Treatment
Treatment for endometrial cancer depends on the type and stage of the disease, along with your age, overall health, and personal considerations such as whether you want to have children in the future. Surgery is the main treatment for most women, and doctors may use radiation therapy, chemotherapy, and hormone therapy. Here are some of the procedures and treatments your doctor may recommend for endometrial cancer.
Surgery
Surgery is the most common option for treating endometrial cancer. The findings at the time of surgery are what allow your doctors to assign the stage. Usually surgery for endometrial cancer consists of the following procedures:
Hysterectomy
A hysterectomy is the main treatment for endometrial cancer. It is surgery to remove the uterus and cervix, but not any surrounding tissues or lymph nodes. This procedure may be performed with a surgical incision in the abdomen, through the vagina, or through a minimally invasive approach (laparoscopic or robotic surgery).
Bilateral salpingo-oophorectomy
In this procedure, your surgeon removes your ovaries and fallopian tubes during a hysterectomy. Doctors usually recommend this procedure for women who have undergone menopause, will undergo menopause shortly, or who are at high risk for adnexal involvement from cancer. This will put young women into menopause early. Your doctor should discuss the risks and benefits of removing the ovaries if you have not gone through menopause on your own.
Pelvic/para-aortic lymph node dissection
In this procedure, lymph nodes from your pelvis and in the abdomen along your aorta are removed and checked for cancer cells from endometrial cancer.
Sentinel Lymph Node Biopsy
In this procedure the doctor identifies and removes only the first lymph nodes to which the tumor is likely to drain. These nodes, known as sentinel nodes, are the ones most likely to contain cancer cells. If these nodes are free from cancer, it is likely that the rest of the lymph nodes are as well. This procedure may help a patient avoid the need for a full lymphadenectomy.
For more advanced cases of endometrial cancer, your doctor may recommend one of the following procedures:
Omentectomy
Your doctor removes the omentum, the layer of fatty tissue that hangs from your intestines.
Radical Hysterectomy
Your doctor may recommend a radical hysterectomy if the cancer has spread to the cervix. In this procedure, the surgeon removes the cervix, uterus, surrounding tissues, and the upper part of the vagina.
Tumor Debulking
If your cancer has spread to the abdominal cavity, your doctor will remove as much of the tumor as can be done safely. Your doctor may partially or totally remove your omentum, spleen, lymph nodes, liver, or intestines during this surgery.
Additional Treatments
Your doctor may also recommend any of the following procedures:
Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Doctors commonly use radiation therapy to treat endometrial cancer. You may receive radiation therapy as your main treatment or after a hysterectomy to destroy any remaining cancer cells. You may receive any of the following types of radiation therapy for endometrial cancer:
- External Beam Radiation: External beam radiation is administered through a large radiation machine as you lay flat in a stable position. This technique is often used to treat the whole pelvis if your doctor thinks that you are at high risk for recurrence after surgery. This is often given as a daily treatment for five weeks.
- Three-dimensional conformal radiation therapy (3D-CRT): Your doctor will use a CT or MRI scan to find the exact location of your tumor. Your doctor will then administer radiation to the tumor from several different angles. This technique allows your doctor to deliver the maximum amount of radiation to the tumor without harming normal tissue.
- Intensity-modulated radiotherapy (IMRT): IMRT changes the shape of the radiation beam to match the shape of the tumor. Your doctor can adjust the strength of the beam to limit the amount of radiation to healthy tissue. This allows your doctor to target the tumor more precisely and administer higher amounts of radiation with fewer side effects.
- Brachytherapy: In brachytherapy, also known as internal radiation therapy, the doctor places the source of radiation inside the body near the tumor. For endometrial cancer, your doctor will insert a cylinder containing radiation into your vagina. In low-dose rate brachytherapy, the cylinder may stay in place for a few days while you stay in the hospital. In high-dose rate brachytherapy, the cylinder delivers a much higher dose of radiation for a few minutes at a time.
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to eliminate cancer cells. Doctors give chemotherapy to shrink the tumor before surgery and destroy any traces of cancer left after surgery. In more advanced stages in which the cancer has spread, chemotherapy may be the best treatment option to relieve symptoms. Chemotherapy can also be used after surgery to help decrease the chance of cancer recurrence in women who are high risk. It can be combined with radiation therapy to make both more effective.
Hormone Therapy
Many endometrial cancers are sensitive to estrogen, therefore anti-estrogen hormones as well as progesterone treatment can be used to treat endometrial cancer. There are a few different types of hormone therapy treatments you may receive for endometrial cancer:
- Progestins: Progestins are progesterone-like drugs that slow the growth of endometrial cancer cells. This can be given as a pill or inside an intrauterine device (IUD).
- Aromatase inhibitors: Aromatase inhibitors prevent your fat cells from producing estrogen after your ovaries are removed.
Targeted Therapy
Targeted therapy is a type of medication that blocks the growth of cancer cells by interfering with specific molecules needed to turn normal cells into cancer cells and make them grow. Targeted therapy drugs work by disrupting the growth and spread of cancer at the cellular level. Cancer cells rely on certain molecules—often proteins—for survival, reproduction, and movement through the body. These molecules are typically produced by cancer-related genes or by the cells themselves. Targeted therapies are specifically designed to block or interfere with these molecules or the genes that produce them, helping to stop the cancer from growing. Targeted therapy can be given intravenously (in the vein) or by mouth.
Immunotherapy
Immunotherapy is a type of treatment that uses medicine to help your body’s immune system recognize and destroy cancer cells. Normally, your immune system protects you by attacking harmful invaders like germs or abnormal cells. However, cancer cells can sometimes hide from the immune system to avoid being attacked. Immunotherapy works by helping immune cells find and target these hidden cancer cells. This treatment works well in endometrial cancer occurring in the setting of Lynch Syndrome.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. In addition, newer clinical trials are combining new targeted agents with conventional IV chemotherapy in the upfront setting. There are no guarantees that you will benefit from a clinical trial – but it may help you or patients like you in the future.
