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Treatment

There are four basic types of treatment: surgery, radiation therapy, hormone therapy and chemotherapy. The treatment that is right for you depends on the extent and location of the cancer and on your personal situation. A combination of these treatments may also be used.

Surgery | Radiation therapy | Hormone therapy | Chemotherapy

Surgery

Surgery is the most common treatment for endometrial cancer. The most common surgical procedure is the removal of the uterus as well as both ovaries and fallopian tubes. This is called a total abdominal hysterectomy (or simple hysterectomy) and bilateral salpingoophorectomy. Your doctor may also recommend sampling the pelvic lymph nodes, to determine whether the cancer has spread to these areas.

Hysterectomy means the removal of the uterus. Oophorectomy is the removal of one or both ovaries. When an oophorectomy is unilateral, only one ovary is removed; if it is bilateral, both ovaries are removed. Salpingectomy is the removal of the fallopian tubes, which can also be unilateral (the removal of just one) or bilateral (both). A salpingo-oophorectomy combines both procedures. Lymph nodes may also be removed from your abdomen, to determine if the cancer has spread.

Hysterectomy Procedures

A simple hysterectomy is the removal of the uterus (the body of the uterus and the cervix). The loose connective tissue around the uterus and the tissue connecting the uterus and sacrum are not removed.

There are two ways of doing a simple hysterectomy:

  • An abdominal hysterectomy removes the uterus through a 10- to 15- centimetre incision in the abdomen. Lymph node sampling/dissection can also be done through the same incision. The benefit of an abdominal hysterectomy is that it allows the surgeon a better view of the pelvic cavity.
  • A vaginal hysterectomy removes the uterus through the vagina. Lymph nodes can also be removed by laparoscopic lymph node sampling. This procedure is not commonly used to treat endometrial cancer. A vaginal hysterectomy is sometimes performed in combination with a laparoscopy, using an instrument the size and shape of a pencil, with a light on one end, to remove the uterus.

    A vaginal hysterectomy is less painful, the recovery and healing period is shorter, and the procedure leaves no scar; however, it is more difficult for the surgeon to see if the cancer has spread and there is a greater chance of complications. Following vaginal hysterectomy, urinary tract difficulties or back pain may occur; some women also experience pain during intercourse if the vagina is shortened significantly as a result of the procedure.

A hysterectomy is done with a general anesthetic. You will need to stay in the hospital for a few days following the procedure. Bleeding and abdominal pain are expected. Your doctor may prescribe antibiotics, to prevent infection, as well as pain medication. Expect to need six to eight weeks to recover from an abdominal hysterectomy, and at least four to six weeks to recover from a vaginal hysterectomy.

If the cancer has spread to the cervix, a radical hysterectomy may be required. This involves removing the uterus, the tissues around the uterus (parametrium and uterosacral ligaments), and the upper part of the vagina next to the cervix. This procedure can take up to three hours and will require five to eight weeks recovery time. Most patients also have lymph node sampling or dissection done if a radical hysterectomy is done. A radical hysterectomy is usually performed by a specially trained gynecologist called a gynecologic oncologist.

Lymph Node Sampling

Lymph node samples may be removed to determine if the cancer has spread, using one of two procedures:

  • Pelvic/para-aortic lymph node dissection is the surgical removal of lymph nodes from the pelvis and the area in the abdomen beside the spine. This operation can be performed at the same time as a simple abdominal hysterectomy or radical abdominal hysterectomy.
  • Laparoscopic lymph node sampling or laparoscopy is a new procedure for viewing the inside of the abdomen and pelvis. This technique involves inserting a tube into a small incision (as opposed to the large incision necessary for a simple abdominal or radical abdominal hysterectomy).

Risks

Complications are unusual for hysterectomies but include excessive bleeding, wound infection, damage to the urinary tract or gastrointestinal system, pelvic pain, bone and joint pain and, on rare occasions, blood clots. Women who have both their ovaries removed along with the hysterectomy experience menopause if they have not already been through menopause before the surgery. This can result in an increased risk for circulatory disease and osteoporosis.

When the uterus is removed, there is also the possibility of prolapse, or “dropping,” of the other organs, such as the bladder or colon.

When lymph nodes are removed, there is also the risk of vein inflammation, nerve damage and lymphedema. Lymphedema can occur immediately after the surgery or several months or years later. A technique called sentinel node biopsy may avoid these risks.

Radiation Therapy

Radiation can be used to kill cancer cells and cure patients with endometrial cancer. There are two ways of targeting endometrial cancer cells: external radiation therapy and internal radiation therapy.

    1. External radiation therapy uses a machine to focus radiation from outside the body onto the cancer cells inside the pelvis.

      External beam radiation therapy may be used after surgery:

      • if the cancer has spread through more than half the myometrial (the uterine muscle) thickness and lymphatic channels have cancer cells in them
      • if cancer was found in the lymph nodes after being removed
      • for certain types of uterine cancer

The number of treatments given varies, but external beam radiation therapy is usually given daily, Monday through Friday, for four or five weeks.

  1. Brachytherapy (or internal radiation therapy) involves placing radioactive devices, such as tubes or catheters which have radioactive seeds sealed inside them, inside the body. These are placed temporarily in the uterus (if done before surgery) or the vagina (if done after surgery).

    Brachytherapy may be given without external treatment or after the external treatment is finished.  It is usually used if cancer cells were found in the cervix as well as the body of the uterus.

Most commonly, radiation of any kind is given after surgery. On rare occasions, radiation therapy may be used before surgery if the cervix is also affected by the cancer.

Side Effects

There can be side effects from radiation treatment. Most will go away. The skin in the treated area may look sunburned and then tanned, but will return to normal within six to 12 months.

Other side effects during treatment include:

  • fatigue
  • diarrhea, which is usually controlled with medication
  • urinary frequency or burning with urination, also often alleviated with medication
  • nausea and vomiting (rare)
  • changes in appetite (rare)

Brachytherapy is minimally uncomfortable when the device is inserted into the vagina but otherwise, has few side effects.

Long-Term Consequences

The potential long-term consequences of radiation therapy include:

  • permanent change in bowel habits, with increased tendency to diarrhea (uncommon)
  • damage to the bowel, which requires surgery (very rare)
  • narrowing of the vagina (called vaginal stenosis), which can make sexual intercourse difficult or painful, but there are strategies to prevent this from happening
  • increased risk for fracturing a pelvic bone

Talk to your doctor about any side effects. There are treatments and medications that can help alleviate some of these effects.

Hormone Therapy

Typically, hormone therapy involves taking progesterone pills (or progestins), to slow the growth of the cancer cells. They are used for recurrent or advanced endometrial cancer.

Chemotherapy

Chemotherapy (drugs used to kill cancer) is being used more often for women with endometrial cancer, especially if the cancer has spread beyond the endometrium. Certain less common but faster growing types of endometrial cancer may also require chemotherapy. These drugs are usually given intravenously. Chemotherapy drugs travel through the bloodstream to reach all areas of the body.

The drugs not only destroy cancer cells but also damage some normal cells, which in turn, can cause side effects. The side effects from chemotherapy depend on the type of drugs being used, the dosage, and the length of time a person takes the medication. Side effects may include:

  • Nausea
  • Upset stomach and vomiting (you will be given anti-nausea drugs)
  • Loss of appetite
  • Temporary loss of hair
  • Increased chance of infection
  • Fatigue

Most of the side effects will go away within a few weeks of completing treatment. Hair starts to regrow a couple of months after stopping the chemotherapy.

 

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