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Uterine cancer surgery, also known as a hysterectomy or uterine cancer resection, is a surgical procedure performed to treat uterine cancer by removing cancerous tissue from the uterus or the entire uterus itself, depending on the stage and extent of cancer. This procedure is performed along with Oncology surgeon as a collaborative approach for effective outcome.

When it is Performed

Uterine cancer surgery is typically performed when

  • Uterine cancer is diagnosed and the tumor is localized.
  • Cancer has not spread beyond the uterus or nearby lymph nodes.
  • The patient's overall health permits surgery.

Purpose of the Procedure

The primary purposes of uterine cancer surgery are:

Cancer Removal

To eliminate cancerous tissue from the uterus.

Cancer Staging

To determine the stage and extent of cancer.

Prevention of Cancer Spread

To prevent the spread of cancer to other organs and tissues.

Symptom Relief

To alleviate symptoms associated with uterine cancer, such as abnormal bleeding and pain.

What is expected to be performed

The specific approach to uterine cancer surgery varies depending on several factors:

Hysterectomy

Involves removing the entire uterus. This can be done through an abdominal incision (abdominal hysterectomy), or laparoscopically (minimally invasive).

Lymph Node Dissection

In some cases, nearby lymph nodes may be removed for cancer staging.

Ovarian Removal

Depending on the stage and type of cancer, the ovaries and fallopian tubes removed (oophorectomy) along with uterus.

Anesthesia

General anesthesia is administered to ensure the patient is unconscious and pain-free during the procedure.

Incisions

The size and location of incisions depend on the surgical approach. Abdominal hysterectomy involves a larger abdominal incision, while minimally invasive techniques use smaller incisions or vaginal access.

Surgical Instruments and Equipment

Surgical instruments may include scalpels, laparoscopes, energy devices (e.g., electrosurgical instruments), and specialized instruments for tissue removal.

Duration of Surgery

The length of surgery varies based on the extent of the procedure, but it typically ranges from 1 to 3 hours.

Intraoperative Monitoring

Monitoring equipment, including ECG and blood pressure monitors, is used to ensure the patient's safety during surgery.

Uterine Cancer Surgery

Potential complications of uterine cancer surgery may include:

  • Infection at incision sites.
  • Bleeding during or after surgery.
  • Injury to adjacent structures (rare).
  • Blood clots (deep vein thrombosis).
  • Surgical complications specific to the chosen approach.

Expected Outcomes

Expected outcomes of uterine cancer surgery include:

  • Removal of cancerous tissue.
  • Staging of cancer to determine its extent.
  • Symptom relief, such as stopping abnormal bleeding.

– Alternatives to Surgery

Depending on cancer stage and type, alternative treatments may include radiation therapy, chemotherapy, hormonal therapy, or a combination of these. However, surgery is often the primary treatment for localized uterine cancer.

– Scarring

The extent of scarring depends on the type of surgery. Abdominal hysterectomy may result in a larger abdominal scar, while minimally invasive techniques lead to smaller incision scars.

Post-operative Care

Post-operative care includes:

  • Pain management.
  • Recovery instructions, including activity restrictions.
  • Follow-up appointments for monitoring and assessment.
  • Recommendations for cancer treatment if further therapy is needed.

– Hospital Stay

Hospital stay duration depends on the type of surgery and individual recovery but typically ranges from 1 to 3 days.

Recovery Time

Recovery time varies but generally follows this pattern:

  • Immediate recovery: Patients may experience discomfort, fatigue, and vaginal bleeding.
  • Return to light activities: Typically within a few weeks.
  • Full recovery: Over several weeks to a few months, depending on the extent of surgery and individual factors.

Recovery Time

Uterine cancer, also known as endometrial cancer, is typically categorized into stages based on the extent of cancer's spread. The staging system helps healthcare providers determine the severity of the cancer and develop an appropriate treatment plan. The most commonly used staging system for uterine cancer is the FIGO (International Federation of Gynecology and Obstetrics) system, which includes the following stages:

1. Stage 0 (Carcinoma in Situ)

  • Cancer is limited to the innermost lining of the uterus (endometrium).
  • It has not invaded nearby tissues or spread to lymph nodes or distant organs.
  • Also known as "in situ" or "precancerous" stage.

2. Stage I:

  • Cancer is confined to the uterus and has not spread to the cervix.
  • Subdivided into:

                  ·         Stage IACancer is limited to less than half of the uterine muscle wall (myometrium).

·        Stage IBCancer has invaded more than half of the myometrium.

3. Stage II:

  • Cancer has spread from the uterus to the cervix, but it has not spread beyond the pelvic area.
  • Lymph nodes are not affected in this stage.

4. Stage III:

  •       Cancer has extended beyond the uterus and cervix to nearby structures within the pelvis, such as the ovaries or fallopian tubes.
  •        It may also involve nearby lymph nodes.
  •       Subdivided into:

·         Stage IIIA: Cancer has spread to the serosa (the outermost layer) of the uterus and/or the fallopian tubes and ovaries.

·         Stage IIIB: Cancer has spread to pelvic lymph nodes and/or the serosa of the uterus.

·         Stage IIIC: Cancer has spread to pelvic and/or para-aortic lymph nodes.

5. Stage IV:

  • Cancer has spread beyond the pelvic area to distant organs or structures, such as the bladder, rectum, or distant lymph nodes.
  • It may also involve the abdominal cavity.
  • Subdivided into:
    • Stage IVA: Cancer has invaded the bladder or rectal wall.
    • Stage IVB: Cancer has spread to distant organs or distant lymph nodes.

Each stage of uterine cancer has its own prognosis and treatment recommendations. Early-stage cancer (Stages 0, I, and some Stage II) is often treated with surgery, and the prognosis is generally more favorable. Advanced stages (Stages III and IV) may require a combination of surgery, radiation therapy, chemotherapy, and targeted therapies.

It's essential for individuals diagnosed with uterine cancer to work closely with their healthcare team to determine the appropriate stage and treatment plan based on their specific condition, overall health, and individual factors. Regular follow-up and monitoring are crucial for managing uterine cancer effectively.

The treatment approach for uterine cancer, including the use of radiation therapy, brachytherapy, and chemotherapy, depends on several factors, including the stage of the cancer, the extent of surgery, and the individual patient's health and preferences. Here's an overview of how these treatments may be used:

Radiation Therapy

Post-Surgery

Radiation therapy is commonly used after surgery (adjuvant therapy) for uterine cancer, especially in cases where there is a higher risk of cancer recurrence. This is typically recommended for women with Stage I or Stage II disease, especially if they have certain high-risk factors.

Without Surgery

In some cases where surgery may not be an option, radiation therapy can be used as the primary treatment. This is more common for women with advanced-stage disease (Stage III or IV) or for those who are not surgical candidates.

Radiation therapy uses high-energy X-rays or other forms of radiation to target and destroy cancer cells. It can be delivered externally (external beam radiation) or internally (brachytherapy).

Brachytherapy

Post-Surgery

Brachytherapy, also known as internal radiation therapy, is often used after surgery to treat uterine cancer. It involves the placement of radioactive sources directly into or near the tumor site. This approach allows for targeted radiation delivery to the affected area while minimizing exposure to healthy tissues.

Brachytherapy is highly effective in treating localized uterine cancer and can spare nearby healthy organs.

Chemotherapy

Post-Surgery

Chemotherapy may be recommended after surgery in specific situations, such as when cancer has spread beyond the uterus or when there is a high risk of recurrence. This is known as adjuvant chemotherapy.

Without Surgery

In cases of advanced-stage or recurrent uterine cancer, chemotherapy may be used as the primary treatment. It can help control the growth and spread of cancer cells and alleviate symptoms and can perform surgery.

Chemotherapy involves the use of drugs that circulate throughout the body, targeting cancer cells both at the primary site and at distant sites. It is often given intravenously but can also be administered orally.

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