Gynaecological Cancer Surgery

Gynaecological cancer surgery spans several different operations on the uterus, cervix, ovaries and surrounding tissue, and the one planned for you follows from where the disease sits and how far it has gone.

The common core is removal of the uterus together with the fallopian tubes and, usually, the ovaries. Where the cervix is involved, a radical hysterectomy takes the supporting tissue on either side and the upper part of the vagina as well, and it works close to the ureters and the nerves of the bladder. Where the ovaries are involved, the aim is to remove all visible disease, which can mean taking the fatty apron over the intestines, sampling or removing lymph nodes, and operating on the surfaces of the abdomen and diaphragm; the completeness of that removal is one of the strongest influences on the outcome.

The route is chosen with the same care as the extent. Keyhole and robotic approaches give a faster recovery and are standard for many uterine operations; an open cut up the middle of the abdomen is used where the surgeon needs full access to the upper abdomen. Chemotherapy is given before surgery in some situations to make a complete removal achievable, and the sequence is decided by a multidisciplinary team.

You are admitted the day before or on the morning of surgery, with a bowel preparation in some cases. Blood is cross-matched where significant bleeding is possible.

The operation is under a general anaesthetic. A straightforward keyhole hysterectomy with node sampling takes two to three hours; a radical hysterectomy or extensive ovarian surgery takes four hours or more. A catheter drains your bladder during and after the operation, and after a radical hysterectomy it commonly stays for several days to a week while bladder function returns.

You wake on the ward, or in a high-dependency bed after a longer operation. Sips of water start the same day and food follows as soon as the bowel wakes up. You will be helped out of bed on the first day. A keyhole operation usually means one to two nights; open surgery means four to seven.

After keyhole surgery most women are comfortable within a week or two and back at desk work at three to four weeks. After open surgery expect six to eight weeks, and longer after extensive ovarian surgery.

Nothing in the vagina for six weeks: no intercourse, no tampons, and no swimming, while the top of the vagina heals. Light vaginal bleeding and discharge for up to six weeks is expected. No heavy lifting for six weeks; driving once you can brake hard without hesitation, usually two weeks after keyhole surgery and four after open.

If your ovaries were removed and you had not yet reached the menopause, it begins immediately and abruptly, with hot flushes, poor sleep, mood change and vaginal dryness that arrive within days. This is more intense than a natural menopause and it is treatable; whether hormone replacement is appropriate depends on the type of disease and is a specific conversation to have with your specialist before surgery. Bone density and cardiovascular risk need attention from then on. The laboratory report comes back in a week to ten days and decides whether further treatment follows.