Options for treating primary endometrial cancer will depend on the characteristics of the cancer, such as the stage, the grade and histology but also on the general health and the patients preferences and are outlined below. Treatment of recurrent endometrial cancer may include radiation therapy as palliative therapy to relieve symptoms and improve the patient’s quality of life, hormone therapy, and chemotherapy with or without biologic therapy.
Most women with endometrial cancer undergo a surgical procedure to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). The following surgical procedures may be used:
- Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
- Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
- Radical hysterectomy: Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
Even if all the cancer that can be seen at the time of the surgery has been removed, some patients may be given radiation therapy or hormone treatment after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. In some instances, radiation is recommended to reduce the risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.
- Radiation from a machine outside your body. Called external beam radiation, during this procedure you lie on a table while a machine directs radiation to specific points on your body.
- Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.
Hormone therapy involves taking medications that affect hormone levels in the body. Hormone therapy may be an option if advanced endometrial cancer has been diagnosed that has spread beyond the uterus. Options include:
- Medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop endometrial cancer cells from growing.
- Medications to reduce the amount of estrogen in your body. Hormone therapy drugs can help lower the levels of estrogen in your body or make it difficult for your body to use the available estrogen. Endometrial cancer cells that rely on estrogen to help them grow may die in response to these medications.
Chemotherapy uses chemicals to kill cancer cells. Patients may receive one chemotherapy drug, or two or more drugs can be used in combination. Chemotherapy may be recommended for women with advanced or recurrent endometrial cancer that has spread beyond the uterus. These drugs enter the bloodstream and then travel through the body, killing cancer cells.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapy being studied in the treatment of endometrial cancer. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy.
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