When you’re diagnosed with endometrial cancer, surgery is often the main treatment option. The most common type of surgery for endometrial cancer is a hysterectomy. There are different types of hysterectomies and other surgeries for endometrial cancer, and it can be overwhelming to figure out which one is right for you. In this article, we will break down the different types of hysterectomies to help you understand your treatment options.

What Is a Hysterectomy?

Endometrial cancer, also called uterine cancer, starts in the endometrium (inner lining of the uterus). To remove the cancer cells in the uterus, a hysterectomy is performed. A hysterectomy is a surgical procedure that removes the uterus and cervix. Sometimes, people with endometrial cancer may also need to have their ovaries, fallopian tubes, and lymph nodes removed.

Types of Hysterectomies

There are different types of hysterectomies. Your health care provider will determine the best type of hysterectomy or other surgical procedure for you based on the stage of your cancer.

1. Total Hysterectomy

A total hysterectomy removes the entire uterus and cervix. This is one of the most common procedures for early-stage endometrial cancer. Usually, the ovaries are not removed during this type of hysterectomy. However, for people with endometrial cancer, a total hysterectomy is often combined with additional procedures to remove the ovaries, fallopian tubes, or lymph nodes.

2. Radical Hysterectomy

A radical hysterectomy is a more invasive surgery and is less common. It is usually done for advanced endometrial cancer, for aggressive types of cancer, or when the cancer has spread beyond the uterus. During this procedure, the surgeon removes:

• The uterus
• Tissues around the uterus
• The cervix
• The upper part of the vagina

3. Subtotal (Partial) Hysterectomy

A subtotal (or partial) hysterectomy removes the uterus but leaves the cervix. This procedure is not recommended for endometrial cancer care because it may leave cancer cells behind. However, this procedure can also be used to treat noncancerous conditions, like uterine fibroids or endometriosis. A subtotal hysterectomy is strongly discouraged when a hysterectomy is being done to treat pelvic pain.

How Hysterectomies Are Performed

There are three common surgical approaches for hysterectomies. These methods are defined by how your surgical team decides to remove the uterus and other organs. When performing a hysterectomy, your surgeon can take the uterus and cervix out through either your abdomen (lower belly) or the vagina.

Abdominal Hysterectomy

An abdominal hysterectomy removes the uterus and cervix through a larger incision (cut) in the abdomen. This is called a simple or total abdominal hysterectomy. This traditional approach gives surgeons direct access to the pelvic organs. The surgery can be performed as an open surgery, by laparoscopy, or by robotic surgery. Both total and radical hysterectomies can be performed using this method.

Vaginal Hysterectomy

A vaginal hysterectomy removes the uterus through the vagina. This method is generally less invasive and leaves no external scars. This approach can also lead to shorter hospital stays and quicker recovery times. This type of surgery may also be a good option for people who aren’t healthy enough for more invasive surgeries.

Laparoscopic or Robotic-Assisted Hysterectomy

Minimally invasive procedures — such as laparoscopic or robotic surgery — use more advanced technology. In a laparoscopic hysterectomy, your surgical team will make small incisions in your abdomen to insert tubes. Through these tubes, they use specialized tools and a camera to perform the surgery.

Laparoscopic surgery can also be done robotically. In this case, robot arms are used instead of manual surgical tools. This is a more advanced and precise approach. This method results in less scarring and fewer complications and side effects. In some cases, laparoscopic surgery and robotic surgery can be done in an outpatient setting, allowing you to go home the same day.

Minimally invasive procedures are becoming more common in treating endometrial cancer. Both total and radical hysterectomies can be done using these methods.

Other Procedures Performed During Hysterectomies

In some cases, other surgical procedures are performed along with the hysterectomy. These procedures can improve outcomes and help treat more advanced cancers. The choice of additional procedures depends on your cancer stage, risk factors, and your overall health. Understanding these options can help you make informed decisions about your treatment and discuss potential procedures with your surgical team.

Bilateral Salpingo-Oophorectomy

A bilateral salpingo-oophorectomy (BSO) involves removing the fallopian tubes and ovaries. It’s very common for people with endometrial cancer to have a combined hysterectomy and BSO as their first treatment. The full surgery is called a total hysterectomy with bilateral salpingo-oophorectomy.

If your ovaries are removed and you are premenopausal, you will go into menopause immediately after the surgery. The side effects of menopause can be managed with hormone therapy. Although it’s rare, some people who are premenopausal may have the option to keep their ovaries. Be sure to discuss all your options with your health care provider.

Lymphadenectomy

Lymphadenectomy, or lymph node dissection, is the removal of lymph nodes from your pelvis or near the aorta (an artery). Your doctor may recommend a lymphadenectomy to find out if cancer has spread to the lymph nodes. The removed lymph nodes are tested to help your provider know what stage cancer you have and guide further treatment decisions.

Omentectomy

If the cancer has spread beyond the uterus, your surgical team may also remove the omentum — a fatty tissue that covers your abdomen. Certain types of endometrial cancer, like clear cell carcinoma, serous carcinoma, and carcinosarcoma, are more likely to have spread to areas outside the uterus, including the omentum. People with these types of endometrial cancer are more likely to need an omentectomy.

Tumor Debulking

In more advanced stages of cancer, you may need tumor debulking during the hysterectomy. This procedure focuses on removing visible tumors around the uterus. Tumor debulking helps make follow-up treatments, like radiation therapy or immunotherapy, more effective.

Abdominal Washings

Abdominal washings, also known as peritoneal lavage, may also be done during a hysterectomy. In an abdominal washing, the surgical team uses a saline solution to wash the abdominal and pelvic cavities. The fluid from the washes is then tested for cancer cells. Your doctor may adjust your treatment plan depending on the results of the abdominal washing.

How Long Does It Take To Recover From a Hysterectomy?

Recovery time after a hysterectomy depends on the type of hysterectomy and your overall health. Minimally invasive surgeries typically have faster recovery times and less pain, while open surgeries may require longer recovery. Here’s a general timeline for recovery for the different types of hysterectomies:

• Total (abdominal) hysterectomy — Three to seven days in the hospital and four to six weeks for at-home recovery
• Radical hysterectomy — Five to seven days in the hospital and four to six weeks for at-home recovery
• Vaginal and laparoscopic hysterectomy — Two to three days in the hospital and two to four weeks for at-home recovery

Are There Any Side Effects of Hysterectomies?

While you recover, you may experience some side effects, such as vaginal bleeding, soreness at the surgery site, trouble with bowel movements or urination, and fatigue.

If you had your ovaries removed and you are premenopausal, you may experience symptoms like vaginal dryness, hot flashes, or trouble sleeping. Talk to your health care provider about how you can manage these symptoms. They may recommend hormone replacement therapy.

Other Effects To Know

A radical hysterectomy can affect the nerves controlling the bladder. Because of this, a catheter is often used after surgery to help drain the bladder. You may have a catheter for a few days while you recover and your bladder function returns to normal. In some cases, the catheter may need to be replaced, or you may be taught how to insert one yourself if recovery takes longer than expected.

A hysterectomy removes all or most of your reproductive organs. Because of this, you will be unable to get pregnant after the surgery. If you’re planning to have children, it’s important to discuss this with your doctor. In some cases, surgery may be delayed if your cancer is in the very early stages or can be managed medically to give you time for family planning.

Additional Treatment for Endometrial Cancer

Depending on the stage of your cancer, you may need additional treatment beyond surgery. Some people with stage 1 endometrial cancer only need surgical treatment. However, if your cancer is more aggressive or at stage 2, 3, or 4, you may require additional treatments such as radiation therapy, chemotherapy, targeted therapy, or immunotherapy. (Cancer stages are often rendered in Roman numerals, e.g., “stage III” instead of “stage 3.”) Your health care provider will guide you through the next steps in your treatment.

Talk With Others Who Understand

MyEndometrialCancerTeam is the social network for people with endometrial cancer and their loved ones. On MyEndometrialCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with endometrial cancer.

If you’ve had a hysterectomy, what type of hysterectomy did you have? Do you have any advice for others undergoing this surgery? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.