Endometrial Cancer: Hysterectomy to Reduce Risk

Surgery to Lower Endometrial Cancer Risk

Note that when we use the terms "female" and "women" we are referring to people assigned female at birth. This section covers the following topics:

What is risk-reducing hysterectomy?

Hysterectomy is surgery to remove the uterus to treat or prevent disease. "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 may not increase how long high-risk 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.  

Who should have risk-reducing hysterectomy?

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 suggest that women who have completed their childbearing should talk with their doctor about risk-reducing hysterectomy if they have an inherited mutations in any of the following genes:

For people at high risk for endometrial cancer who also need to have colorectal surgery, NCCN guidelines recommend considering scheduling their risk-reducing hysterectomy and colorectal cancer surgery at the same time. 

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 fallopian tube and ovarian cancer:

*More research is needed to confirm a link between ovarian cancer and PMS2 mutations.

People with mutations in these genes should have a conversation with their surgeon about the benefits and risks of risk-reducing removal of their ovaries and fallopian tubes (also known as salpingo-oophorectomy) at the time of risk-reducing hysterectomy. 

Hysterectomy during risk-reducing salpingo-oophorectomy

Some people 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 people with mutations in the following genes:

*Note that BRCA1 and BRCA2 mutations have been linked to a rare but aggressive form of endometrial cancer.

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 mastectomy risks can affect recovery. Others can affect the type of scarring and appearance of the breast reconstruction. Some possible risks include:

• Infection
• Fluid build-up at the surgical site (seroma or hematoma)
• Delayed healing
• Blood loss
• Blood clots
• Lack of breast or chest feeling or sensation
• Pain (post-operative and long term pain syndromes)

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.

Surgical recovery

Recovery times after mastectomy vary depending on several factors including whether or not there will be reconstruction and the type of reconstruction chosen. Average recovery time after mastectomy and reconstruction is about 3-4 weeks, but may be up to 6-8 weeks. 

Physical therapy may help to restore range of motion, decrease discomfort and reduce buildup of scar tissue. 

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