Doctor Visits And Tests
Endometrial cancer is most likely to come back within the first few years after treatment, so an important part of your treatment plan is a specific schedule of follow-up visits after treatment ends. How often you need to be seen depends mostly on what stage and grade the cancer was.
- For most women who had endometrial cancer, experts recommend a physical exam every 3 to 6 months for the first 2 to 3 years, then every 6 or 12 months after that. Imaging tests should be done based on the physical exam and any changes the patient reports.
- For women with higher stage or grade cancers , experts recommend that, along with physical exams, a CT scan of the chest, abdomen , and pelvis is done every 6 months for the first 3 years, then every 6 to 12 months for at least the next 2 years.
If symptoms or the physical exam suggests the cancer might have come back, imaging tests , a CA 125 blood test, and/or biopsies may be done. Studies of many women with endometrial cancer show that if no symptoms or physical exam changes are present, routine blood tests and imaging tests arent needed.
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How Is Uterine Cancer Treated
Most people with endometrial cancer need surgery. Your particular treatment plan depends on the type of cancer and your overall health. Other treatments you may have include:
- Chemotherapy, which uses powerful drugs to destroy cancer cells.
- Radiation therapy, which sends targeted radiation beams to destroy cancer cells.
- Hormone therapy, which gives hormones or blocks them to treat cancer.
- Immunotherapy, which helps your immune system fight cancer.
- Targeted therapy, which uses medications to target specific cancer cells to stop them from multiplying.
Researchers continue to study more ways to treat endometrial cancer.
Treatment Options Under Clinical Evaluation For Stage I And Stage Ii Endometrial Cancer
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Can You Fully Recover From Uterine Cancer
Yes, women can fully recover from uterine cancer after aggressive treatment, like surgery and radiation. Many women feel better about 1-2 weeks following surgery and can resume normal activities after 1-2 months.
Recovery from uterine cancer is more challenging if the cancer cells have metastasized to other parts of the body. The 5-year survival rate for all uterine cancer is 81.2%. The survival data are broken down further depending on how advanced the cancer is.
SEER Stage 5-year survival rate
Leiomyosarcoma, local: 64%
Endometrial cancer, all levels: 81%
Treatment Choices For Endometrial Cancer By Stage
The stage of endometrial cancer is the most important factor in choosing treatment. But other factors can also affect your treatment options, including the type of cancer, your age and overall health, and whether you want to be able to have children. Tests done on the cancer cells are also used to find out if certain treatments, like hormone and targeted therapy, might work.
Surgery is the first treatment for almost all women with endometrial cancer. The operation includes removing the uterus, fallopian tubes, and ovaries. . Lymph nodes from the pelvis and around the aorta may also be removed and tested for cancer spread. Pelvic washings may be done, too. The tissues removed at surgery are tested to see how far the cancer has spread . Depending on the stage of the cancer, other treatments, such as radiation and/or chemotherapy may be recommended.
For some women who still want to be able to get pregnant, surgery may be put off for a time and other treatments tried instead.
If a woman isn’t well enough to have surgery, other treatments, like radiation, will be used.
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Expert Review And References
- Alektiar KM, Abu-Rustum NR, Fleming GF. Cancer of the uterine body. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 73:1048-1064.
- Almadrones Cassidy, L. Endometrial cancer. Yarbro CH, Wujcki D, Holmes GB . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 53: 1281-1294.
- American Cancer Society. Uterine Sarcoma. 2014: .
- American Cancer Society. Endometrial Cancer. 2015: .
- American Society of Clinical Oncology. Uterine Cancer. 2014: .
- Cancer Care Ontario. Drug Formulary. Toronto, ON: Cancer Care Ontario
- Levine DA, Dizon DS, Yashar CM, Barakat RR, Berchuch A, Markman M, Randall ME. Handbook for Principles and Practice of Gynecologic Oncology. 2nd ed. Philadelphia, PA: Wolters Kluwer 2015.
- National Cancer Institute. Endometrial Cancer Treatment for Health Professionals . 2015: .
- National Cancer Institute. Uterine SarcomaTreatment for Health Professionals . 2015: .
Types Of Endometrial Cancer
Uterine carcinosarcomas, a poorly differentiated subgroup of uterine carcinomas, account for less than 5% of all uterine malignancies and are rare, aggressive biphasic neoplasms that consist of high-grade malignant epithelial and mesenchymal elements . Five-year progression-free survival rates for uterine-confined disease range from 40 to 75%, compared with 2035% for disease with extra-uterine extension .
The Cancer Genome Atlas Research Network has performed the most comprehensive molecular study of EC, integrating genomic, transcriptomic, and proteomic characterizations of EC based on array and sequencing technologies in 373 primary EC surgical specimens . These data revealed that EC can be classified into four molecularly phenotypically different groups: 1) DNA polymerase epsilon catalytic subunit ultramutated 2) MSI hypermutated 3) copy-number low , endometrioid histology, grade 1/2 tumors, and characterized by mutations in PTEN , CTNNB1 , PIK3CA , PIK3R1 , and ARID1A ) and 4) copy-number high serous-like .
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How Often Do Patients Need Chemotherapy For Endometrial Cancer
Chemotherapy is a drug given to some patients to shrink tumour before surgery or to treat microscopic cancer cells that might float around after endometrial cancer surgeryI often get asked what the chances are that a patient diagnosed with endometrial cancer will require chemotherapy after surgery.
The vast majority of patients will require only surgery. Sometimes stage 1 endometrial cancer that invades only a little into the surrounding muscle layer of the uterus may not even require surgery, and we may be able to treat the cancer using hormonal treatments. You can read more about hormonal treatments in a previous article here.
However, for some patients postoperative chemotherapy is indeed needed. For example, if the surgeon could not remove all the cancer or if the surgeon feels that microscopic cancer cells that are invisible could still be floating around. Therefore, chemotherapy for endometrial cancer is generally for patients with advanced disease .
For other patients, chemotherapy can be used to shrink the tumour load prior to surgery. For example, a patient who had a laparoscopy and a curette for diagnostic purposes: the gynaecologist found cancer around the peritoneum and it was clear to me from the outset that an operation alone would not fix the problem. Such patients have chemotherapy upfront, followed by surgery. The patients we have treated this way, did very well.
Other Types Of Stage I Endometrial Cancers
Cancers such as papillary serous carcinoma, clear cell carcinoma, or carcinosarcoma are more likely to have already spread outside the uterus when diagnosed. Women with these types of tumors don’t do as well as those with lower grade tumors. If the biopsy done before surgery shows a high-grade cancer, the surgery may be more extensive. Along with the total hysterectomy and removal of both fallopian tubes and ovaries, the pelvic and para-aortic lymph node will be removed, and the omentum is often removed, too.
After surgery, chemotherapy with or without radiation therapy are given to help keep the cancer from coming back. The chemo usually includes the drugs carboplatin and paclitaxel, but other drugs can also be used.
If the cancer can’t be removed with surgery, both chemotherapy with or without and radiation are used. Sometimes, the tumor then shrinks so that surgery can then be done to remove it.
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How Fatal Is Uterine Cancer
Uterine cancer is fatal when it goes undiagnosed and spreads. The survival rate for cancer that hasnt spread outside the uterus is 95%. The survival rate decreases to 17% when cancer spreads to other parts of your body outside your uterus. Early detection and early treatment are key to a favorable prognosis.
Chemotherapy For Endometrial Cancer
Chemotherapy is the use of drugs that kill cancer cells. They’re given into a vein or taken by mouth as pills. These drugs go into the bloodstream and reach throughout the body. Because of this, chemo is often part of the treatment when endometrial cancer has spread beyond the endometrium to other parts of the body and surgery can’t be done.
Chemo is also commonly used for high grade cancers, which grow and spread quickly, and cancer that comes back after treatment.
Chemo is not used to treat stage I and II endometrial cancers.
In most cases, a combination of chemo drugs is used. Combination chemotherapy tends to work better than one drug alone.
Chemo is often given in cycles: a period of treatment, followed by a rest period. The chemo drugs may be given on one or more days in each cycle.
Chemo drugs used to treat endometrial cancer may include:
- Doxorubicin or liposomal doxorubicin
Most often, 2 or more drugs are combined for treatment. The most common combinations include carboplatin/paclitaxel and cisplatin/doxorubicin. Less often, carboplatin/docetaxel and cisplatin/paclitaxel/doxorubicin may be used.
For carcinosarcoma, the chemo drug ifosfamide is often used, either alone or along with either cisplatin or paclitaxel. The targeted drug called trastuzumab might be added for carcinosarcomas that are HER2 positive.
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What Causes Endometrial Cancer
While the specific cause of endometrial cancer is unknown, experts believe a genetic mutation in the DNA causes changes to the cells in the uterine lining. Typically, when healthy cells become abnormal, they stop multiplying and die at a set rate. When there are DNA changes, the endometrial cancer cells grow and divide uncontrollably forming a mass or tumor.
What Should I Ask My Healthcare Provider
If youve received a uterine cancer diagnosis, ask your provider:
- What is the stage of my cancer?
- What treatment options will be best for me?
- Will I need more than one treatment?
- Are there clinical trials I can take part in?
- Whats the goal of treatment?
- What can I expect after treatment?
- Will cancer come back?
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Chemotherapy For Cancer Of The Uterus
Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells.
Learn more about:
Chemotherapy may be used:
- for certain types of uterine cancer
- when cancer comes back after surgery or radiation therapy to try to control the cancer and to relieve symptoms
- if the cancer does not respond to hormone therapy
- if the cancer has spread beyond the pelvis when first diagnosed
- during radiation therapy and/or after radiation.
Chemotherapy is usually given by injecting the drugs into a vein . You will usually have several treatment sessions, with rest periods in between. Together, the session and rest period are called a cycle. You will have a number of treatments, sometimes up to six, every 34 weeks over several months. Talk to your doctor about how long your treatment will last.
Treatment is usually given to you during day visits to a hospital or clinic as an outpatient or, very rarely, you may need to stay in hospital overnight. Let your oncologist know if you are taking nutritional or herbal supplements as these can interact with chemotherapy and may affect how the drugs work.
How Long Is A Course Of Chemotherapy For Endometrial Cancer
Chemotherapy is usually administered in cycles, with each treatment session followed by one or more off weeks to allow a patients body time to recuperate from any side effects. The recommended schedule can vary based on the medications prescribed and other factors. Generally, a course of chemotherapy is completed within three to six months and may be repeated if necessary.
In the Gynecologic Oncology Program at Moffitt Cancer Center, our multispecialty team of experts takes a highly individualized approach to uterine cancer treatment. We work closely with each patient to develop an appropriate treatment plan and, if chemotherapy is recommended, determine the most appropriate medications, dosages and delivery schedules.
As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt also offers patients unique opportunities to participate in promising clinical trials. Through these important research studies, participants can be among the first to benefit from groundbreaking new treatments as our researchers evaluate and compare the effectiveness of those treatments to the current standard of care. With an ultimate goal of benefiting all current and future patients, Moffitt is continually improving uterine cancer outcomes and enhancing quality of life for patients.
Medically reviewed by Mian Shahzad, MD, PhD, gynecologic oncologist
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What Is The Evidence For Specific Management And Treatment Recommendations
Fung-Kee-Fung, M, Dodge, J, Elit, L. âFollow-up after primary therapy for endometrial cancer: a systematic reviewâ. Gynecol Oncol. vol. 101. 2006. pp. 520-9.
Aalders, JG, Abeler, V, Kolstad, P. âRecurrent adenocarcinoma of the endometrium: a clinical and histopathological study of 379 patientsâ. Gynecol Oncol. vol. 17. 1984. pp. 85
Haie-Meder, C, Mazeron, R, Magne, N. âClinical evidence on PET-CT for radiation therapy planning in cervix and endometrial cancersâ. Radiother Oncol. vol. 96. 2010. pp. 351-5.
Fiorica, JV, Brunetto, VL, Hanjani, P. âPhase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group studyâ. Gynecol Oncol. vol. 92. 2004. pp. 10-4.
Fleming, GF, Brunetto, VL, Cella, D. âPhase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group studyâ. J Clin Oncol. vol. 22. 2004. pp. 2159-66.
Du Bois, A, Pfisterer, J, Burchardi, N. âCombination therapy with pegylated liposomal doxorubicin and carboplatin in gynecologic malignancies: a prospective phase II study of the Arbeirsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom and Kommission Uterus â. Gynecol Oncol. vol. 107. 2007. pp. 518-25.
Copyright Â© 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
Who Should Perform The Surgery
Full surgical staging is not required for low-risk tumors, defined as well-differentiated tumors with less than 50% myometrial invasion, with positive nodes in less than 5% of cases. Women with these tumors can be safely operated on by a general gynecologist. Patients at greater risk of extrauterine disease who may require lymphadenectomy should, in contrast, be operated on by gynecological oncologists. Care provided by gynecologic oncologists has been associated with better survival in high-risk cancers and results in efficient use of healthcare resources and minimization of the potential morbidity associated with adjuvant radiation.
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When Should Surgery Be Performed
The effect of waiting time for surgical staging on survival outcome for endometrial cancer is controversial. It has been suggested that a longer waiting time for surgical staging was associated with worse survival outcomes in uterine cancer and the delay between diagnosis and surgery should not exceed 6 weeks. However, when focusing on type 1 endometrial cancer only, the waiting time for surgical staging was not associated with decreased survival outcome, presumably owing to its indolent growth and resulting excellent prognosis.
Diagnosis In Young Women
Since endometrial carcinoma is uncommon in women younger than 40 years, diagnosis during the reproductive years should be made with caution, and grade 1 endometrial carcinoma may be confused with severe atypical hyperplasia. In these women, consideration should be given to an estrogen-related underlying condition such as a granulosa cell tumor, polycystic ovaries, or obesity. The safety of fertility preservation is well documented in grade 1 endometrioid endometrial cancer not invading the myometrium ., Progestins such as megestrol acetate or medroxyprogesterone acetate may be appropriate in these situations. Few studies reported the safety of fertility-sparing management of grade 2 and 3 endometrial cancer. However, a large retrospective analysis reported an increased risk associated with uterine preservation in patients with grade 2 and 3 endometrial adenocarcinoma and suggested such management should be limited in time. Equivocal lesions should be examined by an experienced pathologist. In cases of complete response, conception must be encouraged and referral to a fertility clinic is recommended. Although the literature describes successful outcomes, fatal recurrences of endometrial cancer after a conservative approach have been reported as such, the patient must be informed about the nonstandard treatment. Hysterectomy should be recommended once childbearing is complete.
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Infiltration Of Immune Cell Subsets In Different Molecular Subtypes Of Ec
We examined tumor-infiltrating immune cells in the three molecular subtypes using multiplex immunofluorescence assays . The fractions of CD8+ T cells in both the tumor parenchyma and the tumor mesenchyme were higher in the TMB-H and TP53 mutant subtypes than in the NSMP subtype, although the differences were not statistically significant . The infiltration of M1 macrophages and CD56dim NK cells did not differ significantly among the three subtypes.
Figure 3 Immune infiltration in different molecular subtypes of EC by multiplex immunofluorescence. The immune infiltrations in EC of POLE mutant subtype. Intense red fluorescence indicates large amount of CD8+ cell infiltration. The immune infiltration in EC of MSI-H subtype. The immune infiltration in NSMP subtype. Few fluorescence signals could be observed, indicating absence of immune infiltration. The immune infiltration in TP53 mutant subtype. Intense yellow fluorescence indicates the infiltration of FOXP3+ cells. For each subtype, a representative filed was selected, and the major tumor regions are outlined. TMB-H, high tumor mutation burden MSI-H, microsatellite instability high NSMP, no specific molecular profile EC, endometrial cancer.