Specialist uterine cancer surgery with advanced techniques including hysterectomy, lymph node assessment and minimally invasive procedures when appropriate.
Surgery is a major part of treatment for many women with uterine cancer. The operation may involve removal of the uterus and cervix, along with the fallopian tubes and ovaries, depending on your diagnosis. Lymph node assessment may also be performed to check whether cancer has spread beyond the uterus. The exact procedure depends on the type of cancer, its grade, stage and other findings from your investigations.
Dr. Priya Bhati specialises in gynaecologic cancer surgery and has expertise in open, laparoscopic and robotic-assisted procedures. For women with suitable early-stage disease, minimally invasive surgery may be considered. When more extensive surgery is required, the procedure is planned around the location and extent of the cancer rather than simply choosing the least invasive option.
Uterine cancer refers to cancers that develop in the uterus. The most common type begins in the lining of the uterus and is known as endometrial cancer.
Abnormal vaginal bleeding is one of the symptoms that can lead to investigation, particularly bleeding after menopause. Other symptoms can include unusual vaginal discharge, pelvic pain or pressure, although symptoms can vary.
Once cancer is suspected or diagnosed, the next step is not simply deciding whether surgery is needed. Your doctor needs to understand the type of cancer, its grade and whether there is evidence that it has spread.
These details influence both the operation and what treatment may be recommended afterwards.
For many women with endometrial cancer, surgery is the main treatment. It allows the surgeon to remove the uterus and, when indicated, assess nearby structures and lymph nodes.
The tissue removed during surgery is examined by a pathologist. The final pathology report can provide important information about:
This information helps establish the final stage and can influence whether additional treatment such as radiation therapy, chemotherapy, hormone therapy or other systemic treatment is recommended.
The most common surgical procedure for endometrial cancer is a total hysterectomy.
A total hysterectomy removes:
Depending on the individual case, the operation may also include removal of both fallopian tubes and ovaries, known as bilateral salpingo-oophorectomy.
The operation may also include assessment of the lymph nodes to determine whether cancer has spread outside the uterus.
Not every woman needs exactly the same operation. The extent of surgery depends on the pathology, stage, risk category and findings before and during the procedure.
That is why a specialist gynaecologic oncology assessment is important when surgery for uterine cancer is being planned.
A hysterectomy for cancer is different from a hysterectomy performed for a benign condition such as fibroids.
In cancer surgery, the objective is not simply to remove the uterus. The operation must also provide appropriate surgical staging and avoid compromising cancer treatment.
For early-stage endometrial cancer, current guidelines recommend total hysterectomy with removal of both tubes and ovaries, together with appropriate lymph node staging. Minimally invasive surgery is preferred for many patients when it is oncologically suitable.
In selected situations where the cervix or surrounding tissues are involved, a more extensive operation may be required.
The surgical plan is therefore made after considering the complete clinical picture rather than using the same procedure for every patient.
Sometimes.
Cancer cells from the uterus can spread through the lymphatic system. Checking lymph nodes can help determine whether the disease has moved beyond the uterus.
Depending on your cancer characteristics, your surgeon may recommend:
Sentinel lymph nodes are the first lymph nodes to which cancer may drain.
During sentinel node mapping, specific techniques are used to identify these nodes so they can be removed and examined by a pathologist.
Current ESGO guidance recommends sentinel lymph node biopsy for staging in patients with presumed uterus-confined disease.
In selected higher-risk situations, removal of additional pelvic or para-aortic lymph nodes may be appropriate.
The decision depends on factors such as tumour type, grade, depth of invasion, molecular and pathological findings and the suspected extent of disease.
The purpose is accurate staging and treatment planning. More extensive lymph node surgery is not automatically necessary for every woman.
Many women diagnosed with early-stage uterine cancer may be candidates for minimally invasive surgery.
This can include:
Instead of one large abdominal incision, laparoscopic and robotic procedures use several smaller incisions.
Current ESGO guidance identifies minimally invasive surgery as the preferred surgical approach for many stage I and II endometrial cancers, including selected high-risk cases, provided the disease and patient factors make the approach appropriate.
Potential advantages can include smaller incisions, less postoperative discomfort and a shorter recovery compared with open surgery in appropriately selected patients.
However, minimally invasive surgery is not automatically the right choice.
If imaging or other findings suggest disease outside the uterus, a different surgical approach may be necessary. Cancer safety comes before choosing a particular surgical technique.
Laparoscopic hysterectomy allows the uterus and other required tissues to be removed through small abdominal incisions using specialised instruments and a camera.
For appropriately selected patients, laparoscopy can provide a minimally invasive route for hysterectomy and surgical staging.
The suitability of laparoscopy depends on:
The aim is to achieve appropriate cancer surgery while avoiding unnecessary surgical trauma.
Robotic-assisted surgery is another minimally invasive option for selected women.
A robotic system does not perform the surgery independently. The surgeon controls the instruments throughout the operation.
Robotic technology can provide enhanced visualisation and instrument movement during complex pelvic procedures. It may be particularly useful when precise dissection is required in confined areas of the pelvis.
Dr. Priya Bhati is a trained and certified robotic surgeon and has specialist expertise in robotic-assisted gynaecologic cancer surgery. Her official Amrita profile lists robotic-assisted gynae cancer surgery and laparoscopic gynae oncology surgery among her areas of expertise.
However, robotic surgery is not automatically recommended simply because the technology is available. The cancer, stage and surgical requirements determine whether it is appropriate.
Before surgery, you may undergo several investigations to understand the cancer and plan the operation.
These may include:
Your pathology report is particularly important.
The grade and type of endometrial cancer can influence the risk of lymph node involvement and the need for additional staging procedures.
In some situations, existing pathology slides may also need specialist review before treatment is finalised.
Cancer stage describes how far the disease has spread.
A cancer that appears confined to the uterus may be treated very differently from cancer that has spread to lymph nodes or other organs.
For this reason, treatment planning involves more than identifying the presence of cancer.
Your doctor needs to consider:
These findings help determine the extent of surgery and whether additional treatment should follow.
Cervical involvement can change the surgical plan.
Some patients may still undergo hysterectomy with appropriate staging, while more extensive surgery may be considered in selected circumstances.
The decision depends on the extent of cervical involvement and whether clear surgical margins can be achieved.
Current guidance does not recommend automatically performing an extensive radical procedure simply because the cervix is involved. The operation should be based on what is required to achieve appropriate cancer control.
Not all uterine cancers behave in the same way.
Some histological types and high-grade cancers carry a greater risk of spread or recurrence.
Examples of higher-risk histologies include:
These cancers may require more extensive staging and may be followed by additional treatment.
The final treatment plan is based on the complete pathology and staging information rather than the word "uterine cancer" alone.
Not every woman needs additional treatment after surgery.
Once the operation is completed and the final pathology is available, your medical team can determine the risk of recurrence and whether further treatment is appropriate.
Depending on the cancer, additional treatment may include:
The need for further treatment can depend on stage, tumour type, grade, lymph node findings and other pathological or molecular features.
This is one reason surgery and pathology are closely connected in uterine cancer care.
This is an important question for women who have not completed their families.
A standard hysterectomy removes the uterus, which means pregnancy cannot occur after the procedure.
For selected younger women with specific early-stage, low-risk endometrial cancers, fertility-sparing treatment may sometimes be considered instead of immediate hysterectomy.
However, this is not appropriate for every uterine cancer.
Fertility-preserving treatment requires careful assessment of the cancer type, grade, stage and other factors. Close monitoring is also required.
If preserving fertility is important to you, discuss it with your gynaecologic oncologist before starting treatment.
Do not delay cancer treatment without specialist advice.
Recovery varies depending on the type and extent of surgery.
Women undergoing minimally invasive surgery may recover differently from those undergoing open abdominal surgery.
After surgery, your team will monitor:
Your activity will usually be increased gradually.
The time required before returning to work and normal activities depends on the operation performed, your overall health and how your recovery progresses.
Your doctor will give you specific instructions regarding exercise, lifting, driving and sexual activity.
If both ovaries are removed before natural menopause, you may experience surgical menopause.
Symptoms can include:
Whether the ovaries need to be removed depends on factors including age, cancer type and risk.
This is an important discussion to have before surgery, particularly for younger women.
Uterine cancer surgery involves more than performing a hysterectomy.
A gynaecologic oncologist is specifically trained in the surgical management and staging of cancers affecting the female reproductive system.
This can be particularly important when:
Dr. Priya Bhati completed her MCh in Gynaecologic Oncology at Christian Medical College, Vellore, after training in Obstetrics and Gynaecology and working in gynaecologic oncology at CMC Vellore and PGIMER Chandigarh. She currently works as an Associate Professor in Gynaecologic Oncology at Amrita Hospital, Kochi.
Her listed areas of expertise include gynaecologic cancer surgery, robotic-assisted cancer surgery and laparoscopic gynaecologic oncology surgery.
Uterine cancer treatment may involve more than one specialist.
At Amrita Hospital, Kochi, gynaecologic cancer cases are discussed through a multidisciplinary tumour board involving specialists from areas such as medical oncology, radiation oncology, radiology and pathology. Genetic counselling and other supportive services are also available when indicated.
This can be particularly useful when treatment decisions are more complex or when surgery needs to be considered alongside chemotherapy or radiation.
Before scheduling surgery, you may want to ask:
Having these questions answered before treatment can help you understand what the operation is intended to achieve and what decisions may follow it.
A diagnosis of uterine cancer can raise many questions, especially when surgery is being discussed.
Dr. Priya Bhati provides specialist gynaecologic oncology care in Kochi, with expertise in cancer surgery, laparoscopic procedures and robotic-assisted gynaecologic cancer surgery.
The surgical approach is selected according to the cancer and the treatment objective, with appropriate staging and postoperative planning considered as part of the overall treatment.
If you have recently been diagnosed with uterine or endometrial cancer, or have been advised to undergo surgery, a specialist consultation can help you understand your diagnosis and the available surgical options.
1. What is the most common surgery for uterus cancer?
For many women with endometrial cancer, the main operation is a total hysterectomy, often with removal of both fallopian tubes and ovaries. Lymph node assessment may also be performed depending on the cancer characteristics.
2. Is hysterectomy always required for uterine cancer?
Hysterectomy is the standard surgical treatment for many endometrial cancers, but treatment depends on the type, stage, grade and individual circumstances. Selected women with certain early, low-risk cancers may be considered for fertility-sparing treatment.
3. Can uterus cancer surgery be done laparoscopically?
Yes. Minimally invasive surgery is preferred for many women with stage I and II endometrial cancer when it is oncologically appropriate.
4. Can uterine cancer surgery be performed robotically?
Robotic-assisted surgery may be an option for selected patients. It is a minimally invasive technique controlled entirely by the surgeon.
5. Will my ovaries be removed during uterus cancer surgery?
Removal of the ovaries depends on factors such as your age, cancer type, stage and risk. Your surgeon will discuss whether ovarian removal is appropriate before surgery.
6. Why are lymph nodes checked during uterine cancer surgery?
Lymph node assessment helps determine whether cancer has spread beyond the uterus and can contribute to accurate staging and decisions about further treatment.
7. What is sentinel lymph node mapping?
Sentinel lymph node mapping identifies the first lymph nodes that cancer cells are likely to reach. These nodes can then be removed and examined for cancer. ESGO currently recommends sentinel lymph node biopsy for staging in presumed uterus-confined disease.
8. What happens if cancer is found in the lymph nodes?
Lymph node involvement can change the stage and may influence whether chemotherapy, radiation or other treatment is recommended after surgery.
9. Will I need chemotherapy after uterus cancer surgery?
Not necessarily. The need for chemotherapy depends on the final stage, tumour type, grade and other risk factors identified through pathology and staging.
10. Will I need radiation after surgery?
Some women may require radiation after surgery, while others may not. The decision is based on the risk of recurrence and final pathological findings.
11. Can I preserve my fertility after a diagnosis of endometrial cancer?
Fertility-sparing treatment may be possible for carefully selected women with certain early, low-risk endometrial cancers. It requires specialist assessment and close follow-up.
12. Is open surgery better than laparoscopic surgery for uterine cancer?
The surgical approach depends on the cancer and the individual patient. Minimally invasive surgery is preferred for many suitable patients, but open surgery may be necessary when the disease or surgical requirements make it more appropriate.
13. How long does uterus cancer surgery take?
The duration varies according to the type and complexity of the operation, including whether lymph node assessment or other procedures are required.
14. How long does it take to recover from uterus cancer surgery?
Recovery depends on whether the surgery is laparoscopic, robotic or open and on the extent of the operation. Your surgeon can give you a more specific estimate after assessing your planned procedure.
15. What should I bring to my consultation?
Bring your biopsy or pathology report, scan reports and images, previous medical records, medication list and details of any previous cancer treatment. If you have already received a treatment recommendation, bring those documents as well.
16. Should my pathology report be reviewed before surgery?
In some cases, specialist pathology review can be useful, particularly when the diagnosis or tumour type is complex. Your gynaecologic oncologist can advise whether additional review is appropriate.
17. Can uterine cancer spread outside the uterus?
Yes. Uterine cancer can spread to lymph nodes and other tissues. The possibility of spread is assessed through examination, imaging, pathology and appropriate surgical staging.
18. What if the cancer has already spread?
Treatment depends on where the cancer has spread and the type of uterine cancer. Surgery may still have a role in selected cases, while chemotherapy, radiation, hormone therapy or other systemic treatments may also be considered.
19. Is uterus cancer surgery possible after menopause?
Yes. Uterine cancer occurs commonly after menopause, and surgery is an important treatment for many women who are medically suitable for an operation.
20. When should I see a gynaecologic oncologist?
If you have been diagnosed with uterine or endometrial cancer, have an abnormal biopsy suggesting cancer, or have been advised to undergo cancer surgery, consulting a gynaecologic oncologist can help with staging and treatment planning.
MBBS, M. Ch. (Gynaecologic Oncology), MD (Obs & Gynae)
Senior Consultant - Gynae Oncologist and Robotic Surgeon, Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala
Dr. Priya Bhati is a Senior Consultant Gynae Oncologist and Robotic Surgeon at Amrita Institute of Medical Sciences, Kochi. She specialises in the treatment of gynaecological cancers and complex gynaecological conditions, with expertise in cancer surgery, robotic-assisted surgery and laparoscopic surgery. With years of experience at leading institutions such as CMC Vellore and PGIMER Chandigarh, she brings extensive surgical experience along with a caring and patient-focused approach.
Dr. Priya has completed her M.B.B.S. from Kasturba Medical College, Mangalore, M.D. in Obstetrics & Gynecology from Goa Medical College, and M.Ch. in Gynaecologic Oncology from Christian Medical College, Vellore. She treats women with different types of gynaecological cancers and also performs complex benign gynaecological surgeries and advanced procedures such as CRS and HIPEC.
She believes that every patient deserves to understand her condition and treatment clearly. Along with treating gynaecological cancers, Dr. Priya also focuses on prevention and early detection, including HPV vaccination and preventive gynaecologic care. Her goal is to provide personalised treatment while making patients and their families feel informed, comfortable and supported throughout their care.
I was very scared when I came to know about my cancer. Dr. Priya Bhati explained everything clearly and told me what we should do next. I am really thankful for her support.
Dr. Bhati is very patient and listens to all your doubts. She explained my reports in simple words and did not make me feel rushed. I felt much better after talking to her.
We met Dr. Priya Bhati for my mother’s treatment. She explained the surgery properly and answered all our questions. We felt that she really understood our concerns.
I was worried about having surgery, but Dr. Bhati explained the procedure and what to expect. She was very calm and supportive. I am happy that we consulted her.
Dr. Bhati gave us enough time during the consultation and explained the treatment options clearly. She also listened to what we wanted to know. Very good doctor and a very positive experience.
After my diagnosis, I was confused about what to do next. Dr. Bhati went through my reports and explained everything step by step. Her guidance gave me confidence to start my treatment.