Endometrial Cancer treatment

Endometrial cancer is often identified when a woman has symptoms of the disease or has a dilatation and curettage or endometrial biopsy. After this, the woman usually has surgery to remove the uterus, ovaries, and fallopian tubes. This is called a total hysterectomy with bilateral salpingo-oophorectomy. Lymph nodes from around the aorta and in the pelvis may also be taken out at the same time.  All of these areas are examined to see if the cancer has spread. 

Pelvic washings are often done at the same time as the bilateral salpingo-oophorectomy.  The soft tissue taken out at the time of surgery are looked at under the microscope to see the stage of the cancer, which is a measurement of how far the cancer has metastasized.  Depending on the stage of the endometrial cancer, other therapies, such as chemotherapy, and radiation may be suggested.  Surgery may be delayed for a while and other therapies may need to be tried if the woman still wants to get pregnant. 

If the cancer has metastasized, another type of surgery is often done instead.  If the tumor has spread to the lung, liver, or other organs, surgery may not be indicated.  In such cases, chemotherapy or other therapies may be used in its place. 

The typical treatment includes surgery to take the cancer out and to stage the tumor. If the cancer has been staged as a stage I cancer, surgery may not be necessary.  For some individuals, particularly those who suffer from higher grade tumors, physicians are more likely to suggest radiation following surgery.   Pelvic radiation, vaginal brachytherapy, or both, can be utilized. 

Some women with early stage endometrial cancer may have their uterus taken out without removing their ovaries.  While this doesn’t increase the chances that the cancer will return, it doesn’t make it more likely that the patient will die from their cancer.  This might be something the patient will want to talk about with their doctor.  Women who can’t have surgery because they have other medical issues or who are older are often just treated with radiation.

In a younger woman who still wants to have children, surgery may be delayed for a while therapy with progestin is used to treat the tumor.  Using progestin therapy, such as a progestin-containing IUD, injection, or pill, can result in shrinkage of the cancer so that it can even disappear for a while so that the woman has a chance to get pregnant. This an experimental approach and can be dangerous if the patient isn’t looked at closely. 

Often this approach doesn’t work and the cancer doesn’t improve or keeps growing.  Delaying surgery can allow the cancer to spread outside of the uterine wall.  If the cancer doesn’t disappear, surgery is done to take out and stage the cancer.  This includes having a surgery to have the uterus and ovaries removed.  Sometimes the cancer shrinks or goes away for a bit after progestin treatment, but then returns.

Prior to surgery, the patient needs to make an appointment with their primary care physician or an OB/GYN doctor if they have symptoms that are indicative of endometrial cancer.  If the patient dies hasprogression of the disease, they will have to be referred to a physician who specializes in endometrial cancer, such as a gynecologic oncologist. 

Because appointments can be short and there is much to discuss, it is a good idea for the patient to be prepared before the appointment.  These are some things the patient can do:

• Put down any symptoms the patient is experiencing. This includes things that might seem unrelated to the reason the patient arranged for the appointment.
• Make a list. Write down all supplements, vitamins, and medications the patient is taking.  The patient should also list hormone treatments they have had in the past, including tamoxifen, birth control pills, and other types of hormone therapies.
• Write down any questions the patient has.  The patient may have questions that need answering in the preoperative period.
• Ask a friend or family member to help.  Sometimes it can be hard to absorb all the information spoken of during the doctor’s visit.  If someone goes with the patient, they may remember something the patient forgot or missed.

The time with the doctor is short, so making a list of questions to ask ahead of time can help the patient make the most of their time with their doctor.  There are many questions the patient might have about their endometrial cancer.

Most women affected by endometrial cancer are concerned about the short-term and long-term risks that the cancer is returning.   It is crucial for the woman to talk freely with their health care team and their family.   Many patients my get some benefit from having a friend or family member go along with them so that questions may be asked and answered after surgery.  This individual can help the patient understand what is going on after surgery.  There are several support groups that are available after treatment for endometrial cancer. This can include individual counseling, internet discussion groups, and support groups. 

Many experts advocate for close follow up after the treatment for endometrial cancer is completed, especially when the risk of the cancer coming back is high.  This generally includes doing a history and physical examination after surgery.  These are done every 3-6 months for several years after treatment for endometrial cancer. Other tests, such as a CT scan, blood testing, and pap tests may be done during these visits. 

If the cancer doesn’t return after five years, the woman can generally quit seeing the oncologist and can instead have visits with their primary care doctor for the rest of their lives.  They need to call their doctor immediately if they develop any signs or symptoms that suggest that the cancer could come back. 

Endometrial cancer treatment is done whenever a patient has documented evidence of cancer cells in the uterine lining.  It is done to remove all traces of cancer by doing surgery, radiation therapy, and chemotherapy. The type of treatment done depends on the stage of the disease.

After surgery, the patient remains in the hospital for 3-7 days.  Total recovery generally takes place 4-6 weeks after the procedure. If the surgery is done using a laparoscope, the length of stay in the hospital is about 1-2 days, with total recovery taking 2-3 weeks.  Complications of these treatments are uncommon and depend on the surgical approach.  Typical complications include damage to the urinary tract, wound infection, damage to the GI tract, and excessive bleeding. 

Surgery for endometrial cancer generally affects the nerves that go to the bladder.  This means that a catheter may need to be placed in order to drain urine.  It is continued for at least several days following surgery.  If the bladder doesn’t recover completely after the catheter is removed, it may be put back  until the function of the bladder returns.