What are the treatments for uterine cancer?

Surgery Almost all women with uterine cancer will have some type of surgery in the course of their treatment. The purpose of surgery is first to remove the cancer and provide tissue to stage the spread of the cancer. Generally, women with uterine cancer will have a hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) as part of their operation. This is because there is always a risk of microscopic cancer in both of the ovaries as well the uterus, as well as the possibility of there being a coexistent ovarian cancer. This is usually an abdominal procedure performed under general anaesthesia, however in certain situations it may be performed as a laparoscopic total hysterectomy or as a laparoscopic assisted vaginal hysterectomy both with bilateral salpingo-oophorectomy.
On entering the abdomen any free fluid collected or fluid is introduced to the pelvis and then collected and sent for microscopic examination as part of the staging procedure. The pelvic and abdominal contents are carefully inspected for any suggestion of spread (metastasis) of the cancer and for evidence of any other disease process. The lymph node chains along the major abdominal and pelvic vessels are palpated for any evidence of possible spread to them. The uterus, fallopian tubes and ovaries are now removed and the uterus is opened to ascertain the presence of muscular invasion. Depending on the precise tumour type and the depth of myometrial (muscular) invasion by the tumour a decision will be made regarding removal of pelvic and paraaortic lymph glands. In certain tumour types the omentum (a fatty apron that hangs from the stomach) may also be removed. The abdomen is closed at the end of the procedure and during the recovery process the removed tissues and organs are examined by the pathologist and a formal staging is attributed to the tumor as well as occasional revision of the precise nature of the tumor. When these facts become known further treatment options will be discussed by the tumour board and will be discussed with the patient.
Further therapy Even when all cancer is removed, there is always a risk that the cancer might return. Occasionally no further therapy is recommended, particularly in patients with low risk and early stage tumors with little or no chance of recurrence. However after careful staging and evaluation of the tumour further therapy is recommended as appropriate.RadiotherapyHigh energy x-rays are used to kill cancer cells. These come from a machine called a linear accelerator or linac for short. Treatment is usually given as an outpatient. The number of treatments varies but can be up to 5 days a week for to 6 weeks. The treatment takes just a few minutes, and it is painless.
Radiation can also be used to ease the pain of metastases and stop tumors from bleeding. Generally, doctors try to limit the amount of radiation that your vital organs receive, and don't like to treat large portions of the bowel and pelvis.Internal radiation therapy may also be given to deliver higher doses of radiation to the region of the cervix or the top of the vagina. This is called brachytherapy and may be given alone or in combination with external beam radiotherapy.
Chemotherapy In certain less common uterine cancers and sarcomas chemotherapy is used because of a high risk of disease spread or because of known disease spread. There are many different chemotherapy drugs, and they are often given in combinations. Patients will usually have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein. Different chemotherapy regimens are used for different purposes. The most common drugs currently used, alone or in combination include Cisplatin or Carboplatin (platinum containing drugs) Adriamycin, Ifosfamide and Taxol. Sometimes new combinations are tried if there isn't a response to the original combination. There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your cancer and your lifestyle. Our team will also discuss with you about being involved with the latest research into cancer treatment. You will need to consent for a research treatment. It involves being randomized or offered either the gold standard treatment or another combination of drugs that we believe is as good or better. It is through medical research and clinical trials that we have been able to advance cancer treatment.
Hormone therapy Hormone therapy is used occasionally in highly selected situations, which your oncologist will discuss with you. In most situations it has no demonstrated value, however it is sometimes used in recurrent disease. The most commonly used agents are Provera (medroxy progesterone acetate) and Tamoxifen. Occasionally severe menopausal symptoms will occur and if not controlled with alternate therapies it may be necessary to institute oestrogen replacement therapy. The very limited data available suggest no increased risk of recurrence or death. Follow-up testing After treatment is completed, patients are followed up closely and regularly to make sure the cancer does not return. This involves 3 monthly visits to start with. Your doctor will ask you some questions, perform an examination including a pelvic examination and may perform a blood tests (including CA125). Follow up CT scanning is not routinely performed but may be done if the doctor is unsure about his findings on examination or if the blood test starts to become elevated. Annual chest X-rays are often advised as well.
Other health screening should also be attended to especially breast surveillance by examination and regular mammography as well as screening for colonic cancer, both of which are increased in women who have had endometrial cancer.