A Radical Hysterectomy or Wertheim's Hysterectomy is an operation performed to treat cancer affecting the uterine cervix.

The cervix is the lower one-third of the uterus or womb. When cells in the cervix grow abnormally, a tissue mass called a tumor forms. Tumors can be benign or malignant. Benign tumors are localized to one place and are not capable of spreading into surrounding tissues. Malignant tumors can spread or metastasize and interfere with normal tissue function.

Malignant tumor cells can spread directly into nearby tissues, through lymphatic (drainage) channels, or through the bloodstream. When cancer of the cervix spreads, it is usually by direct extension into nearby tissues, such as the uterus, or through the lymphatic system.

More tissue is removed in radical hysterectomy than in a standard hysterectomy because this surgery is designed to treat not only the malignant tumor in the cervix, but also the adjacent areas into which the tumor may have spread.

The uterus and cervix, nearby supporting tissues, the innermost part of the vagina, and pelvic lymph nodes are removed in radical hysterectomy. All tissues are examined carefully under a microscope to determine precisely the extent of the disease. The ovaries may or may not be removed at the time of surgery and this should be discussed clearly with your attending doctor when planning the surgery.

When you are referred to the Gynecological Cancer Centre (GCC) at KK Women's and Children's Hospital (KKH), your care is coordinated by one of our attending doctors. They are all specialists in gynecological oncology and staff members of the Gynaecological Oncology Unit.

Your attending doctor will review your medical history and do a physical examination. He or she will review your laboratory results, as well as pertinent past medical records.

You may be asked to have a chest X-ray and CT scan to determine if the cancer has spread to other organs. Your attending doctor will discuss the findings and alternative methods of treatment with you. Your family are welcome and encouraged to join you for any of these discussions. When all your questions are answered, admission to the hospital will be planned.

Our GCC staff as well as ward nurses are trained in caring for women with gynecological cancer. They will look after you throughout your hospitalization and recovery from surgery.

Our social worker is available to meet with you to discuss a variety of topics, including social and psychological support and financial concerns.

You will become acquainted with several doctors during your hospital stay. In addition to your attending doctor, who will perform the surgery, the resident medical offers (doctors receiving advanced training), house officers, anaesthetists, physiotherapists and medical students will comprise the team involved in your care.

The day before surgery, our resident doctors will meet with you to review the plans initiated by your attending doctor and answer any questions. You may have routine urine and blood studies, as well as a chest X-ray and ECG (electrocardiogram), at this time.

The anaesthetist will examine you and discuss the surgical anaesthetic. He or she will order medications for sedation before surgery, including sleeping medicines for the night before, if you wish.

You may be prescribed a drink to clear you bowels the day before surgery. This is to avoid contamination during surgery. You may have a regular dinner (unless special instructions are given), but nothing to eat or drink after midnight, not even water.

If you usually take important medicines (for example, heart, blood pressure, or diabetic medications) in the morning, ask your doctor whether or not you are to take them (with a sip of water) on the morning of your surgery.

The physiotherapist will teach you breathing exercises that prevent lung congestion and leg exercises that improve blood circulation while you are less active. You will be encouraged to walk soon after surgery because activity stimulates the body's return to normal function.

Your family and close friends are welcome and encouraged to visit you during visiting hours. During your surgery, they will be directed to the waiting area in the ward.

With any surgery there are risks of bleeding, infection and unusual anaesthetic reactions. You may require blood transfusions during or after radical hysterectomy.

In radical hysterectomy, there may be additional risks related to the area of the surgery. There may be damage to the organs next to the surgical site - bowel, bladder, ureters (tubes that drain urine from the kidneys to the bladder) - or to the large blood vessels and nerves. Blood clot formation, nerve damage, prolonged leg swelling and damage to the urinary tract, with resultant urine drainage through the vagina, may occur, but are rare.

A radical hysterectomy usually takes about 3 hours, followed by 2 or 3 hours for recovery from the anaesthetic. Patients after radical hysterectomy are routinely transferred to the intensive care ward or post-operative area for the first one or two days for close monitoring.

As you awaken, you will become aware of the nurse checking your condition frequently. Your blood pressure, pulse, and temperature will be monitored, and you will have an intravenous (IV) line until you are able to drink and eat normally.

One or two tubes may be placed on either side of the incision to drain excess fluid from the surgical site. These will be attached to suction bottles. You may also have a catheter in your bladder to drain urine. Do not be alarmed if you have a nasal tube or are receiving oxygen or a blood transfusion upon awakening. These therapies are common following major surgery. Antibiotics are generally given before and sometimes following surgery to prevent post-operative infection.

You will be encouraged to take deep breaths and to cough deeply every two or three hours to prevent lung congestion. Nurses will help you to turn periodically in bed and to exercise your feet and legs gently to maintain good circulation.

Special compression leg covers or periodic injections of a blood-thinning medicine (heparin) are used to prevent the formation of blood clots. These are discontinued when you are able to walk. You will be urged to sit on the edge of the bed within 24 hours after your surgery and to begin walking as soon as possible.

Your doctors will order pain relief medications for you, as these activities may be uncomfortable after surgery. Your nurse will work with you to schedule medications for adequate pain control, balanced with rest and increasing activity.

After abdominal surgery bowel function normally is sluggish, due to the anaesthetic and surgical exploration. As bowel function returns, you can begin to drink and eat. When your diet advances to regular meals, intravenous fluids will be discontinued.

Persistent slowed bowel function following radical hysterectomy may be caused by the unavoidable cutting of tiny nerves at the surgical site. Dietary management (daily prune juice, high fiber or high bulk diets) or other bowel programs (stool softener medications or mild laxatives) may help prevent difficulties. Increased fluid intake also helps improve bowel function. Once your normal diet and activity are resumed, bowel function usually returns to normal.