Endometrial Cancer

Treatment

After an endometrial cancer diagnosis, the doctor needs to know the stage, or extent, of the disease in order to plan the best endometrial cancer treatment. Staging procedures help the doctor find out whether the cancer has spread and, if so, what parts of the body are affected. For most women, endometrial cancer staging procedures include blood and urine tests and chest x-rays. Doctors may also order a CT scan, MRI, sigmoidoscopy, colonoscopy, ultrasonography, or other x-rays.

After diagnosis and initial evaluation, the doctor will consider the available endometrial cancer treatment options that fit each woman's needs and discusses these options with her. The choice of treatment depends on the size of the tumor, the stage of the disease, whether female hormones affect tumor growth, and tumor grade. (The tumor grade tells how closely the cancer resembles normal cells and suggests how fast the cancer is likely to grow. Low-grade cancers are likely to grow and spread more slowly than high-grade cancers.) Other factors, considered when creating an endometrial cancer treatment plan, include the woman's age and general health. Women with endometrial cancer may be treated by a team of specialists that may include a gynecologist, gynecologic oncologist (a doctor who specializes in treating cancer of the female reproductive tract), and a radiation oncologist.

Methods of Endometrial Cancer Treatment

Most women with endometrial cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormone therapy or chemotherapy. Another treatment option for women is to take part in endometrial cancer treatment studies (clinical trials). Such studies are designed to improve existing endometrial cancer treatments and help develop new treatment options.

Surgery to remove the uterus (hysterectomy) and the fallopian tubes and ovaries (bilateral salpingo-oophorectomy) is the endometrial cancer treatment recommended for most women. Lymph nodes near the tumor may also be removed during surgery to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the disease can usually be cured with surgery alone.

In radiation therapy (also called radiotherapy), high-energy rays are used to kill cancer cells. The rays may come from a small container of radioactive material, called an implant, which is placed directly into or near the tumor site (internal radiation). It may also come from a large machine outside the body (external radiation). Some patients with endometrial cancer need both internal and external radiation therapy. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area. Radiation therapy may be used in addition to surgery to treat women with certain stages of endometrial cancer. Radiation may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, for a small number of women who cannot have surgery, radiation treatment is sometimes used instead.

In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The patient is hospitalized during this treatment. Patients may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, there is no radioactivity in the body. External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.

Hormone therapy is the use of drugs, such as progesterone, that prevent cancer cells from getting or using the hormones they may need to grow. This form of endometrial cancer treatment is a systemic therapy. The drugs, which are usually taken by mouth, enter the bloodstream, travel through the body, and control cancer cells outside the uterus. Women who are unable to have surgery are sometimes treated with hormone therapy. Also, this form of treatment is often recommended for women who have metastatic or recurrent endometrial cancer.

Chemotherapy is the use of drugs to kill cancer cells. Anticancer drugs may be taken by mouth or given by injection into a blood vessel or a muscle. Like hormone therapy, chemotherapy is a systemic therapy; it can kill cancer cells throughout the body. Chemotherapy is being evaluated in treatment studies for patients with endometrial cancer that has spread.

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