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Endometrial Cancer

normal endometrial cavity
Normal lining of the womb at hysteroscopy

Endometrial cancer is cancer arising from the womb lining. It is the commonest gynaecological cancer and tends to occur after the menopause but a small minority do occur in young women. When it occurs after the menopause, the commonest complaint is that of an unscheduled vaginal bleed or vaginal discharge. The vast majority of women with these symptoms do not have a cancer. Only about 10 to 20% do. However, it is very important that all episodes of unexpected bleeding after the menopause should be discussed with your doctor so that a decision can be made whether you need a referral to a gynaecologist to investigate the possibility of cancer. This usually involves a pelvic ultrasound scan to measure the thickness of the womb lining and a biopsy from the womb lining which can sometimes be taken at the clinic consultation (similar to a smear test). Often the biopsy from the womb lining requires an initial hysteroscopy (telescope into the womb cavity) to look for any polyps and then a “scrape” at the end of the procedure which produces a small amount of tissue which can be examined under the microscope. This hysteroscopy can require a general anaesthetic but can sometimes also be done as an outpatient procedure.

endometrial polyp
Polyp on the womb lining

The treatment for womb cancer is a hysterectomy. At this operation the ovaries are also removed and depending on the grade of the cancer and the results of the MRI scan beforehand, lymph glands from the pelvis and para-aortic areas are also taken. After the surgery, some women will require further treatment in the form of radiotherapy and some will require chemotherapy. However, this is all decided after the final results from the hysterectomy are back.

This form of hysterectomy is especially amenable to the robotic technique. One of the main risk factors for womb cancer is obesity. Overweight women produce excess oestrogen hormone which stimulates the womb lining and, in time, progresses to cancer. Pelvic surgery in overweight women can be challenging even when carried out using the conventional open technique through a bikini cut. These women are also prone to having wound infections and deep vein thrombosis. These complications can be minimised if the surgery can be achieved by a keyhole technique.

wound infection
Infection of a bikini wound

Whilst this could be achieved using the conventional laparoscopic techniques,  it can be very tiring for the surgeon who is then more prone to making mistakes or cause more bleeding or tissue trauma leading to more post-operative pain and slower recovery. These difficulties are almost virtually eliminated using the robot which does all the difficult work of lifting the heavy abdominal wall! It means that reduced gas pressures can to be used to inflate the abdomen to allow the surgeon to see the pelvic structures. This reduced pressure is crucial to help the anaesthetist maintain adequate oxygen in the lungs and get rid of the carbon dioxide.

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