Endometrial Cancer
Definition of endometrial cancer
Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.
Important note regarding other types of cancer of the uterus
Cervical cancer
Cervical cancer is a cancer forming in the cervix of the uterus, unlike endometrial cancer which forms in the corpus of the uterus. Diagnosis and treatment of this type of cancer is different from endometrial cancer. Information on cervical cancer can be found here.
Uterine sarcoma
Uterine sarcoma is another type of cancer forming in the corpus of the uterus. It forms in the muscle of the uterus (myometrium) or in other tissues in the uterus.
Although the treatment of uterine sarcoma and endometrial cancer have some similarities, the information presented here is valid for endometrial cancer, but not for uterine sarcoma. More information on uterine sarcoma can be found here.
Uterine carcinosarcoma
Uterine carcinosarcoma is a type of cancer forming in the corpus of the uterus. It is now acknowledged that carcinosarcoma may be a type of aggressive endometrial cancer. The information provided on endometrial cancer is therefore also valid for uterine carcinosarcoma.
About this patient information based on ESMO Guidelines for endometrial cancer
Is endometrial cancer frequent?
Endometrial cancer is the most common cancer of the organs of the female reproductive system. In Europe, 1 to 2 in every 100 women will develop endometrial cancer at some point in their life. In the European Union, about 81,500 women are diagnosed with an endometrial cancer each year. This number is increasing in the majority of European countries. It is the seventh most common cause of death from cancer in women in Western Europe.
Endometrial cancer usually occurs in women over the age of 50 and thus after menopause, but up to 25% of cases may occur before the menopause. At diagnosis, about 75% of women have a cancer confined to the uterus (stage I). For these women, the prognosis is good and the 5-year survival rate is 90%.
What causes endometrial cancer?
Today, it is not clear why endometrial cancer occurs. Some risk factors have been identified. A risk factor increases the risk that cancer occurs, but is neither necessary nor sufficient to cause cancer. A risk factor is not a cause in itself.
Some women with these risks factors will never develop endometrial cancer and some women without any of these risk factors will develop endometrial cancer.
The majority of endometrial cancers need oestrogens to grow. Without oestrogens they stop growing or grow more slowly. This is why, with a few exceptions, the factors increasing the risk of endometrial cancer are linked to oestrogens.
The main risk factors of endometrial cancer are:
- Aging: the risk of endometrial cancer increases as women get older
- Genes: women with hereditary nonpolyposis colon cancer syndrome, also known as HNPCC or Lynch syndrome, have a high risk of developing colon and endometrial cancer. One in 2 women with this syndrome will develop an endometrial cancer at some point in their life. This syndrome is an inherited disorder due to a mutation of a gene.
- Family history of endometrial cancer: having a first-degree relative (mother, sister, or daughter) who had endometrial cancer increases the risk of having endometrial cancer.
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Personal history of breast or ovarian cancer:
- Having had a breast cancer or an ovarian cancer increases the risk of developing endometrial cancer.
- For women with a personal history of breast cancer, the risk also increases if the patient has been treated with tamoxifen. Tamoxifen is an anti-oestrogen substance and a decrease in the risk should be expected, but tamoxifen also has a stimulating effect on the endometrium that can support the development or growth of endometrial cancer. On the whole, for women with breast cancer where tamoxifen is indicated, the benefit of taking tamoxifen outweighs the risk of developing endometrial cancer.
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Personal history of certain gynaecological diseases:
- Polycystic ovarian syndrome: this syndrome leads to a higher level of oestrogens and a lower level of progesterone than usual and consequently increases the risk of developing endometrial cancer
- Endometrial hyperplasia: endometrial hyperplasia is a proliferation of cells of the endometrium. The cells are normal but may become cancerous later. The risk of cancer is very low for simple or mild hyperplasia but is high for atypical hyperplasia.
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Exposure to oestrogen without, or with insufficient amount of progesterone, for example:
- There is sometimes a natural imbalance in some women
- The use or intake of external oestrogens, especially hormone therapies, that contain only oestrogens and no progesterone, after the menopause
- Overweight and obesity: being overweight, or obese, increases the risk of endometrial cancer because it modifies the level of oestrogens and their effects.
- Diabetes: women with diabetes at at an increased risk of developing endometrial cancer because it modifies the level of oestrogens and their effects.
- Geographic factors: women living in North America or in Europe have an increased risk of endometrial cancer.
- No pregnancy: women who have never been pregnant are at a higher risk of developing endometrial cancer. On the other hand, women who have had one child or more are at a lower risk of endometrial cancer. This is especially the case for women with 5 or more children.
- Total number of menstrual cycles: having more menstrual cycles in a lifetime increases the risk of endometrial cancer, again for hormonal reasons.
Taking contraceptive pills containing both oestrogen and progesterone lower the risk of developing endometrial cancer. Other factors have been suspected to be associated with an increased risk (alcohol consumption, lack of physical activity) or a decreased risk (consumption of phyto-oestrogens found in soya food, coffee and vegetables) of endometrial cancer but the evidence is inconsistent.
How is endometrial cancer diagnosed?
In contrast to cervical cancer, no systematic screening for endometrial cancer is recommended.
Cervical cancer screening (cervical smear usually taken every 3 years) performed during gynaecological examination aims to detect cervical cancer and not endometrial cancer. Cervical cancer is the cancer of the cervix, the lowest and narrow part of the uterus that leads to the vagina as shown on the picture presented in the definition. Nevertheless, some cervical smear tests may detect endometrial cancer even if this is not its goal.
The most frequent sign of endometrial cancer is vaginal bleeding. Vaginal bleeding after menopause is not normal and should alert women to consult their doctor. Before menopause, vaginal bleeding between menstrual periods, or unusually heavy vaginal bleeding during menstrual periods, should also alert women to consult their doctor. Endometrial cancer is not the single and most frequent cause of such vaginal bleeding and doctors will recommend further examination.
The diagnosis of endometrial cancer is based on the three following examinations:
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Clinical examination. This includes gynaecological examination to assess the location and volume of the tumor and if it has extended to other organs in the pelvis.
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Radiological examination. This includes ultrasound examination of the uterus. A probe is introduced into the vagina in order to be closer to the uterus, thus allowing for a better examination. This is called trans-vaginal ultrasound. Additional investigations such as chest X-ray, abdominal ultrasound and abdominal CT-scan may be performed to exclude metastasis. If it is suspected that the cancer has spread to the cervix of the uterus, a Magnetic Resonance Imaging (MRI) should be requested.
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Histopathological examination. This is the laboratory examination of the tumor cells by dissecting a sample from the tumor (a biopsy). This laboratory examination is performed by a pathologist who will confirm the diagnosis of endometrial cancer and will give more information on the characteristics of the cancer. The biopsy is obtained manually by the doctor with a special device introduced via the vagina into the uterus during the gynaecological examination. The procedure to obtain the biopsy is sometimes also called curettage. The biopsy is sometimes performed by hysteroscopy, which involves introducing a thin telescope into the uterus. Hysteroscopy is not recommended as the first choice procedure for performing a biopsy. It could, however, be used if the first biopsy did not show any sign of cancer, but when a cancer is still suspected because of persistent vaginal bleeding or for other reasons. A second histopathological examination will be performed later by examination of the tumor removed by surgery.
What is important to know to get the optimal treatment?
Doctors will need to consider many aspects of both the patient and the cancer in order to decide on the best treatment.
Relevant information about the patient
- Personal medical history
- History of cancer in relatives, especially breast and ovarian cancer
- Status regarding menopause
- Results from the clinical examination by the doctor
- General well-being
- Before the operation, a preoperative evaluation will be performed to assess the risks of the anaesthesia and the risks of the operation. A preoperative evaluation consists of specific questions and physical examination. It also usually requires a chest X-ray and blood tests to assess the white blood cells, the red blood cells, the platelets, the function of the liver and kidneys. Some additional exams may be necessary according to the medical history of the patient.
Relevant information about the cancer
- Results of the biopsy
Before surgery, results of the examination of the biopsy should include:
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Histological type
Histological type is based on the type of cells that the tumor is composed of. Endometrial cancers form in the endometrium, the tissue lining the uterine cavity. The main histological types of endometrial cancer are endometrioid carcinoma (75%), papillary serous carcinoma (5%-10%) and clear cell carcinoma (1%-5%). -
Grade
Grade is based on how different from normal endometrial cells tumor cells look and on how quickly they grow. For endometrial cancer, the grade will be between 1 and 3. The higher the grade, the worse the prognosis. When the histological type is papillary serous carcinoma or clear cell carcinoma, the grade is always 3 and the prognosis is significantly worse. -
Lymphovascular space invasion
A lymphovascular space invasion means that tumor cells are found in the blood vessels and in the lymph vessels of the tumor. Finding tumor cells in these vessels means that it is more likely that tumor cells have spread to the lymph nodes, or to other organs. -
Gene expression profile
The quantification of a distinct set of genes expressed by the tumor can also be performed on the biopsy. This is not routinely performed, but can help to predict the aggressiveness of the tumor and the likelihood of benefit from chemotherapy.
Type I endometrial cancers are typically endometrioid carcinomas and grade 1 or 2 cancers. They are thought to be caused by excess of oestrogen. They are usually less aggressive and are less likely to spread to other tissues than type II endometrial cancers.
Type II endometrial cancers are usually papillary serous carcinomas, clear cell carcinomas or carcinosarcomas and grade 3 cancers. They also have different mutations of their genes and express different proteins than type I endometrial cancers. They don't seem to be caused by an excess of oestrogen. Because they are more likely to grow and spread outside of the uterus, doctors tend to use more aggressive treatment to treat patients with type II cancers.
Doctors use staging to assess the extension of the cancer and the prognosis of the patient. For endometrial cancer, the staging system from the International Federation of Gynecology and Obstetrics (FIGO) is commonly used. This FIGO staging system is based on the spread of the tumor from its initial location in the endometrium to other tissues or organs.
The stage is fundamental for the decision regarding treatment. The more advanced the stage, the worse the prognosis. For endometrial cancer, the stage is defined after the patient has been operated on, based on what the surgeon actually observed during the operation and on the results of the laboratory analysis removed tumor. The staging is thus surgical and pathological. The pathologist will assess the depth of invasion of the tumor in the muscle of the uterus, its spread to the cervix, its size and location, its extension to the fallopian tubes and ovaries, its grade, its histological type and the lymphovascular space invasion. If lymph nodes have been removed during surgery, the pathologist will check for the presence of cancer cells in these lymph nodes.
The table below presents the different stages for endometrial cancer. The definitions may be technical, so it is recommended to ask doctors for more detailed explanations.
Stage Definition
Stage I The tumor is found in the uterus but has not spread outside the uterus.
Stage I is divided into stages IA and IB according to the thickness of the tumor in the uterus.
Stage IA The tumor is either limited to the endometrium or has invaded less than 50% of the thickness of the muscle of the uterus.
Stage IB The tumor has invaded more than 50% of the thickness of the muscle of the uterus.
Stage II The tumor is found in the uterus and has spread to the cervix.
Since 2009, stage II endometrial cancer is not divided into stage IIA and IIB anymore.
Stage III The tumor has spread beyond the uterus and cervix to other part(s) of the female genital organ (vagina, ovary, fallopian tube or tissues around the uterus) or to lymph nodes in this area. Stage III is divided into stages IIIA, IIIB, IIIC1 and IIIC2 based on the organs to which the tumor has spread.
Stage IIIA The tumor has invaded the outer membrane of the uterus, called the serosa, or the fallopian tube(s) or to the ovaries.
Stage IIIB The tumor has invaded the vagina or the parametrium, the tissue surrounding the cervix.
Stage IIIC1 Tumorcells are found in pelvic lymph nodes.
Stage IIIC2 Tumor cells are found in para-aortic lymph nodes.
Stage IV The tumor has spread to the bladder or the bowel or to other organs in the body (metastasis). Stage IV is divided into stages IVA and IVB.
Stage IVA The tumor has invaded the bladder or the bowel mucosa.
Stage IVB Tumor cells are found in lymph nodes in the groin or in the abdomen or in distant organs such as the liver or the lung.
Note: the stages presented in this table are based on the 2009-FIGO staging system. Another FIGO staging system was used before 2009. Consequently, all data and evidence for management of endometrial cancers are available on the basis of the old staging system and unfortunately do not fully apply to the current staging system.
What are the treatment options?
The cornerstone of treatment is surgery. Radiotherapy and chemotherapy used after surgery are called adjuvant therapies, meaning that they are used in addition to surgery.
Treatments listed below have their benefits, their risks and their contraindications. It is recommended to ask doctors about the expected benefits and risks of every treatment in order to be informed of the consequences of the treatment. For some treatments, several possibilities are available and the choice should be discussed according to the balance between expected benefits and risks.
Surgery
A preoperative evaluation is performed for every patient. A minority of patients will be considered inoperable because the risk posed by anaesthesia and surgery is too high. This is usually because of other conditions such as obesity, diabetes and cardiac diseases. These patients may be treated with external radiotherapy and/or internal radiotherapy. In external radiotherapy, radiations are produced by an external source and then directed to the tumor. Internal radiotherapy is called brachytherapy and involves placing a source of radiation in the cavity of the uterus.
For patients considered operable, the goal of the surgery is to stage the disease and to remove the uterus containing the tumor.
Staging the disease
Surgery will allow for staging of the disease. This is done by examination of the tumor to evaluate its size, location and to check whether tumor cells can be found in the cervix, in the fallopian tube, in the ovaries, in the lymph nodes or elsewhere in the pelvis and in the abdomen. During the operation, surgeons inspect and palpate other abdominal organs (liver, diaphragm, omentum, peritoneal surfaces). Surgeons also pour liquid in the abdominal cavity, remove it by suction and send it to the laboratory to search for cancer cells. This is called peritoneal washing.
All tissues removed during the operation are sent to the laboratory to be examined by the pathologist (histopathological examination).
Removing the tumor
The uterus containing the tumor will be removed
The operation will involves removing the uterus, the both fallopian tubes and both ovaries. Removal of the uterus is called hysterectomy and removal of the two Fallopian tubes and ovaries is called bilateral salpingo-oophorectomy, or bilateral salpingo-ovariectomy.
For patients with stage I, stage II and stage III cancers, this operation can be performed by an incision on the lower abdomen, or by a technique called laparoscopically-assisted vaginal hysterectomy. This technique uses a video camera to project and enlarge the image on a television screen, in order to guide the removal of the uterus, the fallopian tubes and the ovaries through the vagina.
For patients with stage IV cancers, the goal of the surgery is to remove as much tumor as possible. This is called debulking or cytoreductive surgery. For large tumors, chemotherapy can also be used before the surgery with the intent to reduce the size of the tumor before removing it by means of surgery.
For patients with metastasis (liver, lung, etc.), removal of the uterus to reduce the symptoms could be considered after discussion in an inter-disciplinary team of medical professionals.
Several lymph nodes in the pelvis and along the aorta may be removed
Removal of lymph nodes in the pelvic area and along the aorta may be performed. This practice varies between hospitals. Even if the removal of lymph nodes helps doctors to be more accurate in defining the stage of the cancer, there is no evidence that it has any added value in treating the cancer and ensuring that it does not come back. Removal of the lymph nodes increases the risk of lymphoedema, a condition where lymph fluid accumulates in the legs. However, it is part of the staging procedure and helps to identify patients who may need adjuvant therapies.
Risks and side effects of surgery
Some risks are common for every surgical intervention performed under general anaesthesia. These complications are unusual and include deep vein thrombosis, heart or breathing problems, bleeding, infection, or reaction to the anaesthesia.
The female reproductive organs are located in the pelvis together with the lower urinary tract and the lower digestive tract. During the surgical intervention, the urinary tract and the intestines may be damaged.
When lymph nodes in the pelvis and along the aorta are removed, it can damage or block the lymph system resulting in lymphoedema, a condition where lymph fluid accumulates in the legs and makes them swell. It can occur right after the intervention but also later.
Having a hysterectomy also increases the risk of urinary incontinence and vaginal prolapse years after the surgical intervention, because it can damage or weaken the supporting pelvic floor muscles.
Women operated on before the menopause will experience symptoms of menopause quickly after the operation because of the removal of the ovaries. Hot flashes, mood swings, night sweats, vaginal dryness and trouble concentrating are frequent.
Side effects can be relieved through proper consultation and advice provided by the specialists in oncology.
Adjuvant therapy
An adjuvant therapy is a therapy given in addition to surgery. There is no definitive data supporting the routine use of adjuvant treatment for patients with disease confined to the uterus, i.e. stage I and stage II endometrial cancers. For all stages, there is still controversy and lack of clear evidence of what the best options are. It is recommended that the decision for treatment of endometrial cancer should be based on discussion in an inter-disciplinary team of medical professionals. This meeting of different specialists is called multidisciplinary opinion or tumor board review. In this meeting, the planning of treatment will be discussed according to the relevant information mentioned above.
Adjuvant treatment for stage I cancer
The options for patients with stage I cancer include:
Observation, which consists of medical consultations on a regular basis that includes history-taking (a review of the patient's medical history), a physical and a vaginal examination. Further examinations, such as a radiological examination, blood tests and examination under anaesthesia can be undertaken if signs or symptoms are noticed.
Vaginal brachytherapy, which is an internal type of radiotherapy where the source of radiation is placed in the vagina.
Pelvic radiotherapy, which is an external type of radiotherapy where radiations are produced by an external source and then directed to the pelvis.
The choice depends on the sub-stage and on the grade of the tumor.
For patients with stage IA and grade 1-2 tumor, observation is recommended. Observation is also an option for patients with stage IB and grade 1-2 tumors.
For patients with a grade 3 tumor, vaginal brachytherapy may be considered and chemotherapy can be discussed.
When the tumor shows a lymphovascular space invasion or if the lymph nodes have not been checked for tumor cells during the surgery, pelvic radiotherapy can be considered.
Adjuvant treatment for stage II cancer
The options for patients with stage II cancer include:
Vaginal brachytherapy, which is an internal type of radiotherapy where the source of radiation is placed in the vagina.
Pelvic radiotherapy, which is an external type of radiotherapy where radiations are produced by an external source and then directed to the pelvis.
Vaginal brachytherapy can only be used in patients with grade 1 tumors with no lymphovascular invasion.
When the lymph nodes have not been checked for tumor cells during the surgery, both pelvic radiotherapy and vaginal brachytherapy are recommended.
Chemotherapy for grade 3 tumors may be considered since it is suggested that it may reduce the risk of extra-pelvic recurrence (spread of cancer outside the pelvis known as “metastasis”).
Adjuvant treatment for stage III and stage IV cancer after surgery
Adjuvant therapies should be individualized to the needs, prognosis and health status of each patient. Radiotherapy and chemotherapy can be considered alone or together.
For patients with stage III cancer, pelvic radiotherapy and vaginal brachytherapy are recommended after surgery.
Chemotherapy may be considered for patients with a grade 3 tumor, particularly if tumor cells are found in the lymph nodes.
As mentioned before, chemotherapy can also be used before the surgery with the intent to reduce the size of the tumor before removing it by means of surgery.
It should be noted that radiotherapy, (both internal and external) protects against local tumor regrowth (in the pelvis). Chemotherapy mainly protects against the spread of the disease outside the pelvis.
Specificities regarding adjuvant treatment
Adjuvant therapy for serous papillary and clear cell tumors
Papillary serous and clear cell carcinomas are cancers that are more aggressive and less frequent than endometrioid carcinomas. No definitive evidence could support the different options for patients with papillary serous and clear cell carcinomas.
The options are the same as for endometrioid tumors. For stage I tumors, chemotherapy alone or external radiotherapy alone can be considered. For larger tumors, a combination of chemotherapy, external radiotherapy and vaginal brachytherapy can be considered after surgery.
Adjuvant hormone therapy
Hormone therapy is not recommended as adjuvant therapy but can be indicated after recurrence.
Type of chemotherapy
Drugs that have been studied in the treatment of endometrial cancers are carboplatin, paclitaxel, doxorubicin, epirubicin and cisplatin. It is not clear which drugs are the most effective but the following regimens are the most frequently used:
- doxorubicin and cisplatin with or without paclitaxel
- paclitaxel and carboplatin.
Side effects of adjuvant therapies
The most frequent side effects of adjuvant therapies are usually reversible after treatment. Some strategies are available to prevent or relieve a certain range of these side-effects. This should be discussed upfront with doctors.
Pelvic radiotherapy
Side-effects of external radiotherapy to treat endometrial cancer are mainly due to the irradiation of the organs surrounding the uterus. Effects of radiation on the urinary tract include painful urination, bladder spasms resulting in an urgent need to urinate, presence of blood in the urine, urinary tract obstruction, and ulceration or necrosis of the mucous membrane lining the bladder. Effects of radiation on the lower digestive tract include rectal discomfort, diarrhea, mucus and blood rectal discharge, and, rarely, perforation of the intestines. Vaginal narrowing is another possible late effect of pelvic radiotherapy. Treatment for these post-radiation reactions should be advised by the oncologist. Modern techniques of external radiotherapy such as Intensity Modulated Radiotherapy (IMRT) are intended to reduce its toxicity.
Intravaginal brachytherapy
The aformentioned side effects of external radiotherapy can also appear with intravaginal brachytherapy but less frequently, since this type of radiotherapy is better targeted. Vaginal dryness is frequent during and after the treatment. Vaginal narrowing and dryness can also occur and can result in long-term sexual dysfunction. In young women radiation stops the ovarian function and this may result in further vaginal dryness and sexual dysfunction. It may also result in a higher risk for osteoporosis and/or insufficiency fractures of pelvic bones. Women must be under the care of a specialist for those problems.
Chemotherapy
Side effects of chemotherapy are very frequent. They will depend on the drug(s) administered, on the doses and on individual factors. If you have suffered from other problems (such as heart problems) in the past, some precautions should be taken and/or adaptation of the treatment should be made. Combinations of different drugs usually lead to more side effects than the use of a single drug.
The most frequent side effects of the drugs used for chemotherapy in endometrial cancer are hair loss and decreased blood cell count. Decreased blood cell count can result in anaemia, bleeding and infections. Once the chemotherapy is over, the hair grows back and the blood cell count returns to normal.
Other frequent side effects include:
- allergic reactions, such as flushing and rash
- nerve problems affecting the hands and/or feet (peripheral neuropathy), which can cause tingling feelings in the skin, numbness and/or pain
- temporary loss of or changes in your eyesight
- ringing in the ears or changes in your hearing
- low blood pressure
- nausea, vomiting and diarrhea
- inflammation of areas such as the lining of the mouth
- loss of sense of taste
- lack of appetite
- slow heart beat
- dehydration
- mild changes in nail and skin which soon disappear
- painful swelling and inflammation where the injection is given
- muscle or joint pain
- seizures
- tiredness
Other less frequent but more serious side effects can occur. These include especially, stroke, myocardial infarction and damage to the function of the kidneys and liver. Any of these symptoms should be reported to a doctor.
What happens after the treatment?
Follow-up with doctors
After the treatment has been completed, doctors will propose a follow-up program consisting of consultations on a regular basis and aiming to:
- detect possible recurrence at an early stage
- evaluate treatment-related complications and treat them
- provide psychological support and information to enhance returning to normal life
- implement a surveillance schedule because there is an increased risk of breast, ovarian and colon cancer.
Follow-up visits with the oncologist should include:
- History-taking (a review of the patient's medical history) especially any new vaginal bleeding together with physical and gynaecological examination
- Radiological examination, blood tests and gynaecological examination under anaesthesia can be undertaken if signs, or symptoms are noticed.
Return to normal life
It can be hard to live with the idea that the cancer can come back. From what is known today, no specific way of decreasing the risk of recurrence after completion of the treatment can be recommended. As a consequence of the cancer itself and of the treatment, return to normal life may not be easy for some people. Questions related to body-image, sexuality, fatigue, work, emotions or lifestyle may be a concern to you. Discussing these questions with relatives, friends or doctors may be helpful. Support from ex-patients’ groups or telephone informaition services and helplines is available in many countries.
What if the cancer comes back?
If the cancer comes back, it is called a recurrence and the treatment depends on the extent of the recurrence. If the cancer comes back, it is usually within the first 3 years following the initial treatment.
The extension of the recurrence should be fully evaluated by physical examination, radiological examinations and blood tests. The majority of recurrences for patients for whom the initial tumor was limited to the uterus arise in the pelvis.
The treatment options will depend on the extension of the recurrence. Discussion of treatment options should be done in a multidisciplinary meeting.
If cancer comes back as a recurrence in the pelvis, surgery and radiotherapy are the options.
Radiotherapy is considered for the treatment of the recurrence only if it was not given before. However external radiotherapy can be given if only internal (brachytherapy) was given before and vice versa. External radiotherapy directed at the pelvic area is an option. Brachytherapy can be performed additionally if the health status of the patient is good. The radiation source can be put in the tumor or in the vagina depending on the location and extent of the tumor (after external radiotherapy). The radiation source can be put in the vagina if the tumor recurs at the vaginal vault and if the size of the remaining tumor after external radiotherapy is less than 3–5 mm in diameter.
The surgical intervention that can be considered is called pelvic exenteration. This is a major surgical intervention and it can only be considered for fit patients. It removes all organs in the pelvic cavity in addition to the uterus, the fallopian tubes and the ovaries already removed. The lower part of the colon, the rectum, the anus, the bladder and the vagina may also be removed. This implies the creation of openings through which urines and stools are eliminated from the body. It can be considered after discussion in a multidisciplinary meeting and discussion with the patient.
If cancer comes back as a recurrence with metastasis, options are chemotherapy and hormone therapy.
Chemotherapy can be proposed and considered after discussion in a multidisciplinary meeting and discussion with the patient. Decisions should be taken after considering the expected benefits and side effects of chemotherapy. Doxorubicin and cisplatin are the most active drugs against recurrence of endometrial cancer. Side-effects of chemotherapy are very frequent. These side-effects have been described previously in the chapter entitled ‘What are the treatment options’.
Hormone therapy can be proposed to patients with grade 1 tumors and positive progesterone receptor status. A progestin (medroxyprogesterone acetate or megestrol) is a type of drug that has the same effect as the progesterone, or tamoxifen, which counteracts the action of oestrogens can be used. Side effects of hormone therapy are less frequent than those of radiotherapy and chemotherapy. Build up of fluid causing swelling of the ankles, increase in appetite, and weight gain are the most common side effects of progestins. Other less frequent but more serious side effects can occur. Risk of blood clots (including clots in the lungs), stroke and heart attack increase significantly. Any symptoms should be reported to a doctor.
Surgery of one isolated metastasis can also be considered, whereby it is hoped that it will improve the patient’s symptom(s) and quality of life.
Click here for the ESMO guidelines of endometrial carcinoma.
Endometrial cancer
Uterine cancer
Uterine tumour
Uterine tumor
Corpus uteri cancer
Corpus uteri tumour
Corpus uteri tumor
Endometrial tumour
Endometrial tumor
Cancer of the endometrium
Endometrial carcinoma
Uterine sarcoma
Womb cancer
Cancer of the womb
The following list of treatments is based on what we have found in scientific studies about cancer. More information about the listed therapies can be found under the tab THERAPIES. For registered drugs, radiotherapy and surgical interventions, approval by the authorities is given.
Surgical interventions
Procedures involving instrumental means to investigate or treat a cancer, or to improve the body’s functions or appearance. Generally, a surgical intervention involves an incision. More
Radiotherapy
Registered drugs
Anti-cancer drugs with market authorization in the USA or in countries of the European Union. More
Cell-based therapies
Administration to patients of their own or someone else’s manipulated human cells. More
Natural products (excluding registered drugs)
Substances found in nature that usually have a pharmacological or biological activity. More
A clinical trial is a research study conducted with patients to evaluate whether a new treatment is safe (safety) and whether it works (efficacy). Clinical trials are performed to test the efficacy of drugs but also non-drug treatments such as radiotherapy or surgery and combinations of different treatments. Clinical trials take place in all kinds of hospitals and clinics, but mostly in academic hospitals. They are organized by researchers and doctors.
RCT provides a tool to search for phase III clinical trials by type of cancer and by country. For Belgium, the Netherlands, Switzerland, Luxembourg, France and the UK, RCT provides contacts to get more information about the phase III clinical trials currently ongoing. Discuss the possibilities of participating in one of these clinical trials with your doctor.
The list of the phase III clinical trials for uterine cancer is available here.
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A guide for patients
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This document was last updated on 23 April 2012.
Cancer information
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