Treatment
Treatment depends on the stage endometrial cancer has reached by the time it is diagnosed, and the grade of the tumour itself. High grade ‘grade 3’ tumours are more likely to recur than low grade ‘grade 1’ tumours.
Surgery
To remove the uterus, ovaries and fallopian tubes - total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). This is usually the only treatment that is needed in stage 1 disease. Recovery time from this type of surgery is 6-8 weeks.
In women with higher grade or more aggressive tumours that are more likely to recur:
- The lymph nodes around the uterus may be removed, this is called Lymphadenectomy.
- Adjuvant radiotherapy may be given
Even in advanced disease surgery may be beneficial. For most women surgery will be the first stage of treatment. In advanced disease surgery may be combined with radiotherapy treatment before or more usually after the operation. Pelvic Lymphadenectomy especially followed by radiotherapy carries the long term risk of lymphoedema of the legs.
Palliative treatment may include radiotherapy, chemotherapy or hormone therapy.
Radiotherapy
May be used after surgery in women who are at higher risk of recurrent cancer or who have disease in the pelvis which cannot be surgically removed.
Women who are unable to have surgery either because they are not fit enough or have too widespread disease for surgery to be used may have radiotherapy as their main treatment. The treatment is similar whether surgery has been performed or not and is usually a combination of internal radiotherapy and external beam radiotherapy.
There are two types of internal radiotherapy treatment for endometrial cancer:
- ‘Vault brachytherapy’. This is given in outpatients – 2 sessions is the maximum dose. Side effects include soreness and dryness of the vagina which may make walking painful for some weeks after treatment. In the longer term the treatment causes vaginal narrowing (stenosis) which may require the use of a dilator for life. This treatment may be given without external beam radiotherapy for some cancers.
- ‘Intracavity’ therapy – the rods are put in under general anaesthetic and stay in place for 48 hours. The rods are radioactive and so is the woman during this period. She must stay in a lead lined room during the treatment and anyone visiting her must wear radiation protection. Side effects as above for brachytherapy. ‘High dose’ therapy only takes a few minutes and does not require a stay in hospital as described above, it is not available at every treatment centre.
External beam radiotherapy
This is given daily for 25 days. This is usually Monday to Friday over 5 weeks. Long term results of radiotherapy alone are not as good as surgery. Particular problems for this group are the long term side effects of radiotherapy, particularly problems with bowel and bladder function, sexual problems and the psychological effects of any of these. Urinary or faecal incontinence affects 5-10% of women in the 10 years following successful radiotherapy treatment.
Chemotherapy
This is not usually used in the treatment of primary endometrial cancer. It may be used in primary disease when the tumour is one of the more aggressive types which respond less well to treatment such as the papillary serous sub type. It may be used palliatively for treatment of advanced disease of any tumour type.
Hormone therapy
This is used in advanced disease and is very effective in 15-30% of women. If effective these drugs can prolong survival and reduce symptoms. The drugs used are mostly based on the female hormone progesterone and include hydroxyprogesterone, medroxyprogesterone (Provera) and megestrol (Megace).
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Amended April 2008
