Once you are diagnosed with endometrial cancer, you should consult with a gynecological oncologist, a doctor who specializes in treating cancer. Endometrial cancer detected in its early stages can be cured with treatment and close follow-up. Your doctor will recommend a treatment plan depending largely on the stage of the disease.
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Staging is the process of determining where a cancer is located and whether it has spread to other parts of the body. The stage of the cancer is an important factor in making treatment choices. Certain tests and procedures are used in the staging process. A hysterectomy (an operation in which the uterus is removed) with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection will usually be done to help find out how far the cancer has spread. After looking at your test results, your doctor will tell you the stage of your cancer and discuss the best treatment for you. Treatment choices may include one or more of the following: surgery, radiation therapy, chemotherapy, and hormone therapy.
The grade of the cancer refers to the appearance of the cells in the tumor and gives an idea of how aggressive the cancer is. Grade 1 cancers are made up mostly of normal-looking cells; grade 2 cancers have more abnormal-looking cells; and grade 3 cancer cells have a higher percentage of abnormal-looking cells.
In stage I endometrial cancer, the cancer is found in the uterus only. Stage I is divided into stages IA, IB, and IC, based on how far the cancer has spread. Stage IA is in the endometrium only. Stage IB has spread into the inner half of the myometrium (muscle layer of the uterus). Stage IC has spread into the outer half of the myometrium. Stage I endometrial cancer is often curable with a hysterectomy and bilateral salpingo-oophorectomy surgery. If your cancer is in a very early stage and low grade and you want to preserve your ability to have children, you may be able to have hormone therapy rather than a hysterectomy. However, it is not considered a standard treatment for stage I cancer. If you choose this form of treatment, your physician will probably recommend a hysterectomy when you are done having children. If cancer is found deep in the uterine muscle (myometrium), a hysterectomy may be followed by radiation therapy. The five-year survival rate for stage I is 90 to 95 percent, meaning 90 to 95 percent of women with stage I endometrial cancer survive for at least five years after diagnosis.
In stage II, cancer has spread from the uterus to the cervix, but has not spread outside the uterus. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread into the cervix. Stage IIA has spread to the glands where the cervix and uterus meet. Stage IIB has spread into the connective tissue of the cervix. Stage II may be treated with a radical hysterectomy (which removes the uterus, cervix, ovaries, and structures that support the uterus) and pelvic and para-aortic lymph node removal (lymphadenectomy). In some cases, radiation therapy may be given after surgery. Because other medical problems may prevent surgery from being a treatment option, women with Stage II endometrial cancer may be treated with primary radiation therapy only. The five-year survival rate for stage II is 75 percent.
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis. Stage IIIA has spread to one or more of the following: the outermost layer of the uterus; tissue just beyond the uterus; or the peritoneum (the lining that covers the abdominal cavity and organs). Stage IIIB has spread beyond the uterus and cervix, into the vagina. Stage IIIC has spread to lymph nodes near the uterus. Stage III is treated with surgery to remove the uterus, ovaries, fallopian tubes, cervix and all visible tumors. Chemotherapy or radiation may be used after surgery. Hormonal therapy using progesterone is also an option. Women with stage III endometrial cancer may be candidates for clinical trials of new treatment options. The five-year survival rate for stage III is 60 percent.
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread. Stage IVA has spread to the bladder and/or bowel wall. Stage IVB has spread to other parts of the body beyond the pelvis, including lymph nodes in the abdomen or groin. Stage IV is treated with surgery to remove the uterus, ovaries, fallopian tubes, cervix and all visible tumors. Chemotherapy or radiation therapy may be used after surgery. Hormonal therapy using progesterone is also an option. The five-year survival rate for stage IV is 15 to 26 percent.
Other considerations in choosing the best treatment plan include your age, overall health, childbearing plans, and other personal concerns.
The main surgery done for endometrial cancer is a total hysterectomy with bilateral salpingo-oophorectomy. In this surgery, the uterus is removed along with both ovaries and fallopian tubes, and sometimes the pelvic and para-aortic lymph nodes. In a radical hysterectomy, the surgeon removes the uterus, cervix, surrounding tissue, upper vagina, and usually the and pelvic and para-aortic lymph nodes.
A hysterectomy can be done either through the abdomen or the vagina, depending on a patient's medical history and overall health. Hysterectomies are almost always done with general anesthesia.
Abdominal hysterectomy. In this surgery, the uterus, ovaries, and fallopian tubes are removed through an incision in the abdomen. The large opening into the abdomen allows the surgeon to see the organs easily and determine if and where the cancer has spread. The hospital stay is three to five days for this surgery. The incision leaves a scar on the abdomen, usually about 5 inches.
Laparoscopic or robotic hysterectomy. Alternatively, the uterus and ovaries can be removed through an incision in the vagina. Surgeons use a laparoscope, a lighted viewing instrument or robot, by inserting it through small incisions in the abdomen. The hospital stay is one to two days.
Following a hysterectomy, you will not be able to become pregnant. About four to six weeks after the hysterectomy, you will have a follow-up visit with your doctor and should be able to return to your normal activities, including sexual activity.
Lymphadenectomy. Also called a lymph node dissection, this surgery is used to remove the lymph nodes from the pelvic and para-aortic area. Examining the lymph nodes for cancerous cells lets doctors determine the exact stage and grade of the cancer. This surgery may be done as a part of a hysterectomy. The procedure can be done through an abdominal incision or by laparoscope. It is performed under general anesthesia and the length of time required for recovery depends on which procedure was used. Recovery time with a laparoscopic procedure may be shorter.
Radiation therapy uses high-energy rays to pinpoint and destroy cancer cells. Although radiation treatment is similar to having an X-ray, the dose of radiation is higher and given over a longer period of time. Radiation therapy may be used to treat endometrial cancer after a hysterectomy or as the primary therapy, especially when surgery is not an option. Depending on the stage and grade of the cancer, radiation therapy may also be used at different points of treatment. A radiation therapist delivers the prescribed treatment and will assist you before and after your treatments. You will not be radioactive after receiving radiation treatment.
There are two types of radiation therapy and in some cases, both types are given.
In brachytherapy (internal radiation therapy), radioactive materials called radioisotopes are inserted through the vagina and placed in the uterus or other areas where cancer cells are found and remain there for two to three days. This type of therapy can be done during a hospital stay or on an outpatient basis. Placing the radioisotopes takes about 30 to 45 minutes under local or general anesthesia. Depending on your cancer, several treatments may be needed. Because brachytherapy delivers radiation to a local area with tiny pellets, there is little effect on nearby structures such as the bladder or rectum. Once treatment is completed, removal of the radioisotopes is a straightforward procedure, but it can be painful.
External radiation is similar to an X-ray but takes longer. This treatment is usually done on an outpatient basis for four to six weeks, five days per week for about 30 to 45 minutes each time. How much of the pelvic area needs to be exposed to radiation treatment depends on how far the cancer has spread. When radiation is ordered, patients will be given an appointment for pretreatment simulation. Simulation involves taking X-rays of your pelvis and marking the skin on your hips and lower back with a colored marking pen. The simulation is painless; however, you will have to lie face down on a special table for at least one hour. You will need to keep the colored lines marked on your skin, so you should not take tub baths during the course of radiation treatment, and sponge baths are better than showers. On the days of your actual treatment, you will lie on a treatment table. The radiation therapist will position you so the radiation will reach the right part of your body. Once you are positioned, do not move until the treatment is finished. Your position on the table will be same for each treatment. Your doctor will tell you when you can wash off your colored markings, after the course of treatment is over.
Radiation therapy may make sexual intercourse uncomfortable or painful. You may want to wait until after treatment is finished to resume sexual intercourse. Other side effects of radiation therapy include:
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. There are two types of chemotherapy: systemic and regional. With endometrial cancer, systemic chemotherapy is used. This means that the drugs are taken by mouth or injected into a vein or muscle. Drugs taken this way enter the bloodstream so they can reach cancer cells throughout the body. In regional chemotherapy, the drugs are placed directly into the spinal column, an organ, or a body cavity such as the abdomen, so they mainly affect cancer cells in those areas. One or more chemotherapy drugs may be used in your treatment plan. Chemotherapy for patients with endometrial cancer is given on an outpatient basis and usually lasts three to four months. Each woman reacts differently to chemotherapy. Many women can continue their regular daily activities, including work.
Chemotherapy can have some side effects, but most of them go away after treatment is completed. Side effects will depend on the type of drugs given, the amount taken, and how long the course of treatment lasts. Some side effects include nausea and vomiting, loss of appetite, hair loss, mouth sores, vaginal sores, infection due to low white blood cell count, bleeding or bruising from minor cuts or injuries because of low blood platelets, and shortness of breath or fatigue from low red blood cell counts.
Hormone therapy stops cancer cells from growing by blocking the action of hormones. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have receptors where hormones can attach, drugs can be used to reduce the production of hormones or block them from working. In hormone therapy, progesterone-like drugs known as progestins are used to slow the growth of cancer cells, usually in a pill form or by injections.
New treatments are always being tested in clinical trials and some women with endometrial cancer may want to consider participating in these research studies. These studies are meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the Web site of the National Cancer Institute. You can also read more about factors to weigh when considering volunteering for a clinical trial in the usnews.com clinical trials module.
Last reviewed on 10/13/09
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