Is there still a risk of cancer after a hysterectomy?

Sometimes I get asked from patients why it would be possible to develop gynaecological cancer if “nothing is down there anymore”. This article explains how the risk of gynaecological cancers after a hysterectomy depends on the specific type of hysterectomy performed and the extent of reproductive organs and tissue removed.

There are different types of hysterectomy:

  • Total Hysterectomy: This involves the removal of the uterus and cervix. The term “Total” does not inform about whether ovaries or fallopian tubes are or have been removed.
  • Subtotal or Supracervical Hysterectomy: This involves the removal of the uterus but leaves the cervix intact. I would suggest this is a suboptimal type of hysterectomy.
  • Total Hysterectomy with Bilateral Salpingo-Oophorectomy (radical hysterectomy): In addition to the removal of the uterus and cervix, this procedure includes the removal of both ovaries and fallopian tubes.
  • Radical hysterectomy: This type is used to treat cancers or severe endometriosis and includes the removal of a safety margin for severe endometriosis or gynaecological cancer.

illustration of a uterusA hysterectomy may be a reasonable or necessary option to treat various medical conditions. Here are some common reasons for undergoing a hysterectomy:

  • Cancer: Hysterectomy may be recommended if there is a diagnosis of cancer in the uterus, particularly endometrial, cervical or ovarian cancer or uterine sarcoma.
  • Uterine Fibroids: Large or multiple uterine fibroids that cause symptoms such as pain, heavy bleeding, or pressure on surrounding organs.
  • Uterine Prolapse: When the uterus descends into the vaginal canal due to weakened pelvic floor muscles, causing discomfort or other symptoms.
  • Endometriosis: In severe cases of endometriosis, where the tissue that normally lines the uterus grows outside the uterus.
  • Adenomyosis: This is a condition where the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus. It can cause pain and heavy bleeding.
  • Chronic Pelvic Inflammatory Disease: Severe or recurrent pelvic inflammation that does not respond to other treatments.
  • Abnormal Uterine Bleeding: If other treatments for abnormal uterine bleeding, such as medications or procedures, are not successful, a hysterectomy may be considered.

It's important to note that when performing a hysterectomy it does not eliminate the risk of all types of gynaecological cancers.

Endometrial Cancer: If a total hysterectomy is performed, the risk of endometrial cancer is virtually excluded, as the uterus, where endometrial cancer originates, is removed. However, if a subtotal or supracervical hysterectomy is performed (leaving the cervix intact), there is a small risk of developing endometrial cancer in the remaining cervical tissue.

Cervical Cancer: If the cervix is retained during a (subtotal) hysterectomy, the risk of cervical cancer remains. Women and people with a cervix aged 25 to 74 years of age are recommended to have a Cervical Screening Test every 5 years through their healthcare provider to monitor the health of the cervix and detect any abnormal changes.

Ovarian Cancer: During a hysterectomy the ovaries can be removed or preserved. The risk of ovarian cancer is reduced if both ovaries and fallopian tubes are removed during the hysterectomy. If the ovaries are left intact, there remains a risk of ovarian cancer. Preserving the ovaries maintains the ongoing production of hormones, such as oestrogen and progesterone. Preserving ovaries is recommended in younger women who are not at increased risk of ovarian cancer. Surgically induced menopause at a younger age can increase the risk for osteoporosis, cardiovascular problems or dementia.

Women who plan to or have undergone a hysterectomy should discuss their specific risks with their surgeon to discuss if a personalised follow-up plan needs to be developed.

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