Hysterectomy (Salem Health: Cancer)
Cancers treated: Ovarian, uterine, abdominal, Fallopian tube, and cervical cancers; for certain types of breast cancer, a complete hysterectomy or oophorectomy may be required if the type of tumor is estrogen sensitive.
Why performed: In addition to the treatment of cancer, hysterectomy may be performed for abnormal bleeding or hemorrhaging, endometriosis, pelvic pain, dysmenorrhea, ovarian cysts, ovarian tumors, fibroid tumors, prolapsed bladder, prolapsed uterus, bleeding cervical polyps, pelvic floor reconstruction, hyperplasia, abdominal mass, and pelvic inflammatory disease (PID). Hysterectomy may also be advised for patients with colon, bladder, or rectal cancers to help increase their long-term survival.
Patient preparation: Many patients find that doing their own research and getting a second opinion give them valuable information. They may ask their health care professionals for informational pamphlets from Krames Communication or the American College of Obstetricians and Gynecologists. Prior to having a hysterectomy, most patients undergo some of the following procedures: a Pap test and other laboratory tests, pelvic examination, hormone therapy, biopsy, ultrasound, hysteroscopy, electrocardiography (EKG), computed tomography (CT), magnetic resonance imaging (MRI), colposcopy, laparoscopy, colonoscopy, dilation and curettage (D&C), and myomectomy. Some patients have...
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For Further Information (Salem Health: Cancer)
Dennerstein, Lorraine, Carl Wood, and Ann Westmore. Hysterectomy: New Options and Advances. New York: Oxford University Press, 1995.
Jones, Marcia L., Theresa Eichenwald, and Nancy W. Hall. Menopause for Dummies. 2d ed. New York: Wiley, 2006.
Litin, Scott C., Jr., ed. Mayo Clinic Family Health Book. 3d ed. New York: HarperCollins, 2003.
Porter, Robert S., ed. The Merck Manual of Women’s and Men’s Health. 2d ed. New York: Simon & Schuster, 2006.
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Indications and Procedures (Magill’s Medical Guide, Sixth Edition)
The term “hysterectomy” comes from the Greek hystera, meaning “uterus,” and ektome, meaning “to cut out.” While hysterectomy refers to the removal of the uterus and, most commonly, the attached Fallopian tubes, there are several types of hysterectomies. Total hysterectomy, contrary to popular belief, does not mean that the ovaries are removed with the uterus. Rather, the term indicates the removal of the uterus and cervix. Subtotal, or partial, hysterectomy is the excision of the uterus above the cervix; the cervix is left in place. Either one or both ovaries may be removed with the uterus (unilateral oophorectomy or bilateral oophorectomy). Salpingo-oophorectomy refers to the removal of one of the Fallopian tubes along with the accompanying ovary, while bilateral salpingo-oophorectomy refers to the removal of both Fallopian tubes and ovaries.
Indications for hysterectomy can be divided into noncancerous and cancerous conditions. Within the noncancerous category, the most common indication for hysterectomy is symptomatic fibroids. Many women have fibroids, and the majority of fibroids do not cause symptoms and can be left alone. Symptomatic fibroids are those which are large enough to cause pressure symptoms in the pelvis, compress the bladder or rectum, or cause pain or discomfort during intercourse. Another type of symptomatic fibroids are those which cause excessively heavy...
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Uses and Complications (Magill’s Medical Guide, Sixth Edition)
Hysterectomy can be used to provide relief from pressure, pain, and bleeding from the uterus. It may also be curative in the early stages of uterine cancer and can increase survival in later stages. For women who are finished with childbearing and whose lifestyles or responsibilities do not allow them to try more conservative treatments, many of which require several months to take effect, hysterectomy can provide definitive relief from symptoms within the defined time period needed to undergo scheduled surgery. In cases of life-threatening uterine hemorrhage, hysterectomy can save a woman’s life.
The common complications of hysterectomy are those which are common to many major surgeries. One complication is excessive blood loss. The average blood loss during a hysterectomy is estimated at between 400 and 500 cubic centimeters (about a pint). When removal of the uterus is difficult, for instance because of the position of large fibroids, increased blood loss is likely to occur. When excessive blood loss is of concern, the patient’s blood levels may be checked during the procedure. A patient who is significantly anemic may receive blood transfusions to avoid poor oxygenation of the major organs and to increase blood volume, and hence avoid shock. The number of transfusions depends on the amount of blood estimated to be lost. If a blood vessel continues to bleed after the patient leaves the operating room, then the...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
In ancient times, the complaints of women and the illnesses of the female organs were viewed as coming from an “unhappy uterus.” It was believed that the uterus had the primary purpose of childbearing and that, when the uterus was not occupied with this function, it might show its wrath by abnormal bleeding and pain. These beliefs prevailed for centuries; early medical history indicates that women’s gynecologic complaints were largely ignored. Moreover, no safe surgical procedures had been developed.
A noteworthy event in early American medical history was the operation attempted and documented by a frontier physician and surgeon, Ephraim McDowell. In 1809 in Danville, Kentucky, this daring young doctor carried out experimental surgery on a middle-aged woman to remove a huge ovarian tumor. Without the benefit of anesthesia and a sterile technique, he performed successful abdominal surgery on four out of five other patients.
Myomectomy, or removal of a fibroid tumor of the uterus, was the next procedure to be performed—first in France and later (about 1850) in Massachusetts by Washington Atlee. The first hysterectomy was successfully performed by Walter Burnham in the same decade, but he lost twelve of his next fifteen hysterectomy patients. In the text Operative Gynecology (1898), Howard A. Kelly of Baltimore describes one hundred hysterectomies that he performed in the late nineteenth...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Clark, Jan. Hysterectomy and the Alternatives: How to Ask the Right Questions and Explore Other Options. Rev. ed. London: Vermilion, 2000. Discusses the treatment of uterine fibroids and menstrual disorders and offers alternatives to radical hysterectomy.
Dennerstein, Lorraine, Carl Wood, and Ann Westmore. Hysterectomy: New Options and Advances. 2d ed. New York: Oxford University Press, 1999. This popular work on hysterectomy addresses all aspects of the procedure. Includes a bibliography and an index.
Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 12th ed. New York: Lange Medical Books/McGraw-Hill, 2006. Provides concise summaries of gynecologic problems that could lead to hysterectomy.
Moore, Michele C., and Caroline M. de Costa. Do You Really Need Surgery? A Sensible Guide to Hysterectomy and Other Procedures for Women. New Brunswick, N.J.: Rutgers University Press, 2004. A guide for patients. Discusses anatomy, physiology, gynecological disorders, diagnosis, alternative treatments, and various surgeries.
Stenchever, Morton A., et al. Comprehensive Gynecology. 5th ed. St. Louis, Mo.: Mosby/Elsevier, 2007. One of the definitive textbooks in the field of gynecology. It outlines in an objective and complete manner the indications for hysterectomy and the various types of hysterectomy. Also describes appropriate...
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Hysterectomy (Encyclopedia of Medicine)
Hysterectomy is the surgical removal of the uterus. In a total hysterectomy, the uterus and cervix are removed. In some cases, the fallopian tubes and ovaries are removed along with the uterus (called hysterectomy with bilateral salpingo-oophorectomy). In a subtotal hysterectomy, only the uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries, oviducts, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends on the reason for the procedure. In all cases, menstruation stops and a woman loses the ability to bear children.
Hysterectomy is the second most common operation performed in the United States. About 556,000 of these surgeries are done annually. By age 60, approximately one out of every three American women will have had a hysterectomy. Yet it's estimated that 30 percent of hysterectomies are unnecessary.
About 10% of hysterectomies are performed to treat cancer of the cervix, ovaries, or uterus. Women with cancer in one or more of these organs almost always have the organ(s) removed as one part of their cancer treatment.
The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are non-cancerous (benign) growths in...
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Hysterectomy (Encyclopedia of Surgery)
Hysterectomy is the surgical removal of all or part of the uterus. In a total hysterectomy, the uterus and cervix are removed. In some cases, the fallopian tubes and ovaries are removed along with the uterus, which is a hysterectomy with bilateral salpingo-oophorectomy. In a subtotal hysterectomy, only the uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries, oviducts, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends on the reason for the procedure. In all cases, menstruation permanently stops and a woman loses the ability to bear children.
The most frequent reason for hysterectomy in American women is to remove fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are non-cancerous (benign) growths in the uterus that can cause pelvic, low back pain, and heavy or lengthy menstrual periods. They occur in 300% of women over age 40, and are three times more likely to be present in African-American women than in Caucasian women. Fibroids do not need to be removed unless they are causing symptoms that interfere with a woman's normal activities.
Treatment of endometriosis is the reason for 20% of hysterectomies. The endometrium is the...
(The entire section is 2387 words.)