Endometrial Cancer Treatment
Treating Uterus Cancer

Endometrial Cancer Treatment

Contents

• How is Endometrial Cancer Treated?
• Surgery Options
• Radiation Therapy
• Hormone Therapy

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Endometrial Cancer Guide

How Is Endometrial Cancer Treated?

Endometrial cancer, if diagnosed early, is highly treatable and mostly even curable. Fortunately in the majority of cases in America symptoms of endometrial cancer are discovered early. The treatment plan pursued will depend on the stage (how far it has progressed) and the patient’s general health, age and desire for future children. Once all the test results are returned the doctor (oncologist) will recommend a course of treatment. Early stages of endometrial cancer are usually cured with a hysterectomy as well as the removal of both ovaries and the fallopian tubes. More advanced or virulent cancers may require combining surgery with radiation therapy, chemotherapy or hormonal therapy. If you have received a diagnosis of endometrial cancer, take some time to review the treatment options presented and their side effects. If there is something you do not understand, ask your doctor to explain further. You may also want to consult another doctor for a second opinion. In fact some insurance companies require the patient to do so (although less so with routine cancer treatments). Below is a more detailed look at each treatment option.

Surgical Procedure: Hysterectomy

This is the standard treatment for endometrial cancer. Early stages of the cancer are usually treated with a hysterectomy combined with a bilateral salpingo-oophorectomy. This involves the removal of the uterus and cervix, along with the ovaries and fallopian tubes. If the procedure is carried out with an incision in the abdomen this is called a simple or total abdominal hysterectomy (TAH). If the uterus is removed through the vagina this is known as a vaginal hysterectomy. In order to stage the cancer, lymph nodes in the pelvis and round the aorta are also usually removed at the same time. If cancer is more advanced and has invaded the cervix and surrounding tissues (parametrium) then a radical hysterectomy is performed. This procedure involves removing not only the uterus but also the tissues next to the uterus and the upper part of the vagina.

The normal hospital stay for a hysterectomy is 3 to 7 days and about 5 to 7 days for a radical hysterectomy. Complications do not occur often, if they do, it will be in the form of infection to the wound, excessive bleeding or damage to the urinary or intestinal systems. Removal of the lymph nodes in the pelvis can lead to a build up of fluids in the legs, a condition known as lymphedema (particularly if radiation is also applied).

Women are left infertile after a hysterectomy, but as the majority of women who are diagnosed with endometrial cancer are postmenopause, this should not be a concern for most. Women who were premenopausal before surgery will go into menopause prematurely when the ovaries are removed.

Note: Different methods of surgery are used to perform a hysterectomy, some are more invasive than others. One of the least minimally invasive is called da Vinci surgery. Ask your doctor if you are a candidate for this procedure.

See also: Cancer Surgery

Radiation Therapy Options

Women with early stages of endometrial cancer are usually thought to be curable with the removal of the uterus and cervix (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). If the tumor has invaded deep into the muscle layer known as myometrial muscle - then additional therapies are usually required. This is usually either radiation therapy or hormonal therapy.

Brachytherapy

Radiation may be given externally via a machine or internally by a method called brachytherapy. Vaginal brachytherapy is a procedure sometimes used for gynecologic cancers. It involves placing a cylinder containing a radioactive substance into the vagina. The length of the cylinder can vary. With this method radiation comes into direct contact with the vagina and nearby structures such as the bladder and rectum receives less exposure. This procedure is usually performed about 4 to 6 weeks after a hysterectomy, when the body has had time to heal. There are 2 types of vaginal brachytherapy: Low-Dose Rate (LDR) and High-Dose-Rate (HDR). A LDR device is usually left in place for one to four days and the patient needs to stay in hospital. A HDR is more intense so a device is left in place for less than an hour. The patient can return home the same day. HDR can be given on weekly or even daily basis for at least 3 doses.

External Radiation

External beam radiation therapy (with a machine) is normally carried out 5 days a week for 4 to 6 weeks. Common side effects of both types of radiation treatment include extreme fatigue, nausea, vomiting and diarrhea - much of which can be controlled by medication. Radiation can cause irritation to the bladder causing what is known as radiation cystitis. It can also lead to low red blood counts and anemia. There may also be some vaginal dryness.

Note: If you are interested in experimental treatments, read about
cancer clinical studies.

Chemotherapy

Chemotherapy (or chemo as it is commonly referred as) involves the use of drugs which are taken orally or injected to fight cancer which has spread beyond its original source. In the case of endometrial cancer it may be considered an option where cancer has spread beyond the endometrium (stage 3 and 4, see endometrial cancer staging). The National Cancer Institute and other research groups are studying the benefits of combining surgery with chemo in these instances. The chemo drugs used in trials to date include cisplatin, ifosfamide and doxorubicin. See Chemotherapy guide.

Hormone Therapy

This is the use of hormones or hormone blocking drugs to prevent the growth of cancer. This type of therapy is not the same as that given to women to prevent menopause symptoms (i.e. HRT). In the case of endometrial cancer, hormone therapy is commonly prescribed as a way to manage advanced stages of the disease or as an alternative for women who are not strong enough to cope with more aggressive therapies like radiation or surgery.

Progestins
The main type of hormone used for treating endometrial cancer are progesterone like drugs called progestins (brand names include Provera, Delalutin and Megace). These hormones work by slowing down the growth of cancer cells. Side effects can include menopause type symptoms such as hot flashes, night sweats and weight gain. They can also cause increased blood sugar levels in women with diabetes. Rarely, they can cause blood clots.

Tamoxifen
This is an estrogen blocking drug which is most commonly used for breast cancer treatment and prevention of recurrences. Tamoxifen works by reducing the amount of estrogen circulating in the body (estrogen seems to stimulate the growth of cancer cells). It can cause menopause-type side effects such as hot flashes and vaginal dryness (atrophy). Women taking tamoxifen are also at increased risk of suffering leg blood clots. It may also be prescribed to women who are diagnosed with endometrial cancer recurrence.

GNRH
Most women with endometrial cancer have their ovaries removed or made inactive through radiation treatment (the ovaries are the body's main production area of estrogen). Where women are left with functioning ovaries, gonadotropin-releasing hormone agonists (GNRH) are another way to reduce estrogen levels. These hormones switch off the estrogen producing function in the ovaries of women who are premenopausal. Brand names include Zoladex and Lupron. The drugs are injected every one to three months. Side effects include menopause symptoms such as vaginal dryness and hot flashes. If taken over a long period of time (years) it increases a woman's risk factors for osteoporosis.

Aromatase Inhibitors
Even when the ovaries are removed, some estrogen can still be produced by the body's fat tissue. Drugs called aromatase inhibitors can stop this production. Brand names include Femara, Arimidex and Aromasin. They are more commonly used as hormonal therapy for breast cancer but may be helpful in treating endometrial cancer. Side effects include menopause symptoms and weakened bones if taken for long periods of time.

After treatment, read about endometrial cancer prevention. You may also want to check out women's health books for self-help advice.

Related Articles on Endometrial Cancer Treatment

For more cancer related issues, see the following:

• Endometrial Cancer Survival Rates
• Endometrial Hyperplasia
• What is the best treatment for cancer?
• Causes of Endometrial Cancer

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