Treatment

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Sentinel Lymph Node Biopsy

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.

Radiation Therapy

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.

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).