Endometrial Cancer

Endometrial Cancer Treatment

When endometrial or uterine cancer is diagnosed, patients are referred to a gynecological oncologist to manage their care. Gynecological oncologists are experts in caring for patients with cancer of the female reproductive system. These specialists typically coordinate all aspects of a patient's care, from diagnosis and treatment to support and surveillance. 

These specialists perform surgery, stage the cancer to determine how much it has spread and administer chemotherapy, targeted therapy and immunotherapy when needed. When patients qualify, these specialists can enroll them in clinical trials.

Surgery: minimally-invasive hysterectomy

Typically, patients with both low-grade and high-grade uterine cancer are candidates for a hysterectomy. When performing this procedure, our gynecologic oncologists completely remove the uterus, cervix, ovaries, fallopian tubes and sentinel lymph nodes. We:

• Utilize the most advanced, minimally-invasive surgical technology such as the robotic da Vinci surgical system and laparoscopic techniques.


• Reduce post-operative complications by removing fewer lymph nodes. We accomplish this by locating and removing what are known as the sentinel lymph nodes - the first lymph nodes into which the cancer drains - making them the most impactful lymph nodes to remove.

After a patient's surgery, we test the tumor to help determine the stage of the cancer. The results of the pathology report help your gynecologic oncologist determine the best treatment for you moving forward.

Active surveillance for endometrial cancer

Surgery is typically curative for patients with low-grade endometrial cancer and there is a low risk for recurrence. After surgery, patients with low-risk uterine cancer are often candidates for active surveillance. They check in with their physician to monitor their uterine health at regular intervals for five years following their surgery. We typically do not recommend imaging during active surveillance, as studies have shown that it does not improve outcomes for patients with low-grade endometrial cancer after surgery.

Radiation therapy for uterine cancer

When someone’s pathology suggests a higher risk of recurrence – or the cancer returning – radiation therapy can significantly reduce the risk. We follow evidence-based guidelines to evaluate whether radiation therapy may be beneficial. A patient's pathology provides information that we consider along with their age and other risk factors.

 

High-dose rate brachytherapy

Data shows that most recurrences of endometrial cancer occur in an area called the vaginal cuff, which is the area at the top of the vagina. Vaginal brachytherapy is a type of internal radiation that targets this localized area with a high radiation dose in a short period. The most significant benefit of this type of radiation is that it limits exposure to healthy tissues and organs near the treated area.

We use computed tomography (CT) scans to design an individualized plan that most effectively targets the cancer.

During this session, the patient will have a cylinder device fitted for comfort and effectiveness placed into her vagina. Patients typically need at least one to two sessions per week for three weeks. Depending on personal factors, our radiation oncologist may change the timing or number of the treatments. They will talk with you about what to expect.

External beam radiation therapy (EBRT)

For patients with a tumor in their lymph nodes or other high-risk cancers, external beam radiation therapy (EBRT) may be recommended. This traditional course of radiation is typically delivered to the pelvis and para-aortic lymph nodes for five days a week for up to five weeks.

Wellstar radiation oncologists have various techniques to deliver EBRT, including 3D conformal radiation therapy guided by CT scans.

If necessary, radiation oncologists can use intensity modulated radiation therapy (IMRT). With IMRT, the radiation dose conforms more precisely to the tumor assisted by computer-controlled, movable "leaves" that mimic the tumor's shape. This technology allows a higher dose of radiation to be delivered to the cancer while decreasing the dose to surrounding healthy tissue.

Other therapies & clinical trials

For patients with higher-risk cancer, gynecologic oncologists administer chemotherapy, targeted therapy and immunotherapy. These patients typically have metastatic or recurrent endometrial cancer. People with high-risk uterine cancer can also benefit from pioneering treatment with access to NRG Oncology-sponsored clinical trials through a partnership between the Wellstar Research Institute and Mayo Clinic.