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Radical Hysterectomy
A radical hysterectomy is an operation to remove the cervix,
the corpus of the uterus, top one-third of the vagina,
pelvic lymph nodes and surrounding tissues for women with
cancer of the cervix. It is sometimes also performed for
cancer of the corpus of the uterus if it is suspected
that the cancer has spread to the cervix. More tissue
is removed than in a standard hysterectomy and hence it
takes longer to perform, and the side-effects are potentially
greater.
Cancer of the cervix may spread, usually by direct extension
into nearby tissues, such as the uterus, or the lymph
nodes. This is why these tissues need to be removed. These
are shown in Figure
5. Your ovaries will
not routinely be removed unless previously agreed with
your consultant, or if there is concern that they may
be involved by the cancer. This is rarely the case.
This operation will have been carefully discussed with
you and you should have access to a Clinical Nurse Specialist.
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Before the operation
To ensure you are medically prepared for this operation,
you may be required to have:
· X-ray
studies of your kidneys
· A
special scan called an ‘MRI’
· A
chest x-ray
These will be organised and explained to you by your Consultant
and/or members of the supporting multidisciplinary team.
You will be asked to attend pre clerking to ensure the
necessary investigations have been performed and to again
explain the actual procedure again before you are admitted
to hospital, and answer any questions you may have. A
Clinical Nurse Specialist should be available for you
to discuss any issues to do with your diagnosis or operation
at any time.
If you usually take important medicines (for example heart,
blood pressure or diabetic medications) in the morning,
ask your doctor whether or not you are to take them on
the morning of your surgery. Pain relief following your
operation will be discussed with you by the anaesthetist
looking after you the morning of your surgery. An epidural
may be recommended to reduce your discomfort after the
operation or a small pump (PCA, patient controlled analgesia,)
which administers pain killers into your vein when you
press a button. A full explanation will be given at pre
clerking and once you are admitted to hospital. At pre
clerking, you will be informed of when you are to be admitted
and will have an opportunity to see the ward. You may
be visited by the physiotherapist to explain about post-operative
exercises for your chest, legs and tummy.
Your partner or significant others are welcome and encouraged
to join you for any of these discussions or orientations.
After the operation
You may be nursed in a high dependency area or with an
individual nurse for the first night post-operatively.
Gradually over the next few days food and drink are re-introduced.
A catheter is inserted at the time of surgery and left
in place for up to a week to allow the bladder to rest.
The bladder is very closely related to the cervix and
is always affected to some degree following a radical
hysterectomy.
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Side effects
With any surgery there are risks of bleeding and infection.
You may well require a blood transfusion during or after
radical hysterectomy, this is not considered unusual.
The main side effects may be:
· Changes
in bladder function.
· Changes
in feeling during intercourse.
· Constipation
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Bladder function
Following this type of surgery, you may find you need
to go to the toilet more frequently. Sometimes the sensation
of bladder fullness is reduced and you may be less aware
of having a full bladder. If this happens, it is important
to get into the habit of going to the toilet at regular
intervals – perhaps four times per day. The nursing
staff will be able to help with any such bladder problems.
Occasionally (approximately 5% of cases) injury to the
bladder or the ureters may occur during or after radical
hysterectomy
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Changes in feeling with intercourse
(sex)
We recommend no intercourse for 6 weeks whilst healing
occurs. Resuming gentle intercourse following this is
entirely up to you. Although the top 1/3 of the vagina
is removed, this shortening of the vagina should not affect
intercourse.
Following this operation, many women worry about intercourse
being painful and are concerned about resuming sex. In
the beginning, gentle penetration in a position which
is comfortable for you, is recommended. Sometimes, creams
such as Replens (from a chemist) or Astroglide help with
dryness, especially if you feel a little nervous. You
may find your feeling during penetration is a little numb
and orgasm may be different, or difficult to achieve initially.
This should improve with time. Please feel free to discuss
this with your Consultant or Clinical Nurse Specialist.
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General Advice
There may be a reddish or brown watery discharge from
the vagina for several days. This is part of the normal
healing process. The removal of the lymph glands produces
a lot of lymph fluid which usually drains out of the vagina
with some blood. When recovering from any major surgery
adequate rest and nutrition, as well as mild physical
and diversional activities are advisable. A balanced diet
with an emphasis on high protein foods will help to build
your strength and aid healing.The catheter is removed
after 5 to 7 days. Once you are able to pass urine spontaneously
and your bowels have worked, you should be able to return
home.
Your next appointment will be at the Gynaecological Oncology
clinic. Consultant Gynaecological Cancer Specialists,
the Clinical Nurse Specialist and experienced Nurses will
be available to answer any questions you may have. Your
pathology results will be available and will be explained
by your Consultant. This is usually approximately 2-3
weeks after your operation. Approximately 20 % of women
treated in this way require radiotherapy in addition.
This dependes on the pathology results, and your case
will be discussed and treatment plan agreed by the entire
gynaecological oncology multi-disciplinary team.
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Follow-up
You will be advised to attend for follow-up examinations
at this clinic every 3 months for the first year and gradually
reducing to less frequent intervals. Follow-up is usually
for 5 years after treatment. You will see a member of
the Gynaecological Oncology Team. The Clinical Nurse Specialist
is always available at this clinic and at any other time
from now on.
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