If someone is suspected to have endometrial cancer based on signs and symptoms, certain investigations are required to confirm the diagnosis of the disease. Further, these can help in determining the stage of the disease, which in turn help in choosing an appropriate treatment option.
The endometrial cancer treatment depends on various factors including the type of endometrial cancer, stage of the disease, grade of the tumor, patient’s preference (for example, to retain fertility or not), performance status of the patient, along with other factors.
Treatment for different stages of endometrial cancer
FIGO STAGE I
In case of Stage I endometrial cancer, after hysterectomy, the patient may be kept on observation or may be given radiation therapy with/without chemotherapy depending on stage, grade and other risk factors.
FIGO STAGE II
In case of Stage II endometrial cancer, after hysterectomy, patient requires radiation therapy with/without chemotherapy in most cases.
FIGO STAGE III
In case of Stage III endometrial cancer, surgery (performed only if all cancer tissue can be removed) followed by chemotherapy and/or radiotherapy is considered as the standard treatment.
FIGO STAGE IV
In case of Stage IV endometrial cancer, hormone therapy or chemotherapy is generally considered as the standard treatment.
Surgery and or radiotherapy may also be employed alongside hormone therapy or chemotherapy as palliative treatment to relieve symptoms.
Overview of Endometrial Cancer Treatment Options
Surgery is the first-line treatment for many early-stage and some advanced-stage endometrial cancers. There are mainly 2 aims of surgery in endometrial cancer: first is to stage the disease and second is to remove all possible cancerous tissue to treat the disease. For staging, the tissue removed during surgery is thoroughly tested in a laboratory.
This helps in establishing an accurate stage and thus selecting an appropriate treatment for the disease. Hysterectomy is commonly employed for the management of endometrial cancer. In a total hysterectomy, the entire uterus is removed keeping all other structures in place. In a radical hysterectomy, the uterus along with associated tissues like parametria, uterus ligaments, part of the vagina, pelvic lymph nodes, and fallopian tubes and ovaries are removed.
The hysterectomy and BSO for endometrial cancer result in infertility and thus preferably carried out in postmenopausal women or those who do not wish to retain fertility.
Radiation therapy (or radiotherapy) uses high-energy radiation directed to the affected area to kill cancerous cells. It can be employed either by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). Radiotherapy is commonly combined with other treatment options such as surgery and/or chemotherapy for higher stage disease. Sometimes, it is used as palliative therapy to relieve pain, bleeding, and obstructive problems associated with the advanced-stage disease.
Chemotherapy means treatment with anti-cancer drugs that kill or decrease the growth of rapidly growing cancer cells. It is considered to be the mainstay of treatment for an advanced-stage disease that has spread to distant body parts. Depending on the physician’s preference and patient’s condition, it may also be combined with other treatment options to accelerate the benefit achievement. It may be associated with side effects like nausea/vomiting, hair loss, fatigue, cytopenias, etc due to its effect on normal body cells apart from cancerous cells.
This may help in improving the overall quality of life by providing relief from the symptoms caused by endometrial cancer. They are generally given as supportive care for advanced-stage cancer. These include but are not limited to using drugs to reduce pain and other symptoms such as vomiting, fatigue or external-beam radiation therapy for bleeding or pain, etc.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health conditions are also important to make a treatment choice. Following are the ultimate goals of treating endometrial cancer:
- Prolongation of life
- Reduction of symptoms
- Improvement of overall quality of life
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