Treatment of Uterine Cancer
Various treatment options are available for uterine cancer, such as :
- Radiation therapy.
- Hormone therapy.
- A combination of therapies, such as surgery and radiation.
Although there are broad guidelines for treatment options of endometrial cancer, each case has to be evaluated on an individual basis. There are a host of variables that have to be taken into consideration before choosing any one option or a combination of therapies.
Some of the factors that need to be taken into consideration before deciding on the type of treatment are :
- Age of the patient
- Health status of the patient at the time of cancer detection
- Extent and spread of cancer to distant sites
- Types of uterine cancer
- Desire for future pregnancy
- Women at high risk of endometrial cancer
- Whether the cancer is hormone dependent
Total abdominal hysterectomy (TAH), usually with bilateral salpingo-oophorectomy (BSO), is the favored treatment in case of early stage 1 endometrial cancer. The uterus and cervix, along with the fallopian tubes and ovaries on both sides are removed in this procedure. Abdominal hysterectomy is preferred over vaginal hysterectomy since the abdominal cavity can be visualized better during operation. Also, tissues for biopsy may be removed more easily and with precision.
A radical hysterectomy may be done when the cervix or the area around the cervix has been involved. The uterus, cervix, the tissues around the uterus, and the upper part of vagina are removed, along with BSO.
Lymph node surgery is where the lymph nodes of the pelvis (pelvic lymph nodes) and those along the aorta (para-aortic lymph nodes) may be removed during a hysterectomy if lymph node involvement is suspected. When all or most of the lymph nodes of a certain area are removed, it is known as lymph node dissection. If only some are removed, it is called lymph node sampling.
Pelvic washings may be obtained during surgery by washing the abdominal and pelvic cavity with saline and examining this fluid in the laboratory for cancer cells.
Complications of Surgery for Uterine Cancer
The main complications of hysterectomy, besides the complications that may occur with any major surgery, are the inability to fall pregnant since the uterus has been removed. This is more of a consequence rather than a complication but needs to be taken into consideration in women who desire to fall pregnant. With the onset of menopause due to removal of the ovaries, the symptoms of menopause may then appear which includes hot flashes, night sweats, and vaginal dryness. The psychological impact of a hysterectomy should also be considered.
Radiation therapy may be undertaken in any stage of endometrial cancer. It may be done where surgery is not possible. It may also be used before or after surgery.
In radiation therapy, high-energy radiation is used to kill the cancer cells. Internal radiation therapy or brachytherapy is given by means of radioactive materials placed inside the body near the tumor. External beam radiation therapy is delivered from outside the body. Sometimes, both internal and external radiation therapy may be administered.
Complications of radiation therapy includes nausea, diarrhea, fatigue, vaginal stenosis, temporary loss of pubic hair, vaginal discharge, urinary difficulty, and low blood count. The skin over the treated area may show redness, dryness or irritation. There may be symptoms of early menopause in premenopausal women.
The combination of surgery and radiation is often recommended for stage 1 endometrial cancer which has an increased chance of recurrence, has involved the lymph nodes or is a grade 2 or grade 3 cancer. Stage 2 cancer may also be treated by a combination of surgery and radiation. Where cancer has spread beyond the uterus to other tissues, a combination of radiation and chemotherapy may be recommended.
Chemotherapy is usually recommended for treatment of stage 3 and 4 endometrial cancers. It may be used following surgery where the tumor could not be removed totally, or if there is chance of recurrence. Anti-cancer drugs may be given intravenously or orally. Sometimes, a combination of drugs may need to be given for a better response. Drugs used in chemotherapy for endometrial cancer may include paclitaxel, carboplatin, doxorubicin, and cisplatin.
Complications of chemotherapy may include nausea, vomiting, tiredness, low blood cell count, loss of appetite, hair loss, mouth and vaginal sores. Side effects depend upon the drug used and in most cases are reversible once chemotherapy is stopped.
Endometrial tumors that are hormone-dependent may be treated with hormone therapy. Women with advanced uterine cancer and those with stage 1 cancer who wish to have children may benefit from hormone therapy. Certain hormones or anti-hormones are used in the treatment of endometrial cancer, such as progestins, tamoxifen, gonadotropin-releasing hormone (GnRH) agonists, and aromatase inhibitors.
Progestins such as medroxyprogesterone acetate and megestrol acetate are most often used in hormone therapy for endometrial cancer. It slows down the growth of endometrial cancer cells.
Tamoxifen is an anti-estrogen drug commonly used in the treatment of breast cancer. It acts by opposing the action of circulating estrogen which helps in the growth of cancer cells. Tamoxifen is used mainly in treatment of advanced or recurrent endometrial cancer.
Gonadotroping-releasing hormone (GnRH), such as goserelin and leuprolide act by lowering estrogen levels and thus slowing growth of cancer cells.
Aromatase inhibitors, such as letrozole, anastrozole and exemestane are drugs used in treating breast cancer but are under research for use in the treatment of endometrial cancer.
Complications of hormone therapy depend upon the hormone used. Common complications are hot flashes, night sweats, weight gain, increased blood sugar level (hyperglycemia) in diabetic women, vaginal dryness, increased risk of thrombosis, and osteoporosis.
Treatment of Uterine Cancer according to Stage
- In Stage 1 and Stage 2 endometrial cancer, hysterectomy may result in complete cure of the cancer. In premenopausal women wishing to have children, hormone therapy with progestins may be used but hysterectomy is ultimately advised once further pregnancy is no longer desired.
- In some Stage 2 endometrial cancers, such as type 2 endometrial cancer which is known to be more aggressive, radiation therapy or chemotherapy may be advisable to prevent recurrence of cancer.
- In Stage 3 endometrial cancer, hysterectomy with removal of the affected lymph nodes, may result in a cure. Radiation therapy or chemotherapy may be recommended after surgery.
- In Stage 4 endometrial cancer, a cure may not be possible at this late stage but slowing the progress of the disease and alleviation of symptoms may be done by means of chemotherapy, radiation therapy and hormone therapy.
Alternative Therapies in Treatment of Uterine Cancer
It is understandable that women suffering from uterine cancer may be tempted to try other methods of treatment in place of standard medical treatment. The efficacy of alternative therapies in treatment of endometrial cancer is doubtful and may have dangerous side effects. Valuable time may be lost by trying out these remedies and therapies where regular treatment could have helped the patient.
Complementary therapies are those that are used side by side with standard treatments. It is more often used to get symptomatic relief but caution should be exercised before trying such therapies since some may have harmful side effects.
It is always better to consult with the attending doctor before trying any alternative method of treatment. With proper guidance, some forms of treatment may be tried which will not be harmful to the patient.