16 Jul Uterine (Endometrial) Cancer
Uterine cancer is the 4th most common malignancy in women, and the most common gynecologic cancer, with approximately 40,000 cases diagnosed annually in the United States.
What is the uterus?
The uterus is a pear-shaped organ located in a woman’s pelvis. It is composed of three layers: endometrium, myometrium, and serosa. The endometrium, or inner layer, is the most common site of uterine cancer. The myometrium is the middle layer of the uterus and the serosa, or outer layer, covers only the upper part of the uterus.
What is the uterine (endometrial) cancer?
Uterine (endometrial) cancer is the abnormal tissues of the uterus.
What are the symptoms?
- Postmenopausal bleeding: most common symptom of uterine cancer
- Abnormal vaginal bleeding: any change in a woman’s menstrual cycle, including spotting between menses or increase in duration or heaviness of bleeding
- Pain with intercourse
- Bowel or urinary changes
- Pain in the pelvis or abdomen
If any of the above symptoms are noted, it is recommended to see an ob/gyn promptly for evaluation.
How is it diagnosed?
- Pelvic exam
- Endometrial biopsy
- Pelvic/transvaginal ultrasound
- Hysteroscopy/ dilation & curettage (D & C)
How is it treated?
At Froedtert & the Medical College of Wisconsin, a team of specialists design a treatment plan based on the grade (aggressiveness) and stage (extent) of the cancer, as well the patient’s overall health. This expertise is imperative in order to accurately stage the cancer diagnosis and to develop an appropriate treatment plan.
Treatment options include:
- Clinical trials: As an academic medical center, Froedtert & the Medical College of Wisconsin offer its patients the opportunity to participate in many clinical trials, which offer cutting edge treatment. Patients that are eligible for clinical trials have the opportunity to be treated with novel agents or in combination with treatment that is the standard of care.
- Surgery: There are two main goals in surgery in the setting of uterine cancer: To determine the stage of the cancer and to remove as much of the cancer as possible
Most patients may have minimally invasive surgery; done by laparoscopy- robotic assisted. Typically the recovery and hospital stay is shorter when done robotically. Sometimes laparotomy (a traditional open incision) is the recommended appropriate surgery.
Typically, the gynecologic oncologist will remove and examine the uterus, fallopian tubes, ovaries, lymph nodes and some tissue from the inside of the abdomen; a specially trained pathologist then examines the organs and tissue for microscopic disease. This step is crucial because surgical staging determines an appropriate treatment plan for the patient.
- Vaginal brachytherapy (internal radiation therapy): Depending on the grade and stage of the cancer, radiation therapy may be recommended. In vaginal brachytherapy, small radioactive implants are placed in the vagina, as the vagina can be a site of recurrence of cancer. Because brachytherapy can be targeted to a very specific region, the healthy tissues of the bladder and rectum receive very little radiation and side effects are usually minimal. Medical College of Wisconsin radiation oncologists have extensive experience with brachytherapy; Froedtert & the Medical College of Wisconsin were the first in the region to use high dose rate brachytherapy to treat gynecologic cancers.
- External radiation therapy: If the cancer has spread beyond the uterus, external beam radiation may be required. At Froedtert & the Medical College of Wisconsin, many gynecologic cancer patients receive image-guided radiation therapy, meaning that imaging scans are used to design the radiation fields. This allows the radiation oncologist to specifically target radiation to the desired area. Intensity modulated radiation therapy (IMRT) is treatment that preferentially treats the tumor tissue while sparing normal tissue.
- Chemotherapy: Chemotherapy may be used in conjunction with radiation in patients with high grade and or advanced staging. Sometimes chemotherapy is recommended alone for patients.