Globally, endometrial cancer is the 6th most common type of cancer in 2020(1). Unlike cervical cancer, there is no noninvasive stage with endometrial cancer. During uterine hyperplasia, normal endometrial cells multiple out of control until they build up a cause the uterine wall to thicken. Depending how much that wall has thickened, there is a 5-30% chance of developing endometrial cancer over the next 5-10 years (1). Hyperplasia is not cancer, but it is treated as though it were via surgery or hormonal treatment. This is generally determined based on if the patient is menopausal, or unable to bear children. Endometrial cancer is more likely to affect menopausal women with 65% of cases after the age of 50, and only 4% before the age of 40(1).
If you're interested in the different procedures for treating Endometrium cancer, then read this article from the top down. If you (or someone you know) has gone through this and you are mainly looking to understand recovery, current exercise recommendations through the Cancer Exercise Training Institute (CETI), and what to expect after treatment, then you can scroll to the bottom for those recommendations (As of 2020)
Section 1: Hysterectomy Procedures
Total/Simple Hysterectomy: Removal of the uterus through an incision in the abdomen
Conventional abdominal hysterectomy leaves a 5 inch vertical scar between the belly button and pubic bone. Alternatively, a bikini incision would go side to side.
Hospital stay: 3-7 days
Recovery 6-8 weeks
Vaginal hysterectomy: Removal of the uterus through the vagina
Lymph nodes can be removed by laparoscopy when doing a vaginal hysterectomy
Hospital stay: 1-2 days
Recovery: 2-3 weeks
Bilateral Salpingo-oophorectomy: Removing the ovaries and fallopian tubes. While this is not actually part of a hysterectomy, it is often done during the same operation as a separate procedure.
Laparoscopic Hysterectomy: 3-4 small incisions no more than half an inch long. This is considered minimally invasive creating far less discomfort.
Hospital stay: Usually released the day of
Recovery Period: 1-2 weeks
Radical Hysterectomy: Removal of the uterus and cervix along with the tissues next to the uterus (parametria and the uterosacral ligaments) and the upper part of the vagina next to the cervix
The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so
Surgery is performed through an abdominal incision
Pelvic lymph nodes are often removed as well
Laparoscopic-assisted Radical Vaginal Hysterectomy: Combines both vaginal hysterectomy with a laparoscopic pelvic node dissection
Laparoscopy allows the inside of the abdomen and pelvis to be seen via a tube through small surgical incisions. Small instruments can be controlled through the tube which allows the surgeon to remove lymph nodes without making a large cut in the abdomen. This can make it easier for the surgeon to remove the uterus, ovaries, and fallopian tubes through the vaginal incision
Laparoscopically assisted Radical Hysterectomy with lymphadenectomy: Allows for a radical hysterectomy through the abdomen with lymph node removal happening at the same time.
Potential Side Effects: All Hysterectomy Procedures
Infertility
Unusual bleeding
Wound Infection
Damage to urinary and intestinal systems
Pelvic Pain
Difficulty with bowel movements and urination
Lower extremity lymphedema (Resulting from lymph node removal)
Instant Menopause if ovaries are removed
Infertility, weight gain, increased risk of lymphedema, diabetes, osteoporosis, hot flashes, and night sweats
Current Recommendations for Exercise After a Hysterectomy
Because of the nature of where the incision site is, and the region of organs being removed, exercises that force the abdomen to excessively flex, extend, or rotate are not recommended during the recovery period. A common side effect of any procedure done on the front side of the body includes overtight muscles in the front (chest and abdomen). This causes over lengthening and weakness in the posterior (back) side of your body. After the recovery period (and when your doctor says you're clear to do so) you would want to strengthen the weaker side of your body and gently stretch the tight portions. Pelvic Floor and core exercises will be extremely important to incorporate regularly.
Do: Walking is essential to a smooth recovery and should be done daily
Section 2: Other Procedures
Sentinel Lymph Node Biopsy: Uses a dye that can be traced using imaging in order to see which cancer cells would travel after leaving the uterus. This is called intraoperative lymphatic mapping, or sentinel node mapping. The purpose of this is to try to identify only the lymph nodes that have cancerous cells detected which reduces the total amount of lymph nodes removed.
Side effects include lower extremity lymphedema
Pelvic and Para-aortic lymph node dissection: Removal of lymph nodes from the pelvis and the area next to the aorta to see if they contain cancer cells that have spread from the endometrial tumor. This is often done at the same time as a hysterectomy with lymph nodes removed through the same incision. If a woman has had a vaginal hysterectomy then the lymph nodes can be removed via laparoscopic surgery for a less invasive approach.
Side effects include lower extremity lymphedema
Tumor Debulking: Removing as much of the tumor as possible before radiation and chemotherapy. Tumor debulking is very helpful with other cancers, but it isn't clear yet how effective it is with endometrial cancer and longevity.
Potential side effects: upper and lower extremity lymphedema, nearby organs may be injured, adhesions, digestive problems if stomach is removed, respiratory compromise (lung-lobe removal), instant menopause if ovaries are removed, infertility, constipation, and bladder problems.
Panniculectomy: Also known as a "tummy tuck". This scenario combined both your gynecologic surgeon with a plastic surgeon. The gyno surgeon works to complete the hysterectomy, while the plastic surgeon works on the reconstructive side of the surgery. This is more common when a patient is clinically obese and would have more excess skin after the original procedure.
Potential side effects: Bleeding at the wound site, swelling, scarring, persistent pain, numbness, infection, fluid accumulation, blood clots, and nerve damage
Section 3: Summary
Exercise recommendations are made by thinking about what type of procedure was done, where it was done, and their corresponding recovery times. For uterine cancer, most of the surgical sites happen at the abdomen and the organs removed also reside in the abdominal region. Any time we have an incision or surgical intervention, our instincts are to protect and guard that region afterwards. As we mentioned in the hysterectomy section, this creates an overtight/over contracted section in the anterior of the body, while overstretching/weakening of the posterior side of the body. While the body is healing, we need to avoid adding excessive abdominal pressure. Flexion, Extension, and Rotation in the core does not make sense because that is specifically the region we are trying to heal during recovery. One of the best things you can do is continue to walk as it allows passive movement while still being relatively neutral. If we observe a hunched over position, then gently stretching the abdominal region is recommended. This can be achieved in something as simple as bringing your arms all the way above your head to stretch the abdominals. A hunched position means your back is overextended which makes those muscles imbalanced.
After medical clearance you can start to look into exercises like an upright rowing machine (Key word: UPRIGHT, keep the torso neutral), Cable/Machine rows (light resistance you can easily do 15 times without strain), Anti-Resistance core exercises that are still easy to breath in (something you could easily hold in position for 30 seconds, but no more than 2 minutes), and Pelvic floor exercises. Start modest and then work your way up over time. In the beginning it may feel like you are barely doing anything, but just getting your body through those ranges of motion is very important to regaining pre-surgery posture and function.
Disclaimer: The recommendations for this article are pulled directly from the Cancer Exercise Training Institute (CETI). Although they are the most current research based recommendations, they do not constitute an exercise prescription. You should speak with your doctor prior to engaging in any sort of diet or exercise program. There is no one-size-fits-all approach to exercise, but working with a Medical and/or Cancer exercise specialist and your doctor can help create a one-size-fits-you approach based on your unique situations.
Source(s)
Hyuna Sung PhD. Jacques Ferlay, MSc. ME, Rebecca L. Siegel MPH. Mathieu Laversanne MSc, Isabella Soerjomatara, MD, MSc, PhD, Freddie Bray BSc, MSc, PhD; Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers inn 185 countries. First Publicsed 04 February 2021
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