Fallopian Tube Cancer Treatment

My career path has been full of surprises. Growing up in a small town in northern Pennsylvania, I thought I wanted to be a lawyer. It wasn’t until college that I found a passion for science courses and considered a career in medicine. Eventually, I found a passion for gynecologic oncology.

Another surprise? Experiencing just how hot Houston gets in the summer on my first visit to MD Anderson. But while the heat may have made the first impression, the people and community here were what made a lasting impression.

I’ve always known about MD Anderson. It's the No. 1 cancer center in the nation and its Gynecologic Oncology and Reproductive Medicine department is the oldest and first department of gynecologic oncology in the country. But what I was struck by were the people. The department was full of luminaries in the field who were amazing, normal, nice people, colleagues and friends. I was hooked.

Today, I work alongside those same people treating women with gynecologic cancers and training the next generation of gynecologic oncologists.

Art and science combine in my clinical practice

In my clinical practice, I treat women with all types of gynecologic cancers.

When I meet a patient for the first time, it's important for me to get to know them as a person. We discuss how treatment might impact them and their lives, and decide the best option based on their health history, goals and values. That's where the art of medicine comes in with the science. The real beauty of medicine is figuring out the right treatment for that person.

People are not computers or machines; each of us is a little bit different. Oftentimes, treatments affect how a person lives their life. Not everybody wants to live the same way or has the same goals. Our job is not only to help cure cancer but to treat individual people and make their lives better. That might look different for each patient, and that's where getting to know someone helps us develop a treatment plan for that woman.

A particularly special distinction about being here is that MD Anderson has a unique ability to take care of women with rare gynecologic cancers. Some hospitals may see these rare gynecologic cancers every few years; my team sees them all the time. That allows us to give excellent care for women with rare tumors.

Each of our physicians specializes in our own niche of rare tumors. My area of expertise is in two rare cancers: gestational trophoblastic disease, which can arise from abnormal pregnancies, and ovarian germ cell tumors, a rare type of ovarian cancer that normally occurs in younger women.

Another thing that makes gynecologic oncology unique is that doctors perform surgery and administer chemotherapy and systemic therapies. For other cancers, patients may need to see multiple doctors to receive their treatments. But here, the same doctor can administer medical and surgical aspects of gynecologic cancer care, and relationships with patients deepen as a result.

Educating the next generation of cancer specialists

Since finishing my training, I've always been involved in the education of medical students and residents. But it wasn’t until I came to MD Anderson that I was able to be part of a fellowship program and help OB-GYN fellows take the next step to become gyn-oncologists. I was previously the Gynecologic Oncology Fellowship director and recently recognized nationally by the Society of Gynecologic Oncology as a surgical mentor.

Mentoring these excited, motivated fellows and hearing their fresh ideas and perspectives motivates me. Showing trainees how to do what I do gives me a real sense of accomplishment and pride. I also get to identify their strengths and learn what they're really good at and help promote that.

You see people grow over the course of our four-year fellowship. Fellows come here to train, and it's like a booster rocket taking them to that next stage. The fellows that graduate from the program know how to take care of women with gynecologic cancers and conduct great research. They hit the ground running to be leaders both in their institutions and in our society. When I see them go forward and do wonderful things clinically, in research, and in education, it's a real source of pride.

Clinical trials and collaboration set MD Anderson apart

While we do a great job of taking care of many cancers, there's still a lot to be learned. The only way we're going to advance the field and figure out how to truly cure every woman with gynecologic cancer is by doing clinical trials. Treating patients at MD Anderson allows for access to trials found nowhere else. Here, we're on the forefront of trials from very early drug development to Phase III trials.

There are many reasons I feel it's important for patients to have access to clinical trials. There have been studies in gynecologic cancers showing that women who enroll in clinical trials do better than those that don't. Clinical trials allow patients access to possibly lifesaving and life-extending care and drugs that might not yet be available. Often, these are targeted therapies designed to target specific mutations their cancers may have.

MD Anderson is set up in a way that allows us to do really amazing cutting-edge research. Within our department alone, we have nurses, research data coordinators, physician-scientists and basic scientists who work together to identify areas of research and ways that we can help cure cancer. The physicians who are designing and running these trials are right down the hall from me. We also have research nurses that are embedded in our clinic, and all of our staff have experience enrolling patients in clinical trials.

Because MD Anderson only focuses on cancer care, everyone here has the same mission and is pulling in the same direction. Today, I collaborate with world-renowned experts in gynecologic pathology and gynecologic imaging, as well as surgical oncologists, medical oncologists and doctors who specialize in early drug or Phase I studies.

All of the best in the world are here at MD Anderson. If I have a question or need help for a patient, I know that I can reach out to someone who is top in their field, and – like I experienced years ago – they're also the nicest people.

Request an appointment at MD Anderson online or call 1-877-632-6789.

“Partial hysterectomy” is one of those phrases that isn’t very specific. It’s not always clear what the term means. So, most doctors try to avoid using it. 

But when people speak of a partial hysterectomy, the scientific term for what they’re describing is usually a supracervical hysterectomy. That’s a procedure in which the bulk of the uterus is surgically removed, but the cervix is left behind.

So, why might you need this type of procedure? How will it affect your menstrual cycle? And will you still be able to conceive or carry a child naturally after having one?

Here’s what I tell my patients about partial — or supracervical — hysterectomies.

How does a partial hysterectomy differ from a “full,” “complete” or “radical” hysterectomy? 

• A partial or supracervical hysterectomy removes the bulk of the uterus but leaves the cervix intact.
• A full or complete hysterectomy removes the uterus and the cervix.
• A radical hysterectomy removes the uterus, cervix and upper vagina, as well as some of the tissue surrounding the cervix.

But removal of the ovaries and fallopian tubes is considered a separate surgery. I feel like it’s important to mention that here. Because sometimes, people mistakenly think all the other pelvic organs are removed during a hysterectomy, too. They are not.

When is a partial hysterectomy necessary in cancer treatment?

A partial hysterectomy is used quite rarely in cancer treatment. Any surgical treatment related to endometrial cancer is going to call for a full hysterectomy.

But we do have some data indicating it can be safe for certain patients with ovarian cancer if removing their cervix would increase the risk of prolapse, bladder injury or other complications. 

Are there any other types of cancer that partial hysterectomies can treat?

The only other one I can think of would be peritoneal cancer, under certain circumstances. But it wouldn’t be safe to leave any uterine tissue behind if someone has endometrial cancer. So, those situations would require a total hysterectomy.

Are there any other non-cancerous reasons to have a partial hysterectomy?

Yes. Partial hysterectomies are often used to treat uterine fibroids, or leiomyoma.  

What are the benefits of a partial hysterectomy?

There’s the potential for better sexual function, if you retain the cervix. In theory, that’s because it doesn’t disrupt as many of the nerves and ligaments as a full hysterectomy. But that’s still a somewhat controversial topic.

The other possible benefit is avoiding complications like prolapse and incontinence. If I’m performing surgery on someone with ovarian cancer, for instance, and they’ve got a lot of scar tissue around their cervix, I might opt to leave it alone, because I don’t want them to have any issues with their bladder.

What are the risks of a partial hysterectomy?

If cancer is present in the uterus or cervix, we could potentially leave it behind if we don’t remove the entire organ. That’s why we don’t typically recommend this procedure.

What happens to the other reproductive structures after a partial hysterectomy? 

The ovaries and fallopian tubes are still attached to the abdominal walls by other ligaments. So, they don’t need any additional securing. But when we sew the vagina back together, we usually attach it to the uterosacral ligament to make sure it stays in the proper position.

A hysterectomy is a common procedure used to treat gynecologic cancers, like ovarian cancer, cervical cancer and endometrial cancer, and other health conditions impacting the uterus. But there are still many myths surrounding this type of surgery. And, if you need a hysterectomy, you may have anxiety or questions about long-term side effects, including the impact on your fertility.

We spoke with gynecologist oncologist Jolyn Taylor, M.D., about what patients planning for a hysterectomy should expect.

What is a hysterectomy?

A hysterectomy is a surgery to remove a patient’s uterus. There are a few types of hysterectomies:

• Total hysterectomy: Removal of the uterus and cervix
  
• Supracervical hysterectomy: Removal of the uterus only
• Simple hysterectomy: Removal of the uterus and cervix, but not the tissue adjacent to the cervix (called parametria) or the upper vagina. This is the most common type of hysterectomy.
• Radical hysterectomy: Removal of the uterus, cervix, upper part of the vagina and supporting tissues adjacent to the cervix called the parametria

Removal of a fallopian tube is known as a salpingectomy. Removal of an ovary is known as an oophorectomy. Removal of both a fallopian tube and an ovary is a salpingo-oophorectomy. Some patients may have both fallopian tubes and/or both ovaries removed. 

It is important to talk to your surgeon about whether your ovaries should be removed at the time of hysterectomy. This decision will be based on your age, the reason you are having the hysterectomy and other medical factors. All women, however, should have their fallopian tubes removed if they are undergoing hysterectomy. This has been shown to decrease the risk of ovarian cancer later, and fallopian tubes have no impact on ovarian or hormonal function.

Hysterectomies may be performed through either:

• open surgery, also called a laparotomy with one larger incision, or
  
• a minimally-invasive, laparoscopic or robotic hysterectomy performed through multiple smaller incisions

Patients should talk to their health care provider to see which type of procedure is right for them. Most cervical cancer patients should avoid a minimally invasive hysterectomy, as studies show this could increase the risk of recurrence.

Who needs a hysterectomy?

A hysterectomy is a part of the standard treatment for patients who have been diagnosed with cervical, endometrial or ovarian cancer. However, some women who wish to try to get pregnant in the future may have the option for conservative therapy that does not involve a hysterectomy. Some women may need a prophylactic hysterectomy to reduce their chances of developing cancer in the future if they have been diagnosed with some hereditary conditions.

Outside of cancer care, hysterectomies are performed to treat uterine fibroids, heavy vaginal bleeding, some uterine prolapse, endometriosis (when the tissue that lines the uterus grows outside of the uterus) or adenomyosis (when the tissue that lines the uterus grows inside the walls of the uterus where it doesn’t belong) that are unable to be controlled through non-surgical means.

Are there any risks?

Often, especially when used for cancer treatment, a hysterectomy is performed along with other procedures, so the risk is specific to each individual patient. It’s important that you talk to your doctor about your risks.

What should patients expect during a hysterectomy?

Patients receive general anesthesia before a hysterectomy. During the procedure, the surgeon will remove the uterus through an incision in the abdomen or the vagina. Surgery can last anywhere from one to three hours. It may take longer if the surgeon is doing additional procedures.

How long does it take to recover from a hysterectomy?

Historically, recovery from a hysterectomy was a difficult process, but thanks to efforts like MD Anderson’s Enhanced Recovery Program, patients who have a minimally invasive or open hysterectomy both recovery relatively rapidly. But the experience does vary depending on which type of procedure you have. Patients who have an open radical or simple hysterectomy can expect to be in the hospital one to four days. Patients who have a minimally invasive hysterectomy will be able to leave the hospital as early as the same day as the procedure.

Regardless of the type of hysterectomy, patients should expect to be up and walking around the same day as the surgery. Patients often experience discomfort at the incision site for about four weeks. Patients should refrain from any heavy lifting for six weeks and from being fully submerged in water, using tampons, having sex or placing anything in the vagina until their doctor says they’ve healed.

What type of long-term side effects should a patient expect?

Patients who have had a hysterectomy will not be able to become pregnant, so it’s best to consider the hysterectomy relative to your goals surrounding fertility. Outside of fertility, patients will not experience any long-term side effects. A common myth is that hysterectomies cause patients to experience early menopause, but this is not true as hormonal function comes from the ovaries.

Will a patient still have a period after a hysterectomy?

This is a really frequently asked question. No, a patient who has a hysterectomy will not menstruate. Despite this, a patient who has a hysterectomy will not go into menopause unless the ovaries are removed.

What advice do you have for a patient interested in preserving her fertility?

Any patient who has been told they need a hysterectomy can weigh need for hysterectomy with their reproductive goals with their care team or seek a second opinion. Cancer patients who need a hysterectomy but are interested in preserving their fertility should seek care at a center with an oncofertility program, like MD Anderson. Our oncofertility specialists don’t just treat people with gynecologic cancers. They treat anyone whose cancer may impact their fertility. They can help patients who are considering a hysterectomy weigh their options so they can make the best decision for themselves.

Does a hysterectomy affect sexual function?

No, a hysterectomy alone does not impact sexual function. Recovery from surgery and undergoing therapy for cancer, including possibly going into menopause, however, may impact sexual function. Some hormone therapies used to treat cancer may cause sexual side effects. Patients should share their side effects and concerns with their care team.

Overall, hysterectomies are a safe and effective option for treating several types of cancer, and many patients who have them continue to live normal lives after.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.