Health – A Weekly column prepared by Dr. Balwant Singh’s Hospital Inc.
By Dr Madhu Singh (Consultant Obstetrician/Gynaecologist)
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 offered a radical hysterectomy. This is different 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 first (please see diagram).
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.
What are the benefits
of this operation?
The aim of the operation is to remove all the cancer so that we can assess the extent of the disease. This is known as staging. This will enable the surgical team to know whether further treatment is recommended.
The operation
What is removed during the
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 there be a scar?
Yes, although it will fade. The gynaecologic 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 which should be
done to prepare for the 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.
Remember, radical hysterectomy is not the same as a simple hysterectomy. It is a very complex surgery performed in the most inaccessible areas of the woman’s abdomen, which is not fraught with danger. Most of the time, a simple hysterectomy is not even possible in cases of cervical cancer.
With regard to the cost of the surgery, a radical hysterectomy costs much more than a simple hysterectomy. A repeat surgery for subsequent post-operative problems or additional treatment in the form of radiation therapy could further add to the cost of treatment.
What happens after the 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. 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 fluids 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 fluid 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 14-28 days.
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.
You may also have trouble opening your bowels or have some discomfort due to wind for the first 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 the operation?
You can expect to be extremely sleepy or sedated for the first few hours. This will allow you to rest and recover. An epidural catheter is inserted in your back for pain relief. 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.
You will be encouraged to do gentle leg and breathing exercises to help your circulation and prevent a chest infection.
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 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 first 2 years, then every 6 months up to 5 years, and then every year up to 10 years after your operation.
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. The usual residual tumour is amenable to a lower dose of radiation therapy along with chemotherapy.