Developing cancer after a hysterectomy is possible, but the risk is highly dependent on the extent of the surgical procedure performed. Hysterectomy, the removal of the uterus, eliminates the possibility of typical endometrial cancer, as the organ where this malignancy originates is no longer present. However, the female reproductive system includes several adjacent organs and tissues. Whether these structures were removed or preserved dictates the remaining cancer risk and long-term gynecological health outlook.
Defining the Types of Hysterectomy
Hysterectomy is a term that covers several different surgical procedures, each defined by the specific organs or tissues that are removed from the pelvic cavity. The degree of removal directly influences which potential cancer risks are eliminated and which remain. A supracervical or partial hysterectomy is the least extensive type, where the main body of the uterus is removed, but the cervix is intentionally left intact.
In contrast, a total hysterectomy involves the removal of both the uterus and the cervix. This procedure is often chosen to eliminate the risk of both uterine and cervical cancer. The ovaries and fallopian tubes may or may not be removed during a total hysterectomy.
Removal of the fallopian tubes is called a salpingectomy; removal of the ovaries is known as an oophorectomy. A total hysterectomy with bilateral salpingo-oophorectomy (BSO) is the most extensive common procedure, removing the uterus, cervix, fallopian tubes, and ovaries. The decision to remove the ovaries is often weighed against the risk of surgically induced menopause, especially in younger women.
Residual Cancer Risk After Uterine Removal
Even after the uterus is removed, malignancies can still arise in the remaining tissues of the pelvic region. One significant residual risk is cervical cancer, which remains a possibility for anyone who has undergone a supracervical hysterectomy, as the cervix is still present. For these patients, continued adherence to regular Pap smears and human papillomavirus (HPV) testing is necessary for early detection and prevention.
For those who have had a total hysterectomy, a small, specific risk is the development of vaginal cuff carcinoma. This rare malignancy occurs at the very top of the vagina where the uterus was surgically detached. The vaginal cuff is a potential site for cancer, particularly in individuals with a history of HPV infection or cervical precancerous conditions.
If the ovaries and fallopian tubes were preserved during the hysterectomy, the risk for ovarian cancer and fallopian tube cancer remains, as the organs themselves are still present. However, even in cases where a BSO was performed, removing both ovaries and tubes, the risk is not entirely eliminated. This is due to the possibility of primary peritoneal carcinoma.
Primary peritoneal carcinoma is a cancer that begins in the peritoneum, the thin layer of tissue that lines the abdomen and pelvis, and its cells are structurally similar to those found on the surface of the ovaries. This malignancy behaves and is treated much like ovarian cancer, and it represents a continued, albeit low, risk even after the entire female reproductive tract has been removed.
Recognizing Symptoms That Require Follow-Up
Since the primary symptom of uterine cancer—abnormal vaginal bleeding—is eliminated after the uterus is removed, patients must learn to recognize other, less obvious signs of potential pelvic malignancy. Any new or unexplained vaginal discharge, particularly if it is watery, bloody, or persistent, should be reported to a healthcare provider immediately. This symptom can sometimes indicate a problem at the vaginal cuff or another gynecological issue.
Persistent pelvic pain or a feeling of pressure that does not resolve should also prompt a medical evaluation. Symptoms that mimic digestive or urinary issues can sometimes be associated with peritoneal or ovarian cancers. These non-specific symptoms are frequently overlooked, making reporting them to a doctor especially important.
Non-Specific Symptoms
- Chronic bloating.
- Feeling full quickly when eating.
- Changes in bowel habits like constipation.
- Frequent or difficult urination.
Pain experienced during sexual intercourse that is new or worsening should be discussed with a specialist. Maintaining regular annual gynecological examinations is necessary, even after all reproductive organs have been removed. If the cervix was retained in a supracervical hysterectomy, continued routine Pap testing is required to screen for cervical cancer.