Ovarian Cancer After Hysterectomy Is it Possible
Your Hysterectomy Choices: Different Types and Methods of Uterus Removal
Hysterectomy type depends on which organs or structures, besides the uterus, are removed as well as how the surgery is performed.
A hysterectomy is a surgical operation to remove the uterus, an organ located in the female pelvis.
Attached to the uterus on either side is a single fallopian tube and one ovary.
During pregnancy, a fertilized egg implants itself in the lining of the uterus where the developing fetus is nourished prior to birth.
The uterus is crucial for reproduction. After undergoing hysterectomy, a woman cannot become pregnant.
The Three Types of Hysterectomy
There are three types of hysterectomy, depending on which structures or organs are removed.
A Total Hysterectomy
A total hysterectomy is the removal of the entire uterus, including the cervix (the lower narrower portion of the uterus).
A Supracervical Hysterectomy
A supracervical hysterectomy is the removal of the upper part of the uterus. The cervix is left in place. This type of procedure may be done if you want to keep your cervix or if difficulties arise during surgery that make removal of the cervix complicated. On the other hand, if an unexpected cancer is detected during your operation, your surgeon may decide to remove the cervix.
There has been some controversy over whether it’s better to remove or keep the cervix in place during a hysterectomy. If you’ve had a history of abnormal pap smears, you may be at higher risk of developing cancer in the future, so you may decide that a total hysterectomy is the better personal choice. You should discuss these issues with your doctor well ahead of surgery.
A Radical Hysterectomy
A radical hysterectomy is a total hysterectomy that also involves removing tissues around the uterus called the parametrium. This procedure is usually reserved for cases where cancer is present. (1)
When Hysterectomy Includes Removal of More Than the Uterus
Sometimes a surgeon will perform additional surgeries at the time of hysterectomy.
One or both of the ovaries along with the fallopian tubes may be removed. This is called a salpingo-oophorectomy.
Oophorectomy is the surgical removal of just the ovaries.
A salpingectomy is the removal of the fallopian tubes. The ovaries or tubes may be removed for various reasons, for example when they are affected by endometriosis. (2)
Premenopausal Removal of Ovaries: Side Effects and Symptoms
If both ovaries are removed when a woman hasn’t already reached menopause, she will abruptly experience premature menopause along with menopausal symptoms such as hot flashes, vaginal dryness, and decreased sex drive.
Women who have not gone through may opt to keep their ovaries so as to preserve their natural source of hormones including estrogen, progesterone, and testosterone.
The Role of the Ovaries in a Woman’s Health and Wellness
These hormones are important in reducing the risk of heart disease. In addition, these hormones help prevent loss of bone density (osteoporosis) and play a role in maintaining sexual interest.
Since there is evidence that ovarian cancer often originates in the fallopian tube, rather than the ovary, keeping the ovaries and removing the fallopian tubes may be a better option for some women who are at low risk for ovarian cancer.
Postmenopausal women (at higher risk of breast and ovarian cancer) are often advised to have their ovaries removed because of a small risk of developing ovarian cancer at some point. The benefits of removing or keeping ovaries is something you should discuss with your doctor.
How Is Hysterectomy Surgery Performed?
There are several approaches to hysterectomy or surgical removal of the uterus. The uterus can be removed through an open incision in the lower abdomen, through the vagina or with a laparoscopic technique in which the uterus is removed through a few small incisions made in the abdomen. Each option involves unique risks and benefits, and recovery time can vary depending on the method used. In some instances, a woman’s choice of procedure is limited — for example if she has a very large uterus, a vaginal or laparoscopic procedure may not be an option.
Abdominal Hysterectomy: Important Facts to Know
An abdominal hysterectomy offers the surgeon the most flexibility. It may be recommended over other types of hysterectomy if a woman has a large uterus, scar tissue from previous abdominal surgeries, is obese, or has cancer. In addition, it is the best option in cases of obstetric emergency such as postpartum hemorrhage. (3)
Abdominal hysterectomy is the most common method used in the United States.
The surgery takes approximately one to two hours. (1)
Risks and Complications Related to Abdominal Hysterectomy Surgery
Complications from this type of surgery are uncommon but include the following:
- Excessive bleeding (hemorrhage)
- Blood clots
- Urinary retention (the inability to pass urine)
- Damage to adjacent organs including the bladder, ureters (the tubes that lead from the kidneys to the bladder) and the large and small intestines. These injuries are rare and can be surgically repaired.
Can Hysterectomy Trigger Early Menopause if Ovaries Are Not Removed?
If you’ve had a hysterectomy but have kept your ovaries it’s possible that you may go through menopause earlier than the average age, which is 51, perhaps due to an interruption in blood flow to the ovaries.
Some Less Invasive Hysterectomy Options Are Available
Both vaginal and laparoscopic procedures are considered minimally invasive because they involve smaller incisions. During a vaginal hysterectomy, the uterus is removed through the vagina. No abdominal incision is made. Vaginal hysterectomy generally causes fewer complications that either abdominal or laparoscopic surgery. Elderly and medically compromised patients can benefit from a vaginal approach because it eliminates the risks that can accompany an abdominal incision. Typically, recovery is easier with less invasive methods of hysterectomy compared with abdominal surgery.
Vaginal hysterectomy is also a good option for women who have a small uterus and have already given birth vaginally and have no history of prior pelvic inflammatory disease or prior pelvic surgeries.
Vaginal Hysterectomy: How Surgery Is Performed to Remove the Uterus
During the procedure the surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina. The uterus is also separated from the connective tissue and blood vessels that support it. Unless uterine cancer is suspected, the surgeon may cut an enlarged uterus into smaller pieces and remove it in sections with a surgical instrument called a morcellator.
Recovery time after a vaginal hysterectomy is also shorter for the most part than it would be for an abdominal procedure. Whenever possible, it is the preferred method.
You can expect to be in the operating room for about one to two hours.
Laparoscopic Hysterectomy: How Surgery Is Performed to Remove the Uterus
With this type of surgery only a few small (approximately half-inch) incisions are made in your abdomen. Then a laparoscope, a fiberoptic instrument, is inserted in one of these openings. The laparoscope allows the surgeon to see the pelvic organs. The uterus can be removed in small pieces through the incisions, through a larger incision made in the abdomen or through the vagina (a procedure known as laparoscopic vaginal hysterectomy, or LAVH). This procedure results in less infection than the abdominal option. The procedure takes about two hours. (4)
Another option is a robot-assisted laparoscopic hysterectomy, in which the surgeon is aided by a robotic machine. There can be an increased risk of injury to the urinary tract or other organs with this method.
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