Uterine Cancer Treatment

The Gynecologic Oncology Center uses four primary types of treatment for endometrial cancer and uterine sarcoma. The course of treatment will depend largely on the type of cancer you have and its staging. Other factors, such as your age and overall health, may also be considered.

The four options for treatment are discussed below. Some treatments are used in concert with one another. For instance, surgery may be followed up with chemotherapy to kill any cancerous cells that could not be removed in the selected procedure.

Surgery

If uterine cancer is discovered, surgery is often the necessary course of action that will be by your cancer care team at the Gynecologic Oncology Center. Following are the common procedures that will be performed, depending on the staging of the cancer itself.

Hysterectomy with Bilateral Salpingo-Oophorectomy

In a hysterectomy, the entire uterus, including the cervix is removed. The broad ligaments with tubes and overies are also removed in the treatment of uterine carcinoma.

In a radical hysterectomy, the entire uterus, the surrounding tissues and the upper part of the vagina (about 1” near the cervix) are removed. This procedure is commonly used in cases of cervical carcinomas or uterine malignancies that also invide the cervix. Often the lymph node will be dissected as well, to see if cancer has spread to the nodes.

A hysterectomy can be conducted one of three ways. It can be removed through an incision in the abdomen (called an abdominal hysterectomy) through the vagina (a vaginal hysterectomy) or through a minimally invasive procedure called laparoscopy.

Your doctor may also recommend a robotic hysterectomy. Using our state-of-the-art da Vinci® robotic technology, your surgeon will make a series of small incisions. Micro-instruments are inserted through these incisions, allowing the surgeon to perform extremely accurate surgical procedures, using real time 3D imaging to magnify the surgical environment. The use of da Vinci® robotic technology allows the surgeon to perform the hysterectomy without damaging surrounding tissues and nerves.

Benefits include a shorter stay in the hospital, less pain and scarring, reduced blood loss, fewer infections and complications and the ability to return to your normal routine more quickly.

Bilateral Salpino-Oophorectomy

In this procedure, the fallopian tubes and both ovaries are removed. When treating endometrial cancer and uterine sarcomas, this operation is performed at the same time the uterus is removed, i.e., during a hysterectomy.

Lymph Node Surgery (lymphadenectomy)

During other procedures, your surgeon may elect to do a lymph node dissection. A portion of the lymph nodes in the pelvis and around the aorta are removed and examined under a microscope. If cancer is identified, usually chemotherapy and radiation therapy will be recommended which greatly improves your odds for cure.

Other Procedures That May Be Performed

Omnentectomy. Fatty tissue that covers the abdominal contents is removed. It may also be removed during a hysterectomy if the cancer has already spread there.

Peritoneal biopsies. The peritoneum is the tissue that lines the pelvis and the abdomen. The biopsy’s purpose is to check for cancer cells.

Debulking. If the cancer has spread throughout the abdomen, the surgeon will try to remove as much of the tumor as possible.

Pelvic washings. Salt water is used to “wash” the pelvic and abdominal cavities. The fluid is then sent to the lab to see if cancer cells are present.

Chemotherapy

Used alone or in conjunction with surgery or radiation therapy, chemotherapy uses powerful drugs to kill cancerous cells.  As the drug circulates through the bloodstream, it hunts down and kills the cancerous cells, making it useful for treating cancer that has spread beyond the uterus.

Depending on the stage of the uterine cancer, chemotherapy may be used to shrink the cancer prior to surgery or to kill remaining cancer cells after surgery. It can also be used as the primary therapy for treating uterine cancer.

Hormone Therapy

Hormone therapy can be used to treat patients who have entrometrial stromal sarcomas (ESS) and endometrial adenocarcinoma (EAC).

A variety of hormone therapies exist:

• Progestins are forms of progesterone, a natural hormone produced by the ovaries. ESS and EAC often suppress progesterone receptors which are targets for progesterone therapy.
• Aratamese inhibitors stop estrogen from being produced in the fat tissue, which can take over production after the ovaries are removed. These drugs are also used to treat breast cancer.
• Tamoxifen is another anti-estrogen drug that is used to treat breast cancer. It is also used to treat ESS and EAC. The drug does this by preventing estrogen from nourishing the cancer cells and increasing progesterone receptors.

Radiation Therapy

Using high-energy radiation, radiation therapy destroys cancerous cells with an external beam. Alternately, radioactive materials can be placed near the tumor in a procedure known as brachytherapy. In some cases, external radiation is used along with brachytherapy to destroy cancer cells.

If a tumor can be seen growing through the cervix, experts at the Gynecologic Oncology Center may recommend radiation therapy to make if easier to remove the uterine cancer during surgery. Radiation therapy may also be used to reduce the chance that cancer will return, especially when the cancer is determined to be high grade or is affecting the lymph nodes.