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CancerSmart Web Cast
May 3, 2007 -- Drs. Carol Brown, Nadeem Abu-Rustum, and Paul Sabbatini present, "What You Should Know About the Screening and Treatment of Gynecologic Cancers."
Run time: 71 minutes.

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.

Surgery

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

Many hysterectomies at Memorial Sloan-Kettering are performed using a less- invasive technique called a laparoscopic-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.

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 suggests 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. The results confirm the valuable role of laparoscopy 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]

Find a Clinical Trial
Find a Clinical Trial
Find out about new research studies for endometrial cancer

Sentinel Lymph Node Biopsy

At Memorial Sloan-Kettering, we are currently evaluating an approach called sentinel lymph node biopsy that could eliminate the need to remove 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 lymph nodes in some women, leaving these nodes in place to continue their important role in draining fluids and fighting infection.

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.

Radiation Therapy

When endometrial cancer has spread to the opening of the uterus and beyond, your 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, or internally using high-dose brachytherapy.

In brachytherapy, radioactive material in tiny tubes is implanted through the vagina directly into the tumor. Brachytherapy is used in combination with external beam radiotherapy, in which high-energy rays are aimed at the cancer.

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 types of drugs most often used to treat endometrial cancer include doxorubicin, cisplatin, carboplatin, and paclitaxel, often given in combination.

Memorial Sloan-Kettering researchers continue to conduct 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).


Last Updated: Sep. 4, 2007
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