Surgery to lower endometrial cancer risk

This section covers the following topics:

• Expert guidelines
• Removal of the ovaries and tubes during risk-reducing hysterectomy
• Hysterectomy during risk-reducing salpingo-oophorectomy
• Vaginal or open surgery
• Surgical risks
• Recovery

Hysterectomy is surgery to remove the uterus to treat or prevent disease. Hysterectomy may be used to treat endometrial cancer. “Prophylactic hysterectomy” or "risk-reducing hysterectomy" refers to the removal of the healthy uterus to reduce a person's risk of developing cancer. Often the cervix is also removed during this surgery. Research on hysterectomy in high risk women has shown that:

• hysterectomy is an effective way to lower the risk for endometrial cancer
• hysterectomy does not increase how long women survive 

Surgery can have risks and side effects. It's important for people to speak with experts in order to learn as much as possible about their endometrial cancer risk and to make an informed decision about the best option for lowering their risk.  

Expert guidelines on hysterectomy for high-risk women

The National Comprehensive Cancer Network (NCCN), is an organization of cancer experts that creates guidelines on cancer care and updates them yearly. NCCN's guidelines discuss the benefits and limitations for risk-reducing hysterectomy in women with an inherited mutation linked to endometrial cancer and which women are most likely to benefit from the surgery. The NCCN guidelines include "consider risk-reducing hysterectomy" for women who have completed their childbearing and who have an inherited mutations in the following genes:

• EPCAM
• MLH1
• MSH2
• MSH6
• PMS2
• PTEN

Removal of the ovaries and tubes during risk-reducing hysterectomy

In addition to their increased risk for endometrial cancer, women with mutations in the following genes are also at increased risk for ovarian cancer:

• EPCAM
• MLH1
• MSH2

Experts recommend that women with mutations in these genes consider risk-reducing removal of their  ovaries and fallopian tubes (also known as salpingo-oophorectomy) after childbearing is complete and at the time of risk-reducing hysterectomy. 

Hysterectomy during risk-reducing salpingo-oophorectomy

Some women who have increased risk for ovarian cancer may choose to remove their uterus at the same time that they undergo risk-reducing removal of their ovaries and fallopian tubes. This includes women with inherited mutations in the following genes:

• BRCA1 (note that BRCA1 mutations have been linked to a rare but aggressive form of endometrial cancer)
• BRCA2
• BRIP1
• RAD51C
• RAD51D

You can read more about the benefits and risks of this decision in our section on surgery to lower fallopian tube and ovarian cancer risk.  

Vaginal or open surgery

Hysterectomy may be performed using an incision through the vagina (known as vaginal hysterectomy) or through an incision in the lower abdomen (known as laparotomy). 

• Open surgery (also known as a laparotomy) involves one incision in the lower abdomen to remove the uterus.
• vaginal surgery involves an incision from the vagina into the pelvic area to remove the uterus. This surgery requires a shorter recovery time than open surgery. Most risk-reducing surgeries can be performed vaginally. 

Surgical risks

Every surgery has potential risks; some are more serious than others. Some hysterectomy risks can affect recovery. 

• Infection
• Delayed healing
• Blood loss
• Blood clots
• Pain (post-operative and long term pain syndromes)
• Injury to internal organs
• Bladder incontinence
• Sexual side effects

It is important for people to discuss possible surgical risks with a surgeon to understand the seriousness and likelihood of these risks before making the decision to have risk-reducing surgery.

Recovery

Average recovery time after hysterectomy is about 1-2 weeks.