Endometrial/Uterine Cancer Treatment Approaches
City of Hope uses a multidisciplinary approach to combat uterine cancer. Our surgeons, medical and radiation oncologists and researchers collaborate closely throughout treatment to ensure uterine cancer patients receive the best care possible.
 
Surgery remains the preferred method for treatment of uterine cancer. Because most endometrial cancers are found early, surgery offers an excellent chance at curing the patient.
 
Most surgeons will recommend a hysterectomy (removal of the uterus) or, for a more complete removal, a hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). The predominant technique utilized is the abdominal hysterectomy. As the name implies, the incision and access to the uterus is via an abdominal incision. This allows for a better view and easier dissection of the necessary areas. As an alternative, hysterectomy can also be performed via a vaginal incision, and a laparoscopic approach is also possible. Laparoscopic surgeries allow for smaller incisions, less bleeding and less postoperative pain.
 
City of Hope is one of a few institutions to operate four da Vinci S HD Surgical Systems – the most advanced robotic technology available. Our team possesses a thorough knowledge of robotics, due in part to our large volume of patients and expertise across a variety of procedures.
 
The robotic surgical approach means smaller incisions, reducing trauma to the patient and assisting in quicker healing. This means that women may feel better and return to their normal lives sooner. Robotic systems use highly advanced imaging navigation, high-definition monitors and fine optics so surgeons can operate with more precision than ever before.
 
In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area.
Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, the doctor may suggest radiation treatments for the small number of women who cannot have surgery.

Doctors use two types of radiation therapy to treat uterine cancer:
 
  • External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.
    • Intensity-modulated Radiotherapy (IMRT) has evolved as a technique that can treat certain areas such as the tumor or areas at risk of recurrence while sparing adjacent normal tissues from high-dose irradiation.IMRT is an advanced form of radiotherapy that produces high-dose volume of radiation, which may have an irregular shape that better conforms to the clinical target volume. By having a better conformation of the target volume, normal pelvic tissues (e.g., small bowel, bladder, rectum) are relatively spared. The potential advantage of IMRT in these treatments, in the post-operative setting, is the ability to shape a dose distribution that delivers a lower dose to abdominal cavity contents (e.g., small and large bowel), which in turn will make it possible to reduce side effects from treatment.
  • Internal radiation: In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.
 
Some patients need both external and internal radiation therapies.

Hormonal Therapy
Hormonal therapy involves substances that prevent cancer cells from getting or using the hormones they may need to grow. Hormones can attach to hormone receptors, causing changes in uterine tissue. Before therapy begins, the doctor may request a hormone receptor test. This special lab test of uterine tissue helps the doctor learn if estrogen and progesterone receptors are present. If the tissue has receptors, the woman is more likely to respond to hormonal therapy.
 
Hormonal therapy is called a systemic therapy because it can affect cancer cells throughout the body. Usually, hormonal therapy is a type of progesterone called a progestin. The two most commonly used progestins are:
 
  • medroxyprogesterone acetate (Provera tablets or Depo-Provera injectable)
  • megestrol (Megace tablets)

The doctor may use hormonal therapy for women with uterine cancer who are unable to have surgery or radiation therapy. Also, the doctor may give hormonal therapy to women with uterine cancer that has spread to other areas of the body. It is also given to women with uterine cancer that has recurred.
 
Chemotherapy
If there is evidence of spread beyond the endometrium, chemotherapy may be needed. Combinations of doxorubicin, cisplatin/carboplatin and paclitaxel have proven useful. Ifosfamide and 5-FU are also used.