Endometrial Cancer Treatment

Endometrial Cancer Treatment

Treatment

Treatment for uterine cancer depends on the stage of the disease and the overall health of the patient. Removal of the tumor (surgical resection) is the primary treatment. Radiation therapy, hormone therapy, and/or chemotherapy may be used as adjuvant treatment (i.e., in addition to surgery) in patients with metastatic or recurrent disease.

Surgery
Treatment for uterine cancer usually involves removal of the uterus, including the cervix (called total hysterectomy), and removal of the fallopian tubes and ovaries (called bilateral salpingo-oophorectomy). Surgery may be performed through an incision in the abdomen or through the vagina (called transvaginal hysterectomy).

Postoperative pain, nausea and vomiting, and fatigue are common side effects of surgery. Patients may remain hospitalized for a few days to 1 week and usually can resume normal activities in 4 to 8 weeks. Complications include the following:

• Adverse reaction to anesthesia
• Hemorrhage (bleeding) caused by injury to surrounding blood vessels (e.g., artery, vein)
• Injury to surrounding organs (e.g., large intestine)
• Thromboembolism (blockage of an artery or vein by a blood clot)

Surgery is curative in about 65% of cases of early-stage uterine cancer. Patients with tumors confined to the uterus are at low risk for recurrent or metastatic disease and usually do not require additional treatment. Follow-up care includes physical and pelvic examinations, x-rays, and blood and urine tests at 6 to 12 month intervals.

Radiation Therapy
Radiation uses high-energy x-rays to destroy cancer cells and shrink tumors. This treatment may be used prior to surgery (called neoadjuvant therapy) or after surgery to destroy remaining cancer cells. Radiation also may be used in patients who are unable to undergo surgery.

External beam radiation is an outpatient treatment delivered by a machine outside the body. This treatment usually is administered 5 days a week for several weeks. Most patients refrain from sexual intercourse during and for several weeks following radiation therapy because contact with the genitals and vagina may be painful.

Internal beam radiation may be administered for 4 to 6 weeks after surgery. In this procedure, which is usually performed in the radiation department of a hospital, a special applicator is used to insert pellets of radioactive material into the upper vagina. In some cases, both external and internal radiation therapies are used.

Side effects of radiation include the following:

• Diarrhea
• Dryness, itching, tightening, and burning in the skin of the vagina
• Fatigue
• Frequent, painful urination
• Hair loss
• Loss of appetite

Hormone Therapy
Some uterine tumors contain certain proteins, called hormone receptors, which attract and bind to estrogen and use this hormone to grow. Hormone therapy is a systemic treatment (i.e., affects cells throughout the body) that uses progesterone to balance the effect of estrogen (i.e., prevent it from reaching and binding to receptor cells) and slow tumor growth.

Hormone therapy is used to treat metastatic or recurrent endometrial cancer. It also may be used to treat patients who are unable to undergo surgery or radiation. Prior to treatment, a hormone receptor test may be performed to determine if the endometrial tissue contains these proteins. Hormone therapy usually involves a synthetic type of progesterone in pill form. Side effects include increased appetite, fluid retention, weight gain, and, in premenopausal women, changes in the menstrual cycle.

Chemotherapy
Chemotherapy is a systemic treatment (i.e., travels throughout the body via the bloodstream) that uses a combination of drugs to slow tumor growth and destroy cancer cells. It may be used in addition to surgery (called adjuvant therapy) to treat metastatic endometrial cancer and to prevent recurrent disease. Drugs may be administered orally or intravenously (through an IV).

The following drugs are used to treat endometrial cancer:

• Carboplatin (Paraplatin?)
• Cisplatin (Platinol?)
• Doxorubicin (Doxil?)
• Cyclophosphamide (Cytoxin?)
• Paclitaxel (Taxol?, Paxene?)

Side effects may be severe and include the following:

• Fatigue
• Fever
• Hair loss (alopecia)
• Infection
• Low blood cell count (e.g., anemia, neutropenia, thrombocytopenia)
• Nausea

Prognosis

Prognosis depends on the stage of the disease and overall health of the patient. Cancer that is confined to the uterus can be cured surgically in 60?70% of cases. Metastatic uterine cancer and uterine sarcoma, which has a high rate of recurrence, carry a poor prognosis.