Cancers of the uterus, ovaries and cervix are grouped together because they are treated by the same specialists, but they behave differently, present differently, and the role of surgery is not the same in each.
This page covers all three separately, then the parts that apply to all of them.
Uterine cancer
How it usually presents
Bleeding after menopause is the main warning sign. Any bleeding after menopause needs investigation, without exception. In younger women it may show as bleeding between periods or unusually heavy periods.
Most postmenopausal bleeding turns out not to be cancer. That is precisely why it should be checked rather than assumed.
Diagnosis
A pelvic ultrasound measures the thickness of the uterine lining. If it is thickened, a sample of the lining is taken, usually through a hysteroscopy where a camera is passed into the uterus. The biopsy is what confirms the diagnosis.
The surgery
The standard operation removes the uterus, the cervix, both fallopian tubes and both ovaries. Lymph nodes are assessed at the same time depending on the grade of the tumour and how deeply it has grown into the muscle wall.
For most uterine cancers this can be done laparoscopically, through small incisions, with a shorter recovery than open surgery.
Uterine cancer is staged surgically, meaning the true stage is known only after the removed tissue is examined. Whether you need radiotherapy or chemotherapy afterwards is decided from that report.
Ovarian cancer
How it usually presents
The symptoms are vague, which is the central problem with this cancer. Persistent bloating, a swollen abdomen, feeling full after eating very little, pelvic or abdominal discomfort, and needing to pass urine more often.
The distinguishing feature is not the symptom itself but its persistence. Symptoms that are new, continue most days for more than two or three weeks, and are not explained by anything else deserve investigation.
There is no reliable screening test for ovarian cancer in the general population. CA 125 is a blood test used to monitor known disease and to help assess an ovarian mass. It is not a screening test, and a normal result does not rule cancer out.
Diagnosis
Pelvic ultrasound, a CT scan of the abdomen and pelvis, and a CA 125 blood test. Together these establish how likely a mass is to be cancer and how far it has spread.
The surgery
Ovarian cancer surgery is more extensive than the other two, because this cancer spreads across the surface of the abdominal cavity rather than in a single direction. The operation typically removes the uterus, both ovaries and tubes, the omentum which is the fatty apron covering the intestines, and takes samples from the lymph nodes and the lining of the abdomen.
The aim is to leave no visible disease behind. How completely the disease is removed is one of the most important factors in the outcome, which is why these operations are longer and more thorough than patients expect.
In some patients, chemotherapy is given first to shrink the disease, with surgery performed after a few cycles. This is a deliberate strategy, not a fallback.
In carefully selected young women with very early disease confined to one ovary, fertility-preserving surgery is sometimes possible. Raise this at the first consultation if it matters to you, because it cannot be revisited afterwards.
Cervical cancer
How it usually presents
Bleeding between periods, bleeding after intercourse, bleeding after menopause, or a persistent watery or blood-stained discharge. Early cervical cancer often causes no symptoms at all, which is why screening exists.
Cervical cancer is one of the few cancers that can be prevented. Regular Pap or HPV testing detects changes before they become cancer, and HPV vaccination reduces the risk substantially.
Diagnosis
Examination and a biopsy of the cervix, followed by an MRI of the pelvis to establish how far the tumour extends. The MRI is what determines whether surgery is appropriate.
The surgery, and when surgery is not the treatment
For early-stage cervical cancer, the operation is a radical hysterectomy, which removes the uterus, cervix and the tissue surrounding it, along with the pelvic lymph nodes. In very early disease in a woman who wants to preserve fertility, a smaller operation removing only the cervix may be possible.
For early cervical cancer, current evidence supports performing radical hysterectomy through open surgery rather than key-hole. This is one of the few areas where laparoscopic surgery has been shown to give poorer cancer outcomes, and any surgeon offering you key-hole radical hysterectomy should be able to explain why in your specific case.
For locally advanced cervical cancer, surgery is not the primary treatment. Chemotherapy combined with radiotherapy is, and it works as well as surgery would in that setting. If you have been told you need chemoradiation rather than an operation, that is the correct treatment, not a lesser one.
What applies to all three
Removing the ovaries causes menopause
If your ovaries are removed before natural menopause, menopause begins immediately and the symptoms are usually more abrupt than a natural transition. Hot flushes, sleep disturbance, mood changes and long-term effects on bone density.
Whether hormone therapy is safe for you depends on the type of cancer. Ask before surgery rather than discovering the answer afterwards.
Fertility
Most of these operations end fertility. Where fertility preservation is possible, it applies only to specific early-stage situations and must be planned before surgery. If this matters to you, say so at the first appointment, clearly and early.
Recovery
Laparoscopic surgery usually means two to three days in hospital and around three to four weeks to normal activity. Open surgery, particularly extensive ovarian surgery, means a longer stay and around six weeks.
Avoid heavy lifting for six weeks. You will be advised on when it is safe to resume intercourse, usually after about six weeks.
The pathology report decides what comes next
The final stage is confirmed one to two weeks after surgery. Chemotherapy, radiotherapy or observation is decided from that report. Nothing is settled before it.
Follow-up
Regular examination and, where relevant, blood tests and scans on a defined schedule for several years. Report any new bleeding, pain or swelling between appointments rather than waiting for the next one.
Questions worth asking
- Which organs will be removed, and will my ovaries be among them?
- Will this operation put me into menopause, and can I take hormone therapy afterwards?
- Is fertility preservation possible in my case?
- Should chemotherapy come before surgery?
- Will my surgery be laparoscopic or open, and why that choice?
- What is the plan if the pathology comes back at a higher stage?
Frequently asked questions
I have bleeding after menopause. Does that mean cancer?
Usually not. There are several non-cancerous causes. But it is the main warning sign of uterine cancer and should always be investigated rather than watched.
Is there a test to screen for ovarian cancer?
No reliable one for the general population. CA 125 is used to assess and monitor known disease, not to screen, and a normal level does not exclude cancer.
Can gynaecologic cancer surgery be done by key-hole?
For most uterine cancers, yes. For ovarian cancer it depends on the extent of disease. For early cervical cancer, open radical hysterectomy is currently the preferred approach based on evidence.
Will I go into menopause after the surgery?
If both ovaries are removed and you have not already reached menopause, yes, and it starts immediately.
Can I still have children afterwards?
Most of these operations end fertility. Fertility-preserving options exist for certain very early cancers only, and must be discussed before surgery.
I have been advised chemotherapy and radiotherapy instead of surgery for cervical cancer. Is that worse?
No. For locally advanced cervical cancer, chemoradiation is the standard treatment and is as effective as surgery would be. It is the right treatment for that stage.
Consultation
Dr. Ripudaman Singh Lubana holds a Fellowship in Surgical Oncology from Tata Memorial Centre and HBCHRC, Punjab, and a University Diploma in Minimal Access Surgery from IRCAD, France. He has performed over 3500 cancer surgeries and more than 200 laparoscopic gynaecologic surgeries.
He consults at Doctor Square Hospital on VIP Road Zirakpur, Trinity Hospital in Zirakpur, Curasia Hospital in Dhakoli, and Adesh Medical College Hospital in Mohri, Ambala Cantt.
Bring your scans, biopsy report and any previous gynaecologic records. Call 8054173528 to arrange a consultation.
This page is for patient education. It is not a diagnosis, a prognosis or a treatment plan. Treatment of uterine, ovarian and cervical cancer differs for every patient depending on the type, stage and individual health. Every patient is examined and assessed individually before any treatment is advised.
