Treatment of endometrial cancer by stage

The article was written by Specialist Doctor I Nguyen Thi Minh Thuyen - Pathologist - Laboratory Department - Vinmec Danang International General Hospital.

The stage (degree of spread) of endometrial cancer is the most important factor in choosing a treatment. Other factors can also affect treatment options, such as the type of cancer, your age, your overall health, and your desire to have children. Tests on cancer cells are also done to see if certain treatments (such as hormone therapy, targeted therapy) might work.
Surgery is the first line of treatment for most women with endometrial cancer. Surgery includes removal of the uterus, fallopian tubes, and ovaries. Lymph nodes in the pelvis and around the aorta may also be removed or biopsied and tested for cancer spread. The tissue removed during surgery is checked to see how far the cancer has spread (to determine the stage). Depending on the stage of the cancer, other treatments such as radiation therapy and/or chemotherapy may be recommended.
For some women who still want to get pregnant, surgery can be put on hold for a while and try alternative treatments. If the patient is not healthy enough for surgery, other treatments such as radiation therapy will be indicated.

Stage I cancer is only in the uterus, has not spread to lymph nodes or distant sites.
1.1. Endometrial cancer (stage I) Surgery: The standard treatment to stage cancer. Sometimes, this is the only treatment needed. The patient is then closely monitored for signs of cancer recurrence. Some young women with early-stage endometrial cancer can have a hysterectomy without having their ovaries removed, which helps prevent menopause and its associated problems. This increases the chance of the cancer coming back but does not increase the chance of dying from the cancer. This may be something that you will want to discuss with your doctor. Radiation therapy: For cancers with higher histology. Radiation therapy after surgery. Women who cannot have surgery because of other medical problems or because of advanced age. Hormone therapy: Fertility-conserving treatment for stage IA cancer, histological grade 1: For young women who want to have children, surgery can be postponed and treated with progestin therapy. Progestins can cause the cancer to shrink or even disappear for a while, giving you a better chance of getting pregnant. However, this is experimental and can be risky if the patient is not closely monitored. An endometrial biopsy should be done every 3 to 6 months. If you are still cancer-free after 6 months, you can get pregnant and continue to be screened for cancer every 6 months. Because cancer often recurs, doctors recommend a hysterectomy after childbirth. In many cases, the progestin doesn't work and the cancer doesn't go into remission or continues to grow. Skipping surgery can give the cancer time to spread outside the uterus. If the disease does not go away within 6 to 12 months, surgery is needed to stage the cancer. A second opinion from a gynecological oncologist and a pathologist (to determine the cancer's histology) before initiating progestin therapy is important. You must understand that this is not a standard treatment and may increase your risk of developing and spreading cancer. 1.2. Other types endometrial cancers Papillary serous carcinoma, clear cell carcinoma, or carcinosarcoma with a worse prognosis,... are more likely to have spread ectopic when diagnosed.
Surgery: If a preoperative biopsy identifies a highly histological cancer, surgery may be more extensive. Surgery at this time may include removal of the entire uterus, two fallopian tubes and ovaries, pelvic lymph nodes, para-aortic, and omental tissue. Chemotherapy, radiation therapy: After surgery, chemotherapy alone or with radiation therapy to prevent cancer from coming back. In cases where surgery is not possible.

Cancer has spread to the connective tissue of the cervix but has not spread outside the uterus.
Surgery first, then radiation therapy: Surgery includes radical hysterectomy (removal of the entire uterus, the tissues next to the uterus and the upper part of the vagina), removal of the fallopian tubes, bilateral ovaries. , dissection or biopsy of pelvic and para-aortic lymph nodes. Radiation therapy, usually both intravaginal and extra-pelvic radiotherapy. Radiation therapy first, followed by simple hysterectomy, bilateral salpingo-oophorectomy, and possibly lymph node dissection or biopsy. Radiation therapy: For patients who are too weak or have other diseases that surgery is not safe. Surgery first, then radiation and/or chemotherapy: For cancers with high histology, such as papillary serous carcinoma or clear cell carcinoma. Surgery included oophorectomy and peritoneal biopsy with total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and pelvic lavage. Chemotherapy usually includes the drugs carboplatin and paclitaxel or possibly cisplatin and doxorubicin.

Cancer has spread outside the uterus.
Surgery, followed by chemotherapy and/or radiation. Immunotherapy and/or targeted therapy may also be an option for some women.

Surgery: In most stage IV cases, the cancer has spread too far to be removed with surgery. Hysterectomy and bilateral salpingo-oophorectomy may be performed to prevent excessive bleeding. Radiation therapy: Can also be used to stop excessive bleeding. Hormone therapy: When cancer has spread to other parts of the body. However, the cancer is highly histological and patients without progesterone and estrogen receptors do not respond to hormone therapy. Chemotherapy: May help some women for a while. Targeted drugs and/or immunotherapy may also be an option for some women with endometrial cancer.

Recurrence cancer can be local (at or near where it started) or distant (spread to organs such as the lungs or bones). Treatment depends on the amount of cancer and its location as well as the first treatment.
Local recurrence, such as in the pelvis: Surgery (possibly later radiotherapy). Radiation therapy alone or in combination with hormone therapy: For cases where surgery is not possible. Distant recurrence: Recurrence in only a few small sites (such as in the lungs or bones): Surgery and/or local radiation therapy. More recurrence (cancer spread): Treat as stage IV. As the health system with the first private general hospital to receive JCI global medical certificate, Vinmec always brings the best cancer screening and treatment services to customers, including internal cancer. endometriosis with:
Top modern and advanced machinery system. Laparoscopic surgery methods are performed by a team of highly skilled doctors, providing good treatment results while ensuring aesthetics. Always update the optimal and most effective methods in screening and treatment of endometrial cancer: Cancer screening through genetic testing, robotic surgery with a success rate of up to 95%.

Reference article: American Cancer Society