What are the treatment options?
Treatment options for endometrial cancer include surgery, radiation, chemotherapy, hormone therapy, or some combination of these. The final treatment recommendation is based on several factors, the most important of which are the stage of the cancer, how healthy the woman is, and whether she wishes to have children in the future. The treatment plan can be complex, and some patients require care from more than one doctor. An endometrial cancer patient’s plan for care should be coordinated by a gynecologic oncologist.
Surgery is the most common treatment for endometrial cancer. Surgery both removes the cancer in the uterus and determines the stage. The minimum surgical procedure is hysterectomy (removal of the uterus and cervix) with removal of both fallopian tubes and ovaries. Often surgery also includes the removal of lymph nodes in the pelvis and abdomen. This procedure can be performed through a traditional incision in the skin of the abdomen or with minimally invasive surgery.
Minimally Invasive Surgery
Advances in minimally invasive surgery have enabled gynecologic oncologists to perform this operation through several small incisions instead of a vertical incision. Patients treated with minimally invasive techniques, which include standard laparoscopy or robotic surgery, may have a quicker recovery and experience less pain after surgery and fewer wound complications than patients treated with open surgery. A large clinical trial conducted by the Gynecologic Oncology Group (GOG) found that patients who were properly selected for minimally invasive surgery had no difference in cancer outcome when compared to patients who had their surgery through the traditional vertical incision. If the surgery cannot be performed entirely or safely through the small incisions, a traditional incision can be made to complete the surgery.
Radiation therapy is frequently used in women with endometrial cancer. It helps reduce the chance of cancer recurrence in women who are at risk for this based on their surgical findings. Typically, but not always, radiation therapy is provided to women whose cancers have invaded deeply into the uterine wall, cervix or vagina or have spread to the lymph nodes. Radiation therapy may also be used instead of surgery for women whose cancer is not surgically removable or for women who have severe medical conditions that make surgery unsafe.
Chemotherapy for endometrial cancer is typically recommended for women with advanced-stage (III and IV) and recurrent endometrial cancer (cancer that has returned after the initial treatment). The use of chemotherapy in endometrial cancer is rapidly evolving because we are better able to identify which patients are at risk for distant spread of the cancer. Additionally, the investigation of new treatments is important to find more effective and better tolerated therapies. Many of these treatments are only available to patients enrolled in clinical trials.
Hormonal therapy is not considered standard treatment but may be recommended by the physician when a patient who strongly desires future fertility has cancer presumably confined to the uterus. Using hormonal therapy will require that the patient undergo intermittent biopsies of the inside of the uterus to make sure the cancer is responding to treatment. Occasionally, hormone therapy is used for patients with recurrent disease.
Management of Recurrent Disease
Recurrent endometrial cancer is a complex problem and each patient has a different set of circumstances that play a role in determining the best course of management. These factors include:
- Number and location of recurrent tumors,
- Time interval since last cancer treatment,
- Type of treatment(s) previously given (surgery only, radiation, chemotherapy or both), and
- Overall health and activity level at the time of recurrence.
New treatment options for uterine cancer patients are currently being explored in clinical trials.