated or grade 3.
Contacts and further information
We hope that this booklet answers most of your questions but, if you
have any further queries or concerns, please do not hesitate to contact
your key worker or gynaecology cancer nurse specialist:
The Christie
- Helen Savage
- 161 446 8235
- Ward 10
- 0161 446 3860
Hope Hospital
- Annette Halliwell
- 0161 206 5284
- Eric Rawlings Ward
- 0161 206 5265
St Mary’s Hospital
- Jo O’Neill
- Amanda Storey
- Jane Jones
- Anne Lowry
- Jo Wlson
- 0161 276 6394
- Ward SM9
- 0161 276 6329
- Ward 10
- 0161 276 6006
Wythenshawe
Hospital
- Margaret Ryan
- 0161 291 5963
- Ward C1
- 0161 291 5060
Fairfield Hospital
Leighton Hospital
Macclesfield
Hospital
North Manchester
General Hospital
Oldham Hospital
- Amanda Storey
- 0161 778 5670
Rochdale Infirmary
Royal Bolton
Hospital
- Kae McGuinness
- 01204 390 003
Stepping Hill
Hospital
Tameside Hospital
- Michelle Eckersley
- 0161 331 6961
Trafford General
Hospital
- Gynaecology Unit
- 0161 746 2177
Wigan and Leigh
Infirmary
- Julie Gaskell
- 01942 164694
Support groups and useful organisations
Cancerbackup
Bath Place,
Rivington Street,
London, EC2A 3JR
They provide information on all aspects of cancer and its treatment
and on practical and emotional problems of living with cancer.
Macmillan Cancer Support
89 Albert Embankment,
London SE1 7UQ
They provide specialist advice and support through Macmillan nurses
and doctors and fi nancial grants for people with cancer and their
families.
The Daisy Network
PO Box 183,
Rossendale, BB4 6WZ
They provide a support network for women who experienced a
premature menopause.
Jo’s Trust – Fighting Cervical Cancer
A charity dedicated to women, their families and friends affected by
pre-cancer and cancer of the cervix. Web-based support group.
The Lymphoedema Support Network
St. Luke’s Crypt,
Sydney Street,
London, SW3 6NH.
A charity that aims to ensure that every patient with lymphoedema
receives a correct diagnosis and suitable level of care.
Greater Manchester and Cheshire NHS Cancer Network website
Website with information on all aspects of cancer and support
available for people affected by cancer.
We hope that you have found this booklet
helpful. Please feel free to ask us any
questions you may have.
We have suggested below some questions
you may want to ask.
- How quickly will I be seen by the team who will do my operation?
- Will you let my GP know about my diagnosis?
- How soon will I have my operation?
- If I need chemotherapy or radiotherapy do I have to go to Christie
Hospital for this?
- Who will I contact if I have questions or concerns, once my
treatment has finished
Produced by
Greater Manchester and Cheshire Cancer Network - September 2007
Review date - September 2009
GYN03-09/2007