Endometrial Cancer: Treatment

The International Federation of Gynecology and Obstetrics (FIGO) has adopted a staging system for endometrial cancer. The stage of cancer is determined after surgery. Endometrial cancer is categorized into four stages (I, II, III, and IV) that are subdivided (A, B, and possibly C) based on the depth or spread of cancerous tissue. Seventy percent of all uterine cancers are stage I, 10–15% are stage II, and the remainder are stages III and IV. The cancer is also graded (G1, G2, and G3) based upon microscopic analysis of the aggressiveness of the cancer cells.

The FIGO stages for endometrial cancer are:

• Stage I. Cancer is limited to the uterus.
• Stage II. Cancer involves the uterus and cervix.
• Stage III. Cancer has spread out of the uterus but is restricted to the pelvic region.
• Stage IV. Cancer has spread to the bladder, bowel, or other distant locations.

The mainstay of treatment for most stages of endometrial cancer is surgery. Radiation therapy, hormonal therapy, and chemotherapy are additional treatments (called adjuvant therapy). The necessity of adjuvant therapy is a controversial topic which should be discussed with the patient's treatment team.

Most women with endometrial cancer, except those with stage IV disease, are treated with a hysterectomy. A simple hysterectomy involves the removal of the uterus. In a bilateral salpingo-oophorectomy with total hysterectomy, the ovaries, fallopian tubes, and uterus are removed. This may be necessary because endometrial cancer often spreads to the ovaries first. The lymph nodes in the pelvic region may also be biopsied or removed to check for metastasis. Hysterectomy is traditionally performed through an incision in the abdomen (laparotomy), however, endoscopic surgery (laparoscopy) with vaginal hysterectomy is also being used. Women with stage I disease may require no further treatment. However, those with higher grade disease will receive adjuvant therapy.

The decision to use radiation therapy depends on the stage of the disease. Radiation therapy may be used before surgery (preoperatively) and/or after surgery (postoperatively). Radiation given from a machine that is outside the body is called external radiation therapy. Sometimes applicators containing radioactive compounds are placed inside the vagina or uterus. This is called internal radiation therapy or brachytherapy and requires hospitalization.

Side effects are common with radiation therapy. The skin in the treated area may become red and dry. Fatigue, upset stomach, diarrhea, and nausea are also common complaints. Radiation therapy in the pelvic area may cause the vagina to become narrow (vaginal stenosis), making intercourse painful. Premature menopause and some problems with urination may also occur.

Chemotherapy is usually reserved for women with stage IV or recurrent disease because this therapy is not a very effective treatment for endometrial cancer. The anticancer drugs are given by mouth or intravenously. Side effects include stomach upset, vomiting, appetite loss, hair loss, mouth or vaginal sores, fatigue, menstrual cycle changes, and premature menopause. There is also an increased chance of infections.

Hormonal therapy uses drugs like progesterone to slow the growth of endometrial cells. These drugs are usually available as pills. This therapy is usually reserved for women with advanced or recurrent disease. Side effects include fatigue, fluid retention, and appetite and weight changes.

— Lata Cherath; Belinda Rowland, Ph.D.