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Surgery to remove the uterus is usually the first treatment offered by NYU Langone doctors to women with endometrial cancer. This approach allows the doctor to determine if the tumor has progressed beyond the uterus and surrounding structures, such as the fallopian tubes, ovaries, and lymph nodes.
Hysterectomy is a surgical procedure to remove the uterus. It is performed when a woman has tumors in the lining of the uterus.
For women who have tumors with a low risk of spreading, the surgeon may perform a partial hysterectomy, which involves removing the cervix, uterus, ovaries, and fallopian tubes.
For larger tumors that have spread to the cervix, the doctor may perform a more extensive procedure, known as a radical hysterectomy. During this surgery, the doctor removes the uterus, the cervix, the tissue surrounding the cervix, and the upper portion of the vagina. The surgeon usually removes the lymph nodes near the uterus as well.
Surgeons often perform a bilateral salpingo-oophorectomy during a hysterectomy for the treatment of endometrial cancer. This procedure involves removing and examining the ovaries and fallopian tubes, which carry eggs to the uterus. This helps to ensure the cancer has not spread to these organs.
Removing the ovaries and the eggs they contain causes immediate menopause. Doctors at NYU Langone can help you manage the symptoms of menopause, such as hot flashes and a decline in libido, with medications or integrative therapies.
Women who have a hysterectomy with or without bilateral salpingo-oophorectomy cannot become pregnant. For women who want to have children, our doctors may recommend less extensive surgery combined with medication or other treatments.
In addition, our doctors can refer you to reproductive medicine specialists at NYU Langone’s Fertility Center and NYU Langone Reproductive Specialists of New York. They can offer strategies to help women of childbearing age preserve their fertility during cancer treatment.
During a hysterectomy, the surgeon may also perform a lymphadenectomy procedure. In this procedure, the surgeon removes pelvic lymph nodes—small immune system glands that filter bacteria and viruses—that contain cancer cells.
For women with small tumors that have not progressed too far into the endometrium, the surgeon may first perform a procedure called sentinel lymph node mapping to find out if the cancer has spread to nearby lymph nodes.
The doctor injects a small amount of radioactive material or dye, called a tracer, into the cervix. The tracer travels through the lymphatic system toward the lymph node or nodes where cancer is most likely to spread. These are called the sentinel lymph nodes.
A CT scan is then performed so that the doctor can visualize the sentinel nodes. He or she removes these to see if they contain cancer. If they don’t, there is no need to remove additional lymph nodes.
If you have a large tumor that has invaded the uterine muscle more deeply, our doctors may remove a larger number of lymph nodes to prevent the cancer from spreading.
Whenever possible, surgeons at NYU Langone use minimally invasive techniques to treat women with endometrial cancer. Most endometrial cancers are removed using a minimally invasive approach. These procedures can reduce scarring and the risk of complications, such as bleeding and postoperative pain. Minimally invasive surgery can also shorten recovery time compared with open surgery, which may require a hospital stay of several days.
With either approach, surgery is usually performed using general anesthesia. Epidural anesthesia, which blocks pain below the waist, is an option for women who have an open surgical procedure.
During laparoscopic surgery, the doctor inserts a laparoscope—a lighted metal tube with a camera at the end—into the abdominal cavity to view the uterus and other pelvic organs. With this visual guidance, the surgeon inserts surgical tools into a few small incisions in the lower abdomen to perform surgery.
Doctors at NYU Langone’s Robotic Surgery Center use a system that consists of tiny surgical instruments mounted on three robotic arms. A fourth arm contains a camera, which creates magnified, high-definition, three-dimensional images to guide the surgeon during the procedure.
The surgical tools and camera are inserted through small, quarter-inch incisions in the abdomen and pelvis. The surgeon controls these instruments and the camera using a computer.
Robotic surgery provides surgeons with a highly magnified view of the tumor and nearby organs, blood vessels, and nerves, enabling them to perform delicate procedures with great precision.
Open surgery involves making a vertical incision in the lower abdomen and pelvic area. This type of procedure may be necessary for women who have large tumors or scarring in the abdomen or pelvis from previous surgeries. Scarring can make it difficult to perform minimally invasive surgery.
Open surgery is also the preferred approach for women who have large fibroids in addition to endometrial cancer. Fibroids are noncancerous, but their size can make the uterus too large to remove using minimally invasive techniques.
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