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 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.
Following are the preferred treatment approaches for different stages of endometrial cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.
|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.|
|II||In case of Stage II endometrial cancer, after hysterectomy, patient requires radiation therapy with/without chemotherapy in most cases.|
|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.|
|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.
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Endometrial Cancer Treatment Options
- Surgery: 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 help in establishing accurate stage and thus selecting an appropriate treatment for the disease. Hysterectomy is commonly employed for the management of endometrial cancer. In total hysterectomy, the entire uterus is removed keeping all other structures in place. In 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: 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: 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 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 due to its effect on normal body cells apart from cancerous cells.
- Hormone Therapy: This treatment approach is based on the fact that most endometrial cancer cells grow under the influence of estrogen. Estrogen is predominately produced by the ovaries and a small amount is also produced by the fat tissue in females.
Depriving the endometrial cancer cells of the estrogen or by lowering the estrogen level in the blood cause their shrinkage or make them grow very slowly. Following are some common types of hormonal therapy used for the treatment of endometrial cancer:
Progestins: Progestins are the first-choice hormonal treatment for endometrial cancer. Drugs like medroxyprogesterone acetate and megestrol acetate are commonly used progestins which act similar to progesterone and inhibit estrogen to produce its eliciting effect on endometrial cancer cells.
Tamoxifen: Tamoxifen is a drug commonly used in breast cancer and can be used to treat advanced-stage endometrial cancer. It blocks the estrogen receptors in cancer cells and can act as a weak estrogen in other body tissues like bones.
Luteinizing hormone-releasing hormone agonists: These drugs (e.g. leuprolide, and goserelin) decrease the level of estrogen in the blood by acting on the pituitary gland which in turn signals to stop the production of estrogen from the ovaries. These drugs can be used alone or in combination with other hormonal drugs in pre-menopausal women.
Aromatase inhibitors (AIs): Aromatase is an enzyme that helps in the production of estrogen from fatty tissue. In post-menopausal women, fatty tissue is the main source of estrogen. Thus, AIs (e.g. letrozole, anastrozole, and exemestane) help in lowering estrogen level in post-menopausal women and used for the treatment of endometrial cancer in such patients.
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 condition are also important to make a treatment choice. Following are ultimate goals of treating endometrial cancer:
- Prolongation of life
- Reduction of symptoms
- Improvement of overall quality of life