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Endometrial Cancer Treatment

Surgery

In order to determine if or where the cancer has spread within the abdomen and pelvis, surgery is often advised. This usually involves removal of the uterus, cervix, tubes, ovaries, and possibly lymph nodes and other tissues in the upper abdomen. This is considered major surgery and will require a 4 - 7 day stay in the hospital. Treatment planning or staging, requires that all tissue removed during surgery be carefully looked at under a microscope. This can take up to a week or more after the surgery. The more abnormal the cancer cells look under the microscope and the more organs are involved with the cancer increases the likelihood that microscopic cancer cells are still present in the woman's body. If this cancer is caught very early, surgery may be the only treatment recommended. Additional therapy will be recommended if the physician feels there is a good chance that cancer cells remain after the surgery. This could include radiation, chemotherapy, hormonal therapy or a combination thereof. Treatment after surgery is designed to kill these remaining cells.

Radiation

Radiation therapy can be given a variety of ways. Generally it is designed to treat a very specific location where cancer cells are suspected. It is usually given daily, Monday through Friday and takes 15 - 20 minutes. The radiation doctor, called a radiation oncologist, may recommend from two to six weeks of therapy. Alternatively, radiation may be given to the vagina using an implanted cylinder. This can be done over 2-4 days in the hospital, or at special facilities, weekly, as an outpatient procedure. Side effects of treatment depend on the area being treated but usually involve reactions of the normal tissue to the radiation. For example, radiation to the pelvis can cause bladder irritation, diarrhea, and skin irritation.

Chemotherapy

Chemotherapy for endometrial cancer is usually reserved for more advanced disease, wherein widespread treatment is desired, rather than radiation, which usually treats only a well-defined area of the body. Most often, chemotherapy is given using 2 - 3 drugs into the vein every 3-4 weeks for a period of 4 - 6 months. In most instances, the treatment is given in an outpatient center, which does not require an overnight hospital stay and takes 1-2 days.

Chemotherapy Side Effects

Side effects from chemotherapy depend on the combination of drugs used and the schedule with which they are given, as well as the characteristics of the woman being treated. Like radiation, many side effects of chemotherapy show up as reactions of normal cells to these drugs. Many people associate hair loss with chemotherapy, however not all drugs cause this reaction or do so to varying degrees. But hair cells, which grow relatively quickly, (like cancer cells) are more readily affected than some other areas of the body, which are made up of cells which grow more slowly. The cells in the bloodstream are another example of cells which grow more quickly and are often affected by chemotherapy or radiation. The nature of this treatment requires careful monitoring with blood tests at regular times and additional tests to help prevent side effects from causing problems.

Hormonal Therapy

Treatment with hormones is usually specific to only certain types of cancers that we know are affected by the hormonal environment in the body. These cancers include breast, prostate, and endometrial cancer. This list may grow as we discover more information about other types of cancers. Endometrial cancer cells seem to grow in environments where there is an extra amount of the female hormone, estrogen. We know that woman who take the hormone estrogen (and still have their uterus) without the additional hormone, progesterone, are at risk for developing endometrial cancer if this continues for many years. We suspect the same process can occur in heavy woman, as fat cells make a form of estrogen inside a woman's body. Treating woman with endometrial cancer with anti-estrogen type hormones (hormones that work against or counteract the effect of extra estrogen) works to change the hormonal environment inside a woman's body. Doing this, hopefully, makes it less likely that these endometrial cancer cells will be able to live and grow to cause problems.

Hormonal Therapy Side Effects

Unlike chemotherapy or radiation, hormone treatment does not kill cells directly, but makes where they live a less hospitable place. In this way, it is hoped that the cells will then die off by themselves, as they are no longer in a nourishing environment, suitable to their needs. Side effects are therefore, quite different, than with treatments specifically designed to kill cells. Anti-estrogens used to treat endometrial cancer can cause increased appetite, water retention, nausea, weight gain, mood changes, and hair loss as well as other less common side effects. Some woman who have a history of blood clots or liver problems may be at increased risk for more serious side effects with these medications.

Estrogen Replacement

Traditionally, once a woman has been diagnosed with endometrial cancer and appropriate therapy begun, she is either taken off or not offered hormone replacement with estrogen. Concerns about causing the cancer to grow or come back have been the reasoning in the past. Quality of life issues with respect to hot flash prevention, osteoporosis (loss of bone), and heart disease as well as other issues have lead researchers to begin studies on whether replacement estrogen does increase the risk of endometrial cancer returning. Many cancer experts are beginning to doubt this rationale for withholding estrogen, yet opinions remain controversial within the medical community. Currently, a clinical trial (research study) is in progress at Ellis Fischel and elsewhere around the nation to help determine the safety of estrogen replacement in women with endometrial cancer. It is hoped that in the next few years, we will have some answers to these questions and can recommend appropriate therapy based on fact.

Endometrial Cancer