There are many tests and imaging procedures used to look for the existence of cancer, but a biopsy (i.e., tissue sample) is often the only sure way to know. Many women diagnosed with gynecologic cancer are candidates for surgery as their primary treatment.

Surgical removal of a tumor significantly increases a woman’s chances of survival. The role of the surgeon is to evaluate the size and location of the tumor, and to remove as much of the tumor as possible while preserving as much healthy tissue as possible.

The period leading up to your surgery can be a daunting time, but there are many useful preparations and strategies that can help you improve your outcome as well as your outlook.

Lifestyle Preparation

If you smoke, you will need to stop smoking because of the risks related to anesthesia and the healing process. Get plenty of exercise so that you are in good shape for surgery.

Eat a healthy diet and choose light foods for the days leading up to your surgery. Your doctor will likely instruct you to only drink liquids during the 24 hours prior to the procedure. You should also have a good bowel movement the day before surgery. To ensure that you do, you may use an enema or mild laxative.

Planning Ahead

Choose a friend or family member who can be around to help and coordinate your care before, during, and after surgery. You should plan to be in the hospital for three to five days after surgery, unless your surgeon tells you to expect otherwise.

It is important you get a good night’s sleep before your surgery. If you are anxious the night before, you can take an over-the-counter sleep aid (if you are already on a nerve medication such as diazepam, please contact your primary care doctor for instructions).    

Many patients do not recall being in the operating room, because the medications given during surgery cause amnesia. You will be connected to monitors. After this, you will be given a blood thinner to prevent you from getting blood clots, and antibiotics to prevent a wound infection. Once the anesthesiologist has put you to sleep, your surgeon will begin.

Initially, an operation is often necessary to make an accurate diagnosis and determine how advanced the cancer is. The surgeon will try to determine how large the tumor has grown and whether it has spread to nearby structures or distant organs. Of particular interest are lymph nodes, which are bean-sized collections of immune system cells to which cancers often spread first.

Debulking

The primary goal is to remove as much of the cancer as possible, which may involve performing “debulking” surgery, which includes the removal of your intestines, bladder, spleen, and portions of the stomach, liver, or other organs.

However, to prevent unnecessary node removal and additional procedures, surgeons will often perform a procedure known as a sentinel node biopsy, which use dyes to make it easier to locate lymph nodes where the cancer has spread.

This strategy is often used in vulvar cancer and increasingly in endometrial and cervical cancers. Sentinel node biopsies also help prevent lower leg swelling, which can happen when lymph nodes are removed during gynecologic surgery. 

Minimally invasive surgery, or laparoscopy, is increasingly used in treating gynecologic cancers, often with the assistance of a robotic system. Robotic surgery can give surgeons improved control and precision during intricate procedures, and requires only a few small incisions, as opposed to larger, open surgeries.

Minimally invasive procedures, with or without robotic assistance, can result in fewer surgical complications, less pain, reduced blood loss, decreased chance of infection, less scarring, and shorter hospital stays.

For endometrial (uterine) cancer—the most common gynecologic cancer—the vast majority of patients are eligible for minimally invasive surgery, but this approach may not be right for all gynecologic cancer patients.

Open surgery may be required, depending on the cancer and its stage. Women with ovarian cancer in particular are more likely to be treated with an open surgery, as they are often diagnosed with later stages where the cancer has spread.

After surgery, you will be taken to the recovery room, where you will wake up from anesthesia. Once awake and stable, you will be given water or juice. In most cases, you will have a small tube in your bladder to measure how much urine you are producing and how well your kidneys are functioning. You may also be given oxygen. You will have an IV drip in your arm providing fluids. You will be placed back on your regular medications—with the possible exception of some diabetes, blood pressure, and blood thinner medications.

Medication

You’ll likely be given medications to control your pain. It is common to develop occasional crampy pain and bloating in the abdomen after surgery. This is caused by gas building up in the intestines. The discomfort is usually temporary and will resolve after passing gas or having a bowel movement. Some patients are helped by non-prescription gas-relief medications. Pain or discomfort should improve over time. 

Recovery Period

It is normal to feel tired for a day or two after surgery, especially if general anesthesia was used. However, while rest is important, it is also important to walk around several times a day, starting on the day of surgery. This helps to prevent complications, such as blood clots, pneumonia, and gas pains.

You can resume your normal daily activities as soon as you are comfortable doing them. Walking and stair climbing are fine. Gradually increase your activity level as you are able. Your surgeon can give you specific instructions.

You may return to work when pain is minimal and you are able to perform your job. After minor procedures, you may be able to work within a day or two, while for major procedures, you may require four to six weeks to recover. 

Digestion

After surgery, you will likely be given chewing gum up to three times a day to help get your bowels moving. Recent research has shown that gum chewing makes bowel contents travel through faster. Your initial bowel movements may become loose, or you may be constipated. However, for the vast number of patients, this will get back to normal with time.

You may eat and drink normally after gynecologic surgery. You may have a decreased appetite for the first few days after surgery. Eating small, frequent meals or bland, soft foods may help. A high fiber diet may help to prevent constipation, although other treatments for constipation are also available.

Make sure you eat nutritious meals, drink plenty of fluids, and take regular walks in the first two weeks after your operation. However, if you are not able to eat or drink anything or if vomiting develops, call your healthcare provider. 

Follow Up

Most women will have a follow up appointment with the surgeon two to six weeks after surgery. At this visit, the doctor will usually examine your abdomen and pelvic area to be sure that the tissues are healing properly.

You will be informed about your results if you had a biopsy or tissue removed, and you can ask questions about the procedure or your healing process. 

Fatigue after gynecologic surgery is common. Helping out with everyday physical tasks, such as grocery shopping, cooking, and cleaning, are sure to be greatly appreciated. At the same time, it is good for you to gently ramp up physical activity when ready. Family and friends should know that offering to go for a walk with you is positive encouragement.