Endometrial cancer, often referred to as uterine cancer, ranks as the most common gynecologic cancer in the United States. Fortunately, there are treatments known to work at every stage. Once diagnosed, you will meet with a gynecologic oncologist who will lead the treatment process and include other physicians, such as a radiation oncologist, as needed for each patient's individualized treatment plan.
Diagnosing Endometrial Cancer
Various tests and procedures are used to diagnose endometrial cancer. In addition to performing a physical exam and discussing your health history, your gynecologist may recommend removing some tissue for examination. The tissue is removed using one of the following procedures:
- Endometrial biopsy: A procedure that gently removes tissue from the endometrium
- Hysteroscopy: A procedure that looks inside the uterus for abnormalities
- Dilatation and curettage: A procedure involving the dilation of the cervix and removal of tissue from the uterus
Other procedures, such as a blood test or transvaginal ultrasound, may also be used to help confirm an endometrial cancer diagnosis.
Understanding Endometrial Cancer Staging
After receiving an endometrial cancer diagnosis, your gynecologic oncologist will need to determine if the cancer has spread, a process known as staging. The stage of the cancer gives insight into how serious it is, which influences both the treatment approach and its effectiveness. Some of this is done during surgery, and some is determined after surgery.
The stages of endometrial cancer range from I to IV (4). Stages I and II are early-stage and require fewer treatments. Surgery is common for most of these patients. Advanced endometrial cancer (stages III and IV) means that it has spread to lymph nodes and/or other parts of the body.
Sometimes, sub-stages are assigned, giving more detail about how far the cancer has spread within the stage. These are often referred to as A, B, and C. This means that a stage IIA patient is not as advanced as a patient with stage IIC endometrial cancer.
The treatment approach for endometrial cancer depends on the stage as well as the patient’s overall health. Surgery is common for endometrial cancer but may not be possible depending on the patient’s general health condition.
Endometrial Cancer Treatment Options by Stage
Treatment for endometrial cancer varies by stage.
Stage I
Stage II
Stage III
Stage IV
A hysterectomy is typically one of the first steps in the treatment process for women with endometrial cancer. This surgery removes the uterus, fallopian tubes, and usually the ovaries. It may also include the removal and examination of lymph nodes to determine if cancer has spread to them. A gynecologic oncologist is often the surgeon who performs the procedure and coordinates any follow-up treatments.
Stage I Endometrial Cancer Treatments
Stage I endometrial cancer has not spread to the lymph nodes. It will require surgery, but sometimes it’s the only treatment that’s needed. The ovaries may be spared if the patient is premenopausal, but the surgeon will make the final decision on whether that’s possible.
Radiation therapy can be the primary treatment if surgery isn’t an option for the patient. Radiation is also used for high-grade (faster growing) Stage I tumors after surgery. This makes the cancer less likely to return.
Your gynecologic oncologist will carefully monitor your health after treatment to watch for signs of recurrence.
Stage II Endometrial Cancer Treatments
A radical hysterectomy is often recommended for Stage II endometrial cancer. This includes the removal of the uterus, cervix, and ovaries, as well as the upper area of the vagina and tissue near the uterus. Some lymph nodes will also be removed for testing.
After surgery, most stage II patients receive radiation therapy. Some patients receive radiation before surgery to shrink the tumor so it's easier to remove. It’s common for both internal and external radiation therapy to be given in the pelvic area after surgery to be sure all the cancer cells are destroyed. This lowers the likelihood it will return.
Treatment for Stage III Endometrial Cancer
Treatment for stage III endometrial cancer typically involves a more complex approach. This usually starts with a radical hysterectomy and nearby lymph nodes. The area around the uterus, called the omentum, may also be removed, and any additional cancer that’s found in the pelvic region. This is called debulking. It’s proven to help patients with late-stage endometrial cancer live longer.
Radiation therapy is often used after surgery. However, it may be used before surgery if the cancer is too large to remove. Radiation can shrink it to a size that can be surgically removed.
Chemotherapy is also introduced to most stage III endometrial cancer patients since the cancer has spread to lymph nodes and nearby tissue. Chemotherapy is given through an IV so that it can run throughout the body to kill cancer cells wherever they may be.
Stage IV Endometrial Cancer
For individuals diagnosed with stage IV endometrial cancer, surgery is not typically the best option. This is because the cancer has already spread beyond the uterus to other organs such as the bladder, colon, or even the liver and lungs. Targeted therapy and immunotherapies may be available to these patients in addition to chemotherapy.
In such cases, other treatment approaches will be discussed, including radiation therapy, chemotherapy, and hormone therapy if the cancer shows signs of hormone receptors. Patients might also consider joining a clinical research trial, which can provide access to new, life-saving therapies.
Recurrent Endometrial Cancer Treatments Vary from First-Round Therapies
The treatment approach for recurrent endometrial cancer depends on how much cancer is present, where it is, and the initial type of treatment that was used. If your cancer returns in only the pelvic region, you may receive surgery followed by radiation therapy. If surgery is not an option, radiation therapy may be used alone or in combination with hormone therapy – if there are signs of hormone receptors in the cancer cells.
Immunotherapies and targeted therapies that are available to stage IV patients are also often available to patients whose endometrial cancer has returned.
Endometrial Cancer Treatment from Radiation Oncologists in the Greater Atlanta Area
Radiation therapy is commonly recommended as part of an endometrial cancer treatment plan. If you need radiation therapy, you can choose where you receive your care so that it’s convenient for you. Our radiation oncology centers are conveniently located throughout the Atlanta area in Blairsville, Conyers, Covington, Decatur, and Snellville, Georgia. Request an appointment at a location that’s convenient for you.
