Treatment of Uterine Cancer

Staging of Uterine Cancer

The process used to find out whether the cancer has spread within the uterus or to other parts of the body is called staging. Certain tests and procedures are used in the staging process.

  • Lab tests: A Pap test can show whether cancer cells have spread to the cervix, and blood tests can show how well the liver and kidneys are working. Also, your doctor may order a blood test for a substance known as CA-125. Cancer may cause a high level of CA-125.
  • Chest x-ray: An x-ray of the chest can show a tumor in the lung.
  • CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest. You may receive an injection of contrast material so your lymph nodes and other tissues show up clearly in the pictures. A CT scan can show cancer in the uterus, lymph nodes, lungs, or elsewhere.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your uterus and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in the uterus, lymph nodes, or other tissues in the abdomen.

Uterine cancerThere are three ways by which cancer spreads in the body.

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

 

Metastasis

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, secondary tumor may form. This process is called metastasis. The secondary or metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Stages of Uterine Cancer

Stage 0: The abnormal cells are found only on the surface of the inner lining of the uterus. The doctor may call this carcinoma in situ.

Stage I: In stage I, cancer is found in the uterus only. Stage I is divided into stages IA, IB, and IC, based on how far the cancer has spread.

  • Stage IA: Cancer is in the endometrium only.
  • Stage IB: Cancer has spread into the inner half of the myometrium (muscle layer of the uterus).
  • Stage IC: Cancer has spread into the outer half of the myometrium.

Stage II: In stage II, cancer has spread from the uterus to the cervix, but has not spread outside the uterus. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread into the cervix.

  • Stage IIA: Cancer has spread to the glands where the cervix and uterus meet.
  • Stage IIB: Cancer has spread into the connective tissue of the cervix.


Stage III:
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.

  • Stage IIIA: Cancer has spread to one or more of the following:
    • The outermost layer of the uterus; or
    • Tissue just beyond the uterus; or
    • The peritoneum.
  • Stage IIIB: Cancer has spread beyond the uterus and cervix, into the vagina.
  • Stage IIIC: Cancer has spread to lymph nodes near the uterus.

Stage IV: In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.

  • Stage IVA: Cancer has spread to the bladder and/or bowel wall
  • Stage IVB: Cancer has spread to other parts of the body beyond the pelvis, including lymph nodes in the abdomen and/or groin.

 

Recurrent Endometrial Cancer

Recurrent endometrial cancer is cancer that has recurred after it has been treated. The cancer may come back in the pelvis, in lymph nodes in the abdomen, or in other parts of the body.

Treatment of Uterine Cancer

The treatment of uterine cancer depends on the following factors—

  • Whether the tumor has invaded the muscle layer of the uterus
  • Whether the tumor has invaded tissues outside the uterus
  • Whether the tumor has spread to other parts of the body
  • The grade of the tumor
  • Age and general health

Following types of standard treatments are used foe uterine cancer—

 

Surgery

Surgery is the most common treatment for endometrial cancer. 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.

 

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Among the external radiation technology options, the most advanced forms of radiation therapy include three-dimensional conformal radiation therapy, intensity modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), and brachytherapy.

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

It can be of two types:

Systemic chemotherapy– When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.


Regional chemotherapy
–When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas.

After Treatment

After treatment for uterine cancer ends, a follow-up care plan is developed. This plan may include regular physical examinations and/or medical tests to monitor the recovery for the coming months and years.

In addition to a physical examination, follow-up care may include pelvic examinations, blood tests, yearly Pap tests, and x-rays. These tests may be done more frequently in the first and second year after treatment. Tell your doctor about any new symptoms, especially a loss of appetite, bladder or bowel changes, pain, vaginal bleeding, or weight changes. These symptoms may be signs that the cancer has come back or signs of another medical condition.

Women recovering from uterine cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer-screening tests. Moderate physical activity can help rebuild your strength and energy level.

 

Sources
National Cancer Institute
Centers for Disease Control and Prevention