Endometrial Cancer. Information for patients. Gynaecology Department. Feedback

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1 Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: From a mobile or abroad: ext or Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Endometrial Cancer Information for patients Gynaecology Department This document can be provided in different languages and formats. For more information please contact: If you require a full list of references for this leaflet please or phone ext The Trust endeavours to ensure that the information given here is accurate and impartial. Sue Mills and Julie Cope ext Sally Wright and Julie Golding ext Sue Mills, Gynaecology Department February All rights reserved. Nottingham University Hospitals NHS Trust. Review February Ref: 1223/v3/0216/AS. NUH02017N Public information

2 Macmillan cancer information and support centre Open Monday Friday 8-4pm Ground floor, south entrance Nottingham City Hospital Tel Aim of the leaflet This leaflet is aimed at gynaecological cancer patients. This leaflet aims to give you some information about cancer of the womb (endometrial cancer). Introduction Most cancers of the womb are diagnosed at an early stage and are treated with a full hysterectomy and removal of both ovaries. This can be either a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH, BSO/open cut) or a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH, BSO/keyhole). The options will be discussed with you at your clinic visit. NottGosh (Nottingham Gynae Oncology Support and Help Group) Meetings held last Tuesday of alternate months at Maggies Centre, Nottingham City Hospital, pm All ladies, partners and friends welcome. For further information please contact: Sue Mills & Julie Cope ext We understand that you may be finding this a very difficult time and need support and information. You and your family may have many unanswered questions and we recognise that it can be very distressing to be passed from person to person. At Nottingham University Hospitals we have a team of 2 11

3 Information and support available Free prescriptions People with cancer in England are eligible for free prescriptions. All people undergoing treatment for cancer and the effects of cancer treatment can apply for an exemption certificate by collecting a form FP92A from your GP. Financial advice Financial advice is available from the Benefits Agency (Monday-Friday) Maggie s Centre Based at Nottingham City Hospital. No appointment is required and help is available free of charge; with information, benefits advice, financial advice and psychological support for anyone affected by cancer. gynaecological specialist nurses who are available to see you and offer advice, support and information. They will also give you their contact numbers should you wish to get in touch with them. Investigations You will have the following investigations: Blood tests to check that you are not anaemic and your liver and kidneys are working well Chest x-ray to check that your heart and lungs are healthy Some patients will have an MRI or CT scan A magnetic resonance imaging (MRI) scan uses magnetic and radio waves, to give very detailed pictures of parts of the body. Before going into the scanner you will be asked to remove any metal items you may be wearing. Macmillan cancer support Macmillan produce information booklets on endometrial cancer. These are clearly written and offer up-to-date information. They also offer practical ways of coping with cancer and the emotional effects it has on you and your family. The information booklets are available free to anyone who has cancer as well as their family and friends. Please ask your specialist nurse for a booklet. During this scan you will be asked to lie very still for approximately 30 to 40 minutes. The scan can be very noisy and you will be given headphones to wear. It will take several days to get the results of these tests processed. A computerised tomography (CT) scan takes a series of x-rays which build up a three dimensional picture of the inside of the body. This may take up to 30 minutes and is painless. This scan is used to find the exact area of the cancer, or to check if the cancer has spread. 10 3

4 Enhanced Recovery What is enhanced recovery? It is a progressive approach to planned surgery that ensures patients are in the best condition for treatment, have different care during their operation and experience the best possible post-operative rehabilitation and recovery. Patients on enhanced recovery pathways recover more quickly following surgery, and so can leave hospital and get back to normal activities sooner. The aim of the programme is to enable a quick yet safe recovery from your abdominal surgery. physiotherapist any questions you may have about exercises and what you do when you get home. You can go swimming when your wounds have completely healed. It normally takes about three months to get back to normal after this operation. If you require help when you go home the ward staff or nurse specialist will be able to refer you to social services who will be able to discuss what your needs are. If you have any problems when you get home, the nurse specialist is always available for support and advice. What are the benefits of enhanced recovery? The enhanced recovery programme is about improving patient outcomes and speeding up a patient s recovery after surgery. Our programme focuses on making sure that patients are actively involved in their own recovery process. It also aims to ensure that patients always receive best and proven care at the right time. There are four main parts to our programme: Pre-operative assessment, planning and preparation before admission (including practising your post-operative exercises before you come into hospital). 4 9

5 Everything that is removed during the operation is looked at under the microscope. This usually takes between seven and fourteen days. Your results will be discussed at our multidisciplinary meetings, before we see you back in clinic. You will usually be given a clinic appointment before you leave hospital. Please feel free to bring a friend or relative with you to the appointment. Reducing physical stress of the operation (smaller incisions, unique anaesthetic techniques, reduced time on the operating table). A structured approach to immediate post-operative management, including regular pain relief, prevention of nausea and vomiting and prevention of developing thrombosis in the legs and lungs. Early mobilisation (less complications as a result.) General guidelines There is a small risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) after any operation. You can reduce the risk of clots by being as mobile as possible after your operation. You will also be given a daily injection of Clexane (an anticoagulant which helps reduce the risk of blood clotting) whilst on the ward. This will continue on discharge for 2-4 weeks. The nursing staff will show you how to do this. Avoid prolonged standing do as many things as you can sitting down. Do not lift anything heavy for at least three months. You may feel ready to drive once your wound is healing. It is advisable to take someone with you the first time you drive again. Please check with your insurance company to ensure that you are covered. Don t forget to ask your doctor, specialist nurse or Having an operation can be stressful, both physically and emotionally. Enhanced recovery programmes aim to get you back to full health quickly. Research shows that the earlier you get out of bed and start walking, eating and drinking after your operation, the better. Depending on your operation, you could go home sooner than traditionally expected, therefore it is important to plan and prepare for your return home before you go into hospital. What you can do? We need your help, and the help of your family and friends, to plan ahead for when you get home. You will be able to wash, dress and care for yourself and make light meals but you will need help with the housework and shopping. Plan ahead, put some meals and bread in the freezer and arrange with family and friends for help around the house for the first couple of weeks following discharge. Plan how you are going to get into hospital and home again. If you need hospital transport you can request this yourself and the number to ring is

6 Risks and benefits The benefits of surgery are to remove the cancer cells, and confirm if any further treatment is required. Risks that may occur during or after surgery are: Bleeding you may require a blood transfusion Infection wound, urine or chest Blood clots Damage to bladder, bowel Return to theatre (1 in 100 patients) Admission You will be admitted on the day of your operation. You will be advised when to stop eating and drinking. You will be measured for special stockings to help prevent you developing clots in your legs after the operation. You will also be given a small injection every day, which thins the blood. The most important thing that you can do to prevent clots is to move your legs whilst in bed and to go for regular short walks. You will be encouraged to sit out of bed on the first day after your operation. After the operation You will have a drip (intravenous infusion) in your arm. This replaces the fluids until you are able to start drinking and is normally taken down 24 hours after the operation. There are many ways of controlling pain and sickness after your operation. You will have the opportunity to discuss this with the anaesthetist. You will be offered regular painkillers and sent home with some. A catheter will be inserted during your operation and drains urine from your bladder. This is usually removed the day after your operation. You may have either and up and down cut (midline) or a bikini (transverse) cut in your tummy and may have small tubes (drains) coming from your wound. These drain any excess blood from your wound and are normally removed the day after your operation. The physiotherapist will see you and give you advice on gentle exercises, which you will be able to continue when you are discharged home. You will be assisted with washing, bathing and visiting the toilet. Every day you will be able to do a little bit more. You are normally in hospital for three to four days. Some consultants use stitches and some use staples and you will be advised when these will need to be removed before you are discharged home. (continued overleaf) 6 7

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