Options for treating endometrial cancer depend chiefly on the type and stage of your disease — the size of the cancer, the depth of invasion, and whether the cancer has spread to other parts of the body. Most women have surgery. Others may also need radiation therapy, hormone therapy, and/or chemotherapy.
Total abdominal hysterectomy (removal of the uterus through an incision in the abdomen) is the most common treatment for endometrial cancer. Usually the surgeon will also remove the fallopian tubes and ovaries along with the uterus, in a procedure known as bilateral salpingo-oophorectomy. Some of the pelvic lymph nodes may also be removed and examined to find out whether the cancer has spread to other parts of the body.
Minimally Invasive Surgery — Laparoscopic & Robotic Approaches
Many hysterectomies at Memorial Sloan Kettering are performed using a less-invasive technique called a laparoscopic- or robotic-assisted vaginal hysterectomy. In this procedure, the pelvic cavity is first examined with a laparoscope (a thin, lighted tube with a video camera at its tip), and the image is projected onto a large viewing screen. Some lymph nodes may be removed for examination at this time. Guided by the laparoscope, the surgeon operates through tiny surgical “ports” (small tubes placed in the body) using specially designed surgical instruments to remove the uterus through the vagina.
Dr. Richard Barakat explains the advantages of robotic surgery for the treatment of cervical, endometrial, and ovarian cancers.
To perform robotic-assisted laparoscopic vaginal hysterectomy, specially trained surgeons use an advanced robotic device — called the da Vinci- Surgical System — to assist him or her during the procedure. To use the robot, the surgeon is seated at a multifunctional console positioned next to the patient. The surgeon views the area of the operation on the console via a magnified, three-dimensional, high-definition visual system. The operation is performed by the surgeon at the console using finger and foot controls with the robot precisely copying every movement of the surgeon. As the surgeon uses the robot to operate, the surgical team at the bedside monitors the patient throughout the procedure, assisting as necessary.
Although not all patients are candidates for the minimally invasive approach, women who have laparoscopic surgery often have shorter hospital stays, faster recoveries, and fewer complications than with traditional open abdominal surgery.
One study suggested that the rate of cancer recurrence following laparoscopic surgery is the same as for conventional hysterectomy. Memorial Sloan Kettering also participated in a national clinical trial of about 2,000 women to compare the outcomes of patients who have had laparoscopic-assisted vaginal hysterectomy (including lymph-node removal) with the outcomes of patients who have had an open abdominal surgery. A growing body of research confirms that laparoscopy plays a valuable role in the management of selected patients with endometrial cancer. [PubMed Abstract]
Combining Panniculectomy with Uterine Cancer Surgery
Obesity is common among patients with endometrial cancer. In certain cases, our gynecologic surgeons collaborate with plastic surgeons to combine hysterectomy and staging with a reconstructive procedure known as panniculectomy, or “tummy tuck,” to remove excess skin and underlying fat in the abdominal area. This option for combination surgery is associated with better staging results and fewer complications. [PubMed Abstract]
Sentinel Lymph Node Biopsy
Memorial Sloan Kettering gynecologic surgeons, led by Nadeem Abu-Rustum, developed a simple technique to identify and remove the most important lymph nodes during surgery for early-stage endometrial or cervical cancers.
At Memorial Sloan Kettering, we are evaluating an approach called sentinel lymph node biopsy, which could eliminate the need to remove all of the pelvic lymph nodes for analysis.
Using a blue dye and a special radioactive substance that can be traced using imaging techniques, doctors can identify during surgery the first lymph node (the sentinel node) to which cancer cells would travel after leaving the uterus. This technique is called intraoperative lymphatic mapping, or sentinel node mapping. If this node is free of cancer cells, the goal is to avoid removing additional lymph nodes. If the node does contain cancer cells, then the surgeon continues to remove additional lymph nodes for further examination.
Sentinel node mapping may help avoid the unnecessary removal of all lymph nodes in some women, leaving these nodes in place to continue their important role in draining fluids and fighting infection. This may also lower the risk of lymphedema, or swelling, in the groin.
Surgical Options for Women with Advanced Cancer
Some women whose advanced endometrial cancer has spread to other abdominal organs may choose an extensive surgery known as pelvic exenteration. The operation requires Memorial Sloan Kettering's gynecologic surgeons to remove cancerous tissue and reconstruct the remaining organs so the patient retains optimal function. This is an extremely radical procedure reserved for women with limited treatment options.
Because this procedure is physically and emotionally demanding, investigators at Memorial Sloan Kettering have initiated a trial to learn more about the physical, emotional, educational, and sexual needs of women treated with pelvic exenteration.
When endometrial cancer has spread to the opening of the uterus and beyond, the cancer care team may recommend radiation therapy (the use of x-rays or other high-energy waves to kill cancer cells and shrink tumors) in addition to surgery. Depending on the extent of cancer, the radiation may be applied externally over a period of several weeks (this is known as intensity-modulated radiation therapy or IMRT), or internally using high-dose brachytherapy.
In brachytherapy, radioactive material in tiny tubes is implanted through the vagina directly into the tumor. Brachytherapy may be used in combination with IMRT, a type of external beam radiation that allows more-precise treatment planning and the ability to deliver higher radiation doses with greater safety. With IMRT, which can also be used alone, radiation therapists can shape pencil-thin radiation beams of varying intensity to conform to specific tumor shapes and sizes, reducing the dosage of radiation to healthy tissues and possibly the side effects of treatment.
Radiation therapy may be given alone or in combination with chemotherapy.
Chemotherapy & Hormone Therapy
Your cancer care team may recommend chemotherapy (drugs administered intravenously or orally) after surgery, if there is a possibility that some cancer cells remain undetected or if the disease has already spread. The drugs most often used to treat endometrial cancer include doxorubicin, cisplatin, carboplatin, and paclitaxel, often given in combination.
Learn about the different treatment options that are now available for women with endometrial cancer.
Memorial Sloan Kettering researchers are conducting clinical trials to determine the best way to incorporate both radiation and chemotherapy into the treatment of women with high-risk endometrial cancer. Our researchers are currently assessing the effectiveness of new combinations of chemotherapy drugs and of novel targeted agents for women with advanced or recurrent forms of the disease.
Hormone therapy (treatment with substances that prevent cancer cells from getting or using the hormones they may need to grow) may be used to halt the spread of advanced or aggressive endometrial cancer, particularly in women who cannot have surgery or radiation therapy. Women are more likely to respond to hormone therapy if the cancer cells on the uterine tissue have proteins on their surface where hormones can attach (receptors).