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¡°±Ê²¹°ù³Ù¾±²¹±ô hysterectomy¡± is one of those phrases that isn¡¯t very specific. It¡¯s not always clear what the term means. So, most doctors try to avoid using it.?

But when people speak of a partial hysterectomy, the scientific term for what they¡¯re describing is usually a supracervical hysterectomy. That¡¯s a procedure in which the bulk of the uterus is surgically removed, but the cervix is left behind.

So, why might you need this type of procedure? How will it affect your menstrual cycle? And will you still be able to conceive or carry a child naturally after having one?

Here¡¯s what I tell my patients about partial ¡ª or supracervical ¡ª hysterectomies.

How does a partial hysterectomy differ from a ¡°full,¡± ¡°complete¡± or ¡°radical¡± hysterectomy??

• A partial or supracervical hysterectomy removes the bulk of the uterus but leaves the cervix intact.
• A full or complete hysterectomy removes the uterus and the cervix.
• A radical hysterectomy removes the uterus, cervix and upper vagina, as well as some of the tissue surrounding the cervix.

But removal of the ovaries and fallopian tubes is considered a separate surgery. I feel like it¡¯s important to mention that here. Because sometimes, people mistakenly think all the other pelvic organs are removed during a hysterectomy, too. They are not.

When is a partial hysterectomy necessary in cancer treatment?

A partial hysterectomy is used quite rarely in cancer treatment. Any surgical treatment related to endometrial cancer is going to call for a full hysterectomy.

But we do have some data indicating it can be safe for certain patients with ovarian cancer?if removing their cervix would increase the risk of prolapse, bladder injury or other complications.?

Are there any other types of cancer that partial hysterectomies can treat?

The only other one I can think of would be peritoneal cancer, under certain circumstances. But it wouldn¡¯t be safe to leave any uterine tissue behind if someone has endometrial cancer. So, those situations would require a total hysterectomy.

Are there any other non-cancerous reasons to have a partial hysterectomy?

Yes. Partial hysterectomies are often used to treat uterine fibroids, or leiomyoma.??

What are the benefits of a partial hysterectomy?

There¡¯s the potential for better sexual function, if you retain the cervix. In theory, that¡¯s because it doesn¡¯t disrupt as many of the nerves and ligaments as a full hysterectomy. But that¡¯s still a somewhat controversial topic.

The other possible benefit is avoiding complications like prolapse and incontinence. If I¡¯m performing surgery on someone with ovarian cancer, for instance, and they¡¯ve got a lot of scar tissue around their cervix, I might opt to leave it alone, because I don¡¯t want them to have any issues with their bladder.

What are the risks of a partial hysterectomy?

If cancer is present in the uterus or cervix, we could potentially leave it behind if we don¡¯t remove the entire organ. That¡¯s why we don¡¯t typically recommend this procedure.

What happens to the other reproductive structures after a partial hysterectomy??

The ovaries and fallopian tubes are still attached to the abdominal walls by other ligaments. So, they don¡¯t need any additional securing. But when we sew the vagina back together, we usually attach it to the uterosacral ligament to make sure it stays in the proper position.

A hysterectomy is a common procedure used to treat gynecologic cancers, like ovarian cancer, cervical cancer and endometrial cancer, and other health conditions impacting the uterus. But there are still many myths surrounding this type of surgery. And, if you need a hysterectomy, you may have anxiety or questions about long-term side effects, including the impact on your fertility.

We spoke with gynecologist oncologist , about what patients planning for a hysterectomy should expect.

What is a hysterectomy?

A hysterectomy is a surgery to remove a patient¡¯s uterus. There are a few types of hysterectomies:

• Total hysterectomy: Removal of the uterus and cervix
  
• Supracervical hysterectomy: Removal of the uterus only
• Simple hysterectomy: Removal of the uterus and cervix, but not the tissue adjacent to the cervix (called parametria) or the upper vagina. This is the most common type of hysterectomy.
• Radical hysterectomy: Removal of the uterus, cervix, upper part of the vagina and supporting tissues adjacent to the cervix called the parametria

Removal of a fallopian tube is known as a salpingectomy. Removal of an ovary is known as an oophorectomy. Removal of both a fallopian tube and an ovary is a salpingo-oophorectomy. Some patients may have both fallopian tubes and/or both ovaries removed.?

It is important to talk to your surgeon about whether your ovaries should be removed at the time of hysterectomy. This decision will be based on your age, the reason you are having the hysterectomy and other medical factors. All women, however, should have their fallopian tubes removed if they are undergoing hysterectomy. This has been shown to decrease the risk of ovarian cancer later, and fallopian tubes have no impact on ovarian or hormonal function.

Hysterectomies may be performed through either:

• open surgery, also called a laparotomy with one larger incision, or
  
• a minimally-invasive, laparoscopic or robotic hysterectomy performed through multiple smaller incisions

Patients should talk to their health care provider to see which type of procedure is right for them. Most cervical cancer patients should avoid a minimally invasive hysterectomy, as studies show this could increase the risk of recurrence.

Who needs a hysterectomy?

A hysterectomy is a part of the standard treatment for patients who have been diagnosed with cervical, endometrial or ovarian cancer. However, some women who wish to try to get pregnant in the future may have the option for conservative therapy that does not involve a hysterectomy. Some women may need a prophylactic hysterectomy to reduce their chances of developing cancer in the future if they have been diagnosed with some hereditary conditions.

Outside of cancer care, hysterectomies are performed to treat uterine fibroids, heavy vaginal bleeding, some uterine prolapse, endometriosis (when the tissue that lines the uterus grows outside of the uterus) or adenomyosis (when the tissue that lines the uterus grows inside the walls of the uterus where it doesn¡¯t belong) that are unable to be controlled through non-surgical means.

Are there any risks?

Often, especially when used for cancer treatment, a hysterectomy is performed along with other procedures, so the risk is specific to each individual patient. It¡¯s important that you talk to your doctor about your risks.

What should patients expect during a hysterectomy?

Patients receive general anesthesia before a hysterectomy. During the procedure, the surgeon will remove the uterus through an incision in the abdomen or the vagina. Surgery can last anywhere from one to three hours. It may take longer if the surgeon is doing additional procedures.

How long does it take to recover from a hysterectomy?

Historically, recovery from a hysterectomy was a difficult process, but thanks to efforts like MD Anderson¡¯s Enhanced Recovery Program, patients who have a minimally invasive or open hysterectomy both recovery relatively rapidly. But the experience does vary depending on which type of procedure you have. Patients who have an open radical or simple hysterectomy can expect to be in the hospital one to four days. Patients who have a minimally invasive hysterectomy will be able to leave the hospital as early as the same day as the procedure.

Regardless of the type of hysterectomy, patients should expect to be up and walking around the same day as the surgery. Patients often experience discomfort at the incision site for about four weeks. Patients should refrain from any heavy lifting for six weeks and from being fully submerged in water, using tampons, having sex or placing anything in the vagina until their doctor says they¡¯ve healed.

What type of long-term side effects should a patient expect?

Patients who have had a hysterectomy will not be able to become pregnant, so it¡¯s best to consider the hysterectomy relative to your goals surrounding fertility. Outside of fertility, patients will not experience any long-term side effects. A common myth is that hysterectomies cause patients to experience early menopause, but this is not true as hormonal function comes from the ovaries.

Will a patient still have a period after a hysterectomy?

This is a really frequently asked question. No, a patient who has a hysterectomy will not menstruate. Despite this, a patient who has a hysterectomy will not go into menopause unless the ovaries are removed.

What advice do you have for a patient interested in preserving her fertility?

Any patient who has been told they need a hysterectomy can weigh need for hysterectomy with their reproductive goals with their care team or seek a second opinion. Cancer patients who need a hysterectomy but are interested in preserving their fertility should seek care at a center with an oncofertility program, like MD Anderson. Our oncofertility specialists don¡¯t just treat people with gynecologic cancers. They treat anyone whose cancer may impact their fertility. They can help patients who are considering a hysterectomy weigh their options so they can make the best decision for themselves.

Does a hysterectomy affect sexual function?

No, a hysterectomy alone does not impact sexual function. Recovery from surgery and undergoing therapy for cancer, including possibly going into menopause, however, may impact sexual function. Some hormone therapies used to treat cancer may cause sexual side effects. Patients should share their side effects and concerns with their care team.

Overall, hysterectomies are a safe and effective option for treating several types of cancer, and many patients who have them continue to live normal lives after.

or by calling 1-877-632-6789.

Abdominal radical hysterectomies (also called ¡°open¡± hysterectomies) typically are thought of as more difficult for patients to recover from than a minimally invasive radical hysterectomy. But new research shows they¡¯re safer for early-stage cervical cancer patients.

MD Anderson gynecologic oncologists led two studies looking at the two techniques:

• abdominal radical hysterectomy: the more traditional method of surgery in which surgeons remove the uterus and other surrounding structures, ?through an incision in the patient¡¯s lower abdomen
• minimally invasive radical hysterectomy: when surgeons conduct a surgery using very small incisions and remove the uterus and surrounding parts

They found that cervical cancer patients who had minimally invasive radical hysterectomies were four times more likely to experience recurrence than those who had open surgery. They also had lower survival rates.

As a result of the studies' findings, MD Anderson gynecologic oncologists made the decision to no longer perform minimally invasive radical hysterectomies on cervical cancer patients. Our physicians recommend that these patients undergo open abdominal radical hysterectomies instead. ?

We spoke with a gynecologic oncologist and surgeon who led one of the studies, about what else patients should know about surgery for cervical cancer treatment. Here¡¯s what he had to say.?

What¡¯s the difference between a radical hysterectomy and a simple hysterectomy?

In a simple hysterectomy, the uterus is removed. In a radical hysterectomy, the uterus and some surrounding parts around the cervix are removed. ?The open radical hysterectomy is performed by removing the uterus through an incision (similar to the one made in a C-section) in the lower abdomen. Radical hysterectomies typically are used in cancer treatment to ensure that all of the cancer is removed.

Who needs a radical hysterectomy for cervical cancer treatment?

A radical hysterectomy is the standard treatment for early-stage cervical cancer. That includes stage I cervical cancer, and more specifically, stage IA2 and IB1. Often these patients are younger, between ages 20 and 40. Surgery is not the standard of care for advanced-stage cervical cancer patients. Typically, these patients receive radiation and chemotherapy.

What should cervical cancer patients who¡¯ve already had a minimally invasive radical hysterectomy know?

Patients who¡¯ve had a minimally invasive radical hysterectomy for cervical cancer treatment have an 8% chance of the cancer coming back. In other words, one out of 10 patients will have a recurrence.

If you¡¯ve had a minimally invasive radical hysterectomy, talk to your gynecologic oncologist about what next steps are best for you. This may or may not mean more follow-up appointments and possibly additional imaging. The important thing is that you talk with your doctor and decide what¡¯s best for you.

Are minimally invasive hysterectomies still safe for patients with other types of gynecologic cancers, like uterine cancer and ovarian cancer?

Yes, they are. Other studies show that minimally invasive hysterectomies are still safe for uterine cancer. We¡¯re not completely sure of the reason why, but we think it has to do with the biological makeup of the tumor. Regardless, it remains the standard of care for uterine cancer.

Minimally invasive surgery is only routinely performed to determine what type of treatment (surgery or chemotherapy) is needed next in patients with advanced ovarian cancer.

What should patients preparing for an abdominal radical hysterectomy expect?

Thanks to our enhanced surgical recovery programs at MD Anderson, we¡¯ve been able to make dramatic improvements in recovery time from hysterectomies. Patients used to stay in the hospital for four to five days after surgery. Now patients can go home the next day. They experience less pain and are able to resume their normal activities more quickly.

If you¡¯re preparing for an abdominal radical hysterectomy, choose a hospital with an enhanced surgical recovery program.

If your doctor suggests a minimally invasive radical hysterectomy for cervical cancer, discuss the study results and seek a second opinion.

Regardless of what type of cancer you have, talk to your doctor about any questions or concerns you have about an upcoming surgery. Your oncologist can address those concerns and help find the treatment that¡¯s best for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

If you¡¯ve been told you need an endometrial biopsy, you probably have some questions. Why has it been ordered? What will it involve? And, most importantly, what will the results show your doctors?

We sat down with gynecologic oncologist , to learn more.

What is an endometrial biopsy?

It¡¯s a very simple, in-office procedure that allows doctors to obtain a sample of the cells that form the lining of the uterus, also known as the endometrium.?

Doctors use these samples to look for evidence of abnormalities that could indicate precancerous changes in the cells or the presence of actual cancer in the endometrium.

Why are endometrial biopsies usually performed?

Your doctor could order an endometrial biopsy for several reasons:?

• Abnormal bleeding from the vagina:?In post-menopausal women, this would mean any bleeding at all. In pre-menopausal women, this would mean unusual patterns of bleeding.
• Hereditary cancer syndromes: We don¡¯t normally screen for endometrial cancer in women at average risk. But for certain patients in high-risk groups, such as those with Lynch syndrome or other hereditary cancer syndromes, screening may be recommended.
• Abnormal scan results: An endometrial biopsy may be needed if an ultrasound reveals a thick endometrial ¡°stripe,¡± for example, or a radiologist sees something unusual that they don¡¯t think should be there.?
• Treatment monitoring: Sometimes, a hysterectomy is recommended for someone with endometrial hyperplasia (a type of abnormal cell growth that can lead to cancer), early-stage endometrial cancer, or a uterine tumor that is not otherwise removable. Patients who wish to preserve their fertility may wish to be treated with hormone therapy instead. In those situations, doctors would likely perform an endometrial biopsy every three months to monitor their progress.

What happens during an endometrial biopsy?

The doctor inserts a speculum into the vagina so that they can see the cervix. A speculum is the same instrument used to hold open the vagina during a Pap test.?

Then, the doctor passes a tiny, soft, flexible straw called a pipelle through the cervix until it touches the fundus, or uppermost part, of the uterus. They gently move it around while drawing back the plunger to suck in some tissue. Then, they remove the pipelle, which is only about the diameter of a piece of linguine.

That¡¯s really all there is to it. Other than the speculum, which is usually made out of stainless steel, there¡¯s no metal involved. There¡¯s also no blade and no cutting.

What happens if the pipelle can¡¯t pass easily through the cervix?

If the uterus is moving around too much, we have an instrument called a tenaculum that we can place on the cervix to help stabilize the uterus and hold it steady.?

If the cervical canal is too narrow, we have a series of very small rounded instruments to gently dilate it in the clinic.

If all else fails, we can perform the biopsy under general anesthesia. But that scenario is very rare.

What do the results of my endometrial biopsy mean?

Here are some words and phrases you might see on your biopsy results:?

• Proliferative endometrium
• Atrophic endometrium?????????
• Hyperplasia
• Carcinoma

If you see either of the first two phrases, your results are normal.

If you see either of the other two phrases, your results indicate that some abnormal/precancerous or cancerous cells were found. Ask your doctor what that means for next steps, as you will likely need some form of treatment.

What is the recovery process like for an endometrial biopsy?

The cervix doesn¡¯t like to be opened, so many patients compare the experience to having bad menstrual cramps. Unfortunately, topical anesthesia hasn¡¯t been shown to be effective in reducing this sensation. But it¡¯s often helpful to take ibuprofen before the procedure. Talk to your doctor to see if that might be appropriate for you, and if so, what dosage they¡¯d recommend.?

Any lingering discomfort from the biopsy usually goes away within 10 to 20 minutes. After that, most people are fine, and can go right back to doing whatever they were doing before the procedure.

or by calling 1-877-632-6789.