ENDOMETRIAL CANCER TREATMENT

Once a diagnosis of endometrial cancer is made, then the main treatment is hysterectomy with removal of the uterus, cervix, fallopian tubes and ovaries, since spread to these organs can occur. If the cancer has spread it is usually only detected following removal of these organs when they are examined under the microscope. When the hysterectomy is undertaken, then the gynecological cancer surgeon usually decides whether or not to remove the lymph glands. Such a decision rests on the presence or absence of ‘high risk’ features, i.e. a high risk of spread to lymph glands.
At the time of surgery, a pathologist is usually present who will examine the uterus closely to see how much of the muscle has been invaded or if the cervix, tubes or ovaries are involved. In any of these cases, especially when the muscle is invaded more than halfway, then lymph gland removal from the pelvic sidewalls is undertaken.
If at the time of surgery the gynecological oncologist feels or sees enlargement of the lymph nodes, then these glands will be removed. If the pathologist finds malignant cells in the glands (the pathologist freezes the tissue, cuts it and then stains it to look at it under the microscope – ‘a frozen section’), then the glands higher up, outside the pelvis along the major blood vessels (‘para-aortic glands’) are also removed. In these circumstances radiation therapy will always be required after surgery and the exact site of spread within the lymph gland ‘chain’ must be ascertained, so that the radiation therapy can be delivered accurately.
Sometimes, if the woman is too overweight and access to the lymph glands is difficult, or they are found to contain malignant cells, the lymph glands may not be removed. Radiation to the lymph node bearing areas is then given, commencing usually six weeks following surgery.

Radiation treatment usually also covers the top of the vagina which is the most common site of recurrence of this cancer. In some cases where the lymph node bearing areas do not require radiation but the top of the vagina does, then brachytherapy’ will be recommended. This involves placing a tube up to the top of the vagina; radiation seeds are then pushed along this tube and high dose local irradiation given. This takes a very short time and four or five treatments are usually required in comparison to the external radiation therapy which is given to the lymph node bearing areas which takes about five to six weeks in sequences of five days, Monday to Friday.
Endometrial cancer has a very high overall cure rate. Should the cancer recur in an area that has not been treated previously by radiation, such as the top of the vagina, or bone, or lymph glands, it will be usually treated with radiation. This can sometimes be curative. For instance, if investigations reveal that the vagina is the sole site of recurrence of endometrial cancer then cure can be expected in many cases.
If the cancer recurs a type of hormonal therapy is often given.
There is a very limited place for anti-cancer drugs (‘chemotherapy’) in recurrent endometrial cancer, since side effects are common and it is not very effective.
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