Patient guide to Radical hysterectomy

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Cancer of the cervix is the second most common cancer in young women. The majority of cancers of the cervix are believed to be the result of a longstanding infection with a common virus, known as Human Papilloma Virus (HPV). In most women the infection is temporary. In some women it persists, commonly in smokers and those with a weakened immune system. Over time the virus can cause abnormal tissue which can be detected by pap smears. If left untreated over a period of time, those abnormal tissues can develop into cancer, usually over a period of years.

Patient guide to Radical hysterectomy

How is cancer of the cervix treated?

An operation called a radical hysterectomy and pelvic lymphadenectomy can cure cancer of the cervix in the early stage. If the cancer is at a later stage radiation is often needed.

Who is a Gynecologic Oncologist?

Your doctor is a specialist called a Gynecologic Oncologist. Gynecologic Oncologists have extra training in gynecologic cancer surgery. Your Gynecologic Oncologist will coordinate with other medical specialists so you get the best possible care. These specialists include other doctors, nurses, social workers and dietitians.

What is a radical hysterectomy and pelvic lymphadenectomy?

This surgery removes your uterus, cervix, fallopian tubes and lymph nodes. The cervix is the name of the opening of the uterus (womb).

• A radical hysterectomy is surgery to remove the uterus and cervix, and extra tissue, like a collar, all around the cervix. If there are no cancer cells in this tissue, this is called “clear margins”. This is a good sign that the surgery may have cured the cancer.

• In a pelvic lymphadenectomy, the pelvic lymph nodes are removed. Lymph nodes work like little filters that weed out any bacteria or cancer cells. The surgeon removes the lymph nodes at the beginning of the operation. Clear lymph nodes (meaning that no cancer cells are found in them) are a good sign that the cancer has not spread.

• Bilateral salpingectomy is the removal of the fallopian tubes. The importance of removing the fallopian tubes for this surgery, is that new evidence is emerging that the fallopian tubes may actually be the primary source of ovarian cancer rather than the ovaries themselves. As the tubes have no hormonal function, removing them as part of this surgery may reduce your risk of developing another cancer in the future.

• Sometimes, the surgeon finds and removes lymph nodes that do not look normal. A specialist will look at them immediately under the microscope. If cancer cells are seen, the surgeon may stop because surgery alone could not guarantee a cure. Your doctor will then arrange for you to meet a Radiation Oncologist to discuss the best treatment options for you.

Are the ovaries removed as well?

Cervix cancer rarely spreads to the ovaries so it is safe to leave them in. In women who have already entered menopause or are close to the age when menopause occurs, the doctor may suggest removing the ovaries. This is a decision you will wish to discuss in detail with your doctor or nurse.

Ovaries produce hormones that help a woman’s body work well. After menopause, these hormones are no longer produced in the ovary but small amounts are still available. A woman can also take pills to replace the hormones if she wishes. Your doctor will discuss hormone replacement therapy with you.

What fills the empty space when everything is removed?

Normally, the uterus, ovaries and fallopian tubes fill a space in your pelvis about the size of your hand. The small bowel or intestines are just above. After surgery, the intestines will dip down to fill the space.

Is it normal to be nervous about surgery?

Yes. Most people have worries and concerns about a cancer diagnosis and treatment. Some women have said that even though they are relieved there is good treatment available, they still have fears. Often talking with your caregivers helps to lessen these fears. Listening to relaxing music or relaxation and healing tapes is also soothing. Some people bring in crafts, crossword puzzles or books as well as some family pictures to pass the time as they recover.

Will I have a lot of pain?

This is a common concern. During your pre-op visit the anesthesiologist will talk to you about pain control.  There are 2 main types of pain control used after surgery:  Patient Controlled Analgesia and Epidural Analgesia. You will most likely have one of these when you wake up after surgery.

Patient Controlled Analgesia, or PCA: PCA consists of a pump that delivers medicine by intravenous (IV) when you push the button. There is a dose and time limit set on the pump so you do not have to worry about giving yourself too much or becoming addicted to it. You will find that you may use it a lot the first day or so and then less the next day. Patients usually have a PCA for 1 to 2 days after surgery.

Epidural: Epidural analgesia consists of a small tube placed in your back by the anesthesiologist during your surgery. The tube is then taped to your back and over your shoulder. A pump will deliver medication continuously so that you will feel less pain in the surgical area. Some patients have slight numbness or heaviness of one or the other thigh/leg. This is normal and will be closely watched by the nurses. Your strength and sensation will return once the epidural is taken out.

You will still be getting up and walking with the epidural in place after surgery. Patients usually have an epidural in for 2 to 3 days after surgery.

What changes will there be sexually?

Most women report few sexual changes as a result of the operation. Healing of all incisions usually take 6 to 8 weeks. After that, it is possible to start intercourse again. Of course, affection, touching and other kinds of caresses are possible before that time if you wish.

This surgery will not change your ability to have sex or change your level of interest in sex. 

You may notice these changes:

• The vagina is shorter in its relaxed state, as the top section is removed with the uterus. As the vagina is very stretchy, most people cannot tell the difference during lovemaking.  In the “aroused” state, the vagina naturally lengthens.

• The operation will not affect your ability to have an orgasm or sexual climax. However, a climax causes muscle contractions in the uterus as well as other parts of the body. Since the uterus is no longer there, some women have said they have felt a slight difference in their orgasm.

• Before the operation, some women may have felt pain or had bleeding during intercourse because of the cervical cancer. After surgery this should be resolved. 

• If the ovaries have just been removed and menopause had not previously started, it will now. Many women find the vagina does not get as lubricated as it did before menopause. It is a good idea to spend more time becoming aroused before making love so the vagina can be ready. It also helps to use a water-soluble lubricant such as KY Jelly. Oil based lotions or Vaseline does not flow out of the body freely and should not be used.

• A cancer diagnosis and surgery can be stressful. If you have been tired, anxious or worried, you may find that your interest in sex is less. Talking to your partner or a health care provider, plus time and patience will often help your sexual feelings to return. By six months, most women report a return to their usual lovemaking.

Will I experience any other changes?

Yes, there is usually a temporary change with your bladder. During the surgery, some of the sensitive nerves to the bladder may be cut or bruised. While those nerves heal, it is not easy to tell if your bladder is empty or full. A bladder that is stretched can spill over or only partially empty. This can lead to infection.

To prevent this complication, a catheter is kept in the bladder for 7 days. A catheter is a tube that is put into your bladder and drains the urine from your bladder into a bag. This allows the bladder to rest and for any inflammation around the bladder to resolve. After that time the catheter will be removed by a nurse. 

You will be asked to drink plenty fluids and try to empty your bladder normally. Once you have done that a nurse will insert a catheter into your bladder to measure the amount of urine left behind. If the amount is more than a cup, then the catheter will be put back in for another 7 days and the process repeated.

 What should I expect after surgery?

The goal of care is to help you recover and to prepare you for going home. A number of people will be involved in your care.  They are all part of your health care team. The most important person on the team is “you”.

The health care team plans your care according to your individual needs. Your care involves:

Pain control: Pain control options with be offered to help you maintain a level of comfort. Remember, pain is an individual experience and cannot be compared to others.

Intravenous (IV): IV fluids are needed until you are drinking enough to meet your body’s needs. As well, an IV provides a way to give you medications to help prevent or treat nausea, heartburn, itching or if antibiotics are needed.  

Vaginal bleeding: Check for vaginal bleeding. A pad is worn to check for this as well as for comfort. A small amount of vaginal bleeding can be normal for a few weeks after surgery. 

Incision: It is not unusual to have the dressing removed the day after surgery and left uncovered. Usually there is only a small amount of reddish pink drainage from your incision. There may be numbness around your incision. This is normal and will get better over the next few months. If this worsens over a few days, contact your surgeon’s office for what to do.  

Urinary catheter: Your bladder catheter tube will be cleaned and cared for until your bladder can work normally again. The catheter is usually in place for 7 days. 

Bowel activity: You will be offered ice chips soon after surgery to keep your mouth moist and to help prevent nausea. Your diet will gradually increase from fluids to solids as your bowel function returns to normal.  Your bowel activity will be slow at first. Many women feel bloated and have “gas pains”. Pain medication helps but walking is most effective to help get the gas moving and ease the discomfort.  Chewing gum can help get the gas moving after surgery. You can chew gum if you don’t have dental problems or dentures. If you want to chew gum after surgery, bring this with you from home, since the hospital does not provide it. Stool softeners will be provided so your bowel movements will be soft and easy to pass so as not to put added strain on the incision area.  

Blood thinners: You will receive a blood thinning medication by needle in your upper thighs to help prevent blood clots from forming. This medication will likely be stopped when you leave the hospital, however, in some situations your doctor may recommend using it for a longer period of time after the surgery. 

Activity, walking and moving: Getting up and walking, starting the day after surgery is the most important thing you can do to have a good recovery from your surgery. Our recommendation is that the day of surgery you sit at the edge of your bed. The first day after surgery we encourage you to walk, with assistance from staff, in the hallway 3 times per day and spend time sitting in a chair rather than staying in bed most of the time.

Once you are steady on your feet, you must walk several times a day to regain your general strength. Aim to walk around the nursing station at least 3 times per day. Staff or a family member can help you push the IV pole. Increase the number of times you walk as well as the distance each day. Your goal for walking after surgery should be to walk around the hallways at least 3 times per day. 

Breathing and leg exercises: For several days after your surgery, your activity will be less than normal. During this time, your breathing is shallower at rest. Fluid buildup may occur in the lungs. This could lead to complications, therefore it is very important to do your breathing and leg exercises as described on the next page.

Do leg and breathing exercises every 1 to 2 hours while awake. On the day after surgery, you will be helped with getting out of bed and into a chair. You will be shown how to support your abdomen when getting out of bed so you do not put any stress on your incision.

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