Two Types of Hysterectomies Used for Treating Endometrial/Uterine Cancer

00:00:00:00 – 00:00:17:23
Unknown
hello. Welcome to our webinar mini webinar with Dr. Tiffany Lai, and I am Corby Arthur, the SHARE Uterine Cancer patient support coordinator.

00:00:18:00 – 00:00:50:15
Unknown
Dr. Ly will be talking about different surgeries for uterine cancer. The short before she begins, I need to tell you about share shares and national nonprofit that supports, educates and empowers anyone who has been diagnosed with women’s cancers and provides outreach to the general public about the signs and symptoms. Because no one should have to face uterine, ovarian, cervical or breast cancers alone.

00:00:50:17 – 00:01:37:11
Unknown
For more information about upcoming webinars, support groups and our helplines, please visit our website at Share Cancer Support dot org. And let me give you a little background about Dr.. She is a health sciences assistance clinical professor in Oncology GYN. We’re going oncology at the University of California in which is UCLA. She completed her medical degree in GYN and and residency at the University of Hawaii and she is a was a gynecological oncology fellowship fellow at UCLA.

00:01:37:13 – 00:02:12:20
Unknown
Dr. Lai’s clinical and research interests include hereditary cancers, targeted and novel therapeutics in gynecological cancers, palliative care and comprehensive care for women with gynecologic cancers. And with that, hello doctors like, so nice to see Corby. Nice to see you and thank you so much for having me. So let’s get into it. So what kind of surgeries do you do for endometrial uterine cancer?

00:02:12:22 – 00:02:35:10
Unknown
Yeah. So primarily the goal of surgery for endometrium cancer is kind of twofold. One is treatment or removing the cancer, and the second is diagnostic to see where the cancer has spread, if at all. And so generally, surgery will include a hysterectomy, which means removal of the uterus, cervix, and then usually removal of the fallopian tubes and ovaries.

00:02:35:12 – 00:03:01:07
Unknown
And then we also do what’s called staging procedure. So usually removal of the lymph nodes in the pelvis, and that is for pathologists to be able to analyze the specimen and see if there is spread of any cancer. So there’s kind of two main ways that we can approach surgery. And the probably more common way right now is to do a minimally invasive approach.

00:03:01:07 – 00:03:26:17
Unknown
So using laparoscopy or robotic surgery. And that allows for a better overall recovery time, smaller institutions. And it also allows us to kind of see things a little bit more clearly, especially on the robotic platform, as well as do something called sentinel lymph nodes, meaning that we just remove one lymph node from each site during surgery or during a hysterectomy.

00:03:26:18 – 00:03:50:24
Unknown
The goal of surgery is to remove the tumor. We also would like to, as much as possible, remove the tumor or the uterus in one piece. And so occasionally, for whatever reason, if the uterus is very large or if we are concerned about extra uterine disease or a disease that has spread outside of the uterus, we will make a larger incision.

00:03:51:01 – 00:04:15:12
Unknown
So that could be like an up and down decision or or incision or a side to side incision like a C-section to be able to remove the entire tumor in one piece. The differences between the two. So, like I said, with the minimally invasive approach, generally there are smaller incisions. And I can go ahead and just share a couple of pictures with you, if that’s okay.

00:04:15:17 – 00:05:07:03
Unknown
Yeah, I’d love that. Okay. So generally in a laparotomy. Okay. So meaning which means a bigger incision, it can either be an up and down incision, which is more common or a horizontal incision. And with this type of incision, we have more access and a better visibility of you know, the entire abdomen and pelvis. And in general, these surgeries are reserved for patients who have, like I said, bigger uteruses or other findings where we would be concerned and feel the need to explore the entire abdomen and pelvis as opposed to minimally invasive surgery with laparoscopy or robotic surgery.

00:05:07:04 – 00:05:34:14
Unknown
There are a few. Usually about 4 to 5 smaller incisions, each, measuring about a centimeter or so in the upper abdomen usually. And this is how we’re able to access the abdomen. I will stop sharing now. So the difference between the two approaches is the length of surgery as well as the length of recovery or the the actual recovery time.

00:05:34:16 – 00:06:08:07
Unknown
Usually someone with a laparotomy or a bigger incision will usually require staying in the hospital for a few days for recovery. Whereas I would say the majority of patients who receive a robotic or laparoscopic surgery are able to go home on the same day. In total, we generally still say that recovery takes about 6 to 8 weeks. But as you can imagine, with smaller incisions, the pain associated with surgery is a little bit less than with a bigger incision.

00:06:08:09 – 00:06:41:22
Unknown
and so tell me more about post surgery. What should patients know? Like what? What will they be going through and maybe what they can do to mitigate side effects from that? So, you know, in general, I would say people will do pretty well after surgery, aside from some pain and cramping. You know, some of the other things that patients can experience after pelvic surgery and undergoing general anesthesia is it can slow down the bowels quite a bit.

00:06:41:22 – 00:07:04:02
Unknown
And so one of the side effects that people can experience is constipation. Sometimes people can have kind of changes or discomfort with urination and that can be because, you know, a Foley catheter may be placed in the in the bladder at the time of surgery. We also can work very closely to the bladder at the time of surgery.

00:07:04:02 – 00:07:29:04
Unknown
And so there tends to be some inflammation in that area, which takes some time to improve. With laparoscopy or robotic surgery, we do fill the abdomen with air to help us allow to see kind of the different structures that we need to. And so, you know, women can experience bloating and feeling full, and that usually takes a few weeks to resolve and things that we can help.

00:07:29:06 – 00:07:56:20
Unknown
So staying mobile or active after surgery, walking helps kind of healing after surgery as well as helping the bowels improve and as well as staying on a stool softener or laxative just to help with bowel movements after surgery. Thank you. Maybe they’ll cut this out. Darling, I’m going to close the door and sit outside so I can finish this interview.

00:07:56:22 – 00:08:05:02
Unknown
Would you do that?

00:08:05:04 – 00:08:11:18
Unknown
And so you met my granddaughter. She’s very cute.

00:08:11:20 – 00:08:49:23
Unknown
I mean, make sure I ask the question. do you ever start with. This was a question today we got. Do you ever start with laparoscopy and then have to change your mind, like during the surgery? So, yes, that’s that can happen for a number of reasons. So, you know, occasionally, I’d say if, you know, we are concerned about extensive disease or cancer that is spread outside of the uterus, we generally only like to do surgery if we feel that we can remove it all.

00:08:50:00 – 00:09:35:09
Unknown
And if there is a question about that and, you know, imaging and other things may not necessarily be predictive of what we see in the operating room, sometimes people will try to do a laparoscopy first just to kind of assess what things look like inside of the abdomen before making a decision to make a bigger incision. Occasionally, even if there is no disease outside of the uterus or no cancer outside of the uterus, and we attempt to do things laparoscopically or robotically if there is a lot of scar tissue from, say, prior surgeries or, you know, infectious processes in the abdomen, if we encounter something that we, you know, that is unexpected, which can happen

00:09:35:09 – 00:10:06:09
Unknown
at the time of surgery, sometimes that does mean that we need to make a bigger incision, and that’s mainly for safety as well as to achieve the goals of surgery, which is to remove all of the cancer. Is this so this is that after the surgery is when you really stage everything. So yeah, So after surgery. Exactly. After surgery, all of the tissue that was removed gets sent to the pathologists where they’re able to kind of do all of their tests, analyze everything.

00:10:06:11 – 00:10:29:00
Unknown
And then we get a report back saying, you know, what their findings were if they found cancer just limited to the uterus or sometimes cancer in the ovaries or the lymph nodes or other biopsies that we took at the time of surgery. And that will give us the stage. And then what other information will the patient probably receive after surgery?

00:10:29:02 – 00:10:56:13
Unknown
So the patient will receive not only the stage, but we also have some understanding in terms of exactly what type of endometrium cancer there is. And, you know, to some extent, we do understand a little bit of that with a biopsy prior to surgery, but we get a confirmation of the type of the material cancer. So there’s different types based on what the cancer cells look like under the microscope.

00:10:56:15 – 00:11:23:00
Unknown
The other thing is that pathologists are now and we are now running what’s called molecular profiling, meaning that we take a look and see what types of proteins are specifically addressing your type of cancer. And so some of these may be linked to hereditary disorders. And so if there is, you know, a testing on the tumor that is suggestive of a hereditary disorder at that time, we would usually recommend genetic testing.

00:11:23:02 – 00:11:51:02
Unknown
And then it also looks at a number of other protein expression that may help us, you know, especially in the future, as endometrial cancer studies are now moving more towards a targeted approach. We are starting to classify endometrium cancers into different molecular classifications, and that gives us a better understanding of how best to treat endometrial cancer after surgery as well as prognosis.

00:11:51:04 – 00:12:31:02
Unknown
And I guess another thing I wanted to ask was like when when does a patient come back to see you or to see the doctor? And so in general, and everyone’s practices may differ a little bit, slightly. I like to see my patients at about 1 to 2 weeks after surgery, and that really is just to check in on how the patient is feeling after surgery, if there’s any issues, as well as to review the pathology reports in detail and talk about what further steps need to be taken in terms of treatments, if there are any.

00:12:31:04 – 00:12:46:03
Unknown
And then I usually like to see patients about six weeks after surgery, and that really is to do a pelvic exam because after a hysterectomy there is an incision at the top of the vagina. And so that’s really just to make sure that everything is healing.

00:12:46:03 – 00:12:49:20
Unknown
wonderful. I think that all the questions that I

00:12:50:08 – 00:12:50:23
Unknown
have

00:12:51:19 – 00:12:57:20
Unknown
now and so I want to thank you very much, Dr. Love, for your time and your information.

00:12:57:20 – 00:13:02:01
Unknown
You’re very welcome. And thank you for having me. This is really nice to be able to do with you.