Uterine cancer is usually cancer starting from the inner lining of the uterus, called the endometrium. Advanced uterine cancer means cancer that has spread beyond the uterus, typically stage three to four. According to the National Institutes of Health, five-year survival rates, an index of response to treatment, are much better when the cancer is still confined to the uterus. The options for treatment of advanced uterine cancer are diverse and are usually combined to improve effectiveness.
Surgery
Total hysterectomy with salpingo-oophorectomy, which involves removal of the uterus with the ovaries and fallopian tubes, is the surgery carried out when the bulk of the cancer still lies within the uterus, with some cancer cells seen in wash-outs of the pelvic cavity. In cases of extensions beyond the cervix into the vagina, a radical hysterectomy, involving removal of the uterus with the upper vagina, surrounding tissues and ligaments that attach the uterus to the walls of the pelvis plus the ovaries and fallopian tubes, is carried out. The National Cancer Institute explains that lymph node dissection usually accompanies this procedure. These procedures are usually followed up by radiation therapy and/or chemotherapy for best results in advanced uterine cancer.
Radiation Therapy
There are two approaches to radiation therapy in uterine cancer. External beam radiation therapy involves the use of external sources of high-energy radiation. Internal radiation, or brachytherapy, involves placing the source of radiation in the vagina. Both external beam radiation and vaginal brachytherapy may be combined in advanced uterine cancer. As noted by the American Cancer Society, radiation therapy may be used before surgery in very large cancers to shrink the tumor to an operable size. It is typically used after surgery in advanced cases of uterine cancer. Radiation therapy may be used alone in cases of uterine cancer that is inoperable or in cases where surgery is not possible due to other medical factors.
Chemotherapy
Chemotherapy involves the use of drugs to kill the cancer cells or stop them from growing. Drugs used in uterine cancer chemotherapy, according to the ACS, include carboplatin, cisplatin, paclitaxel and doxorubicin. Another drug, ifosfamide, is added in high-grade cancers or carcinosarcomas.
Chemotherapy is used after surgery in advanced uterine cancer. Usually the drugs are used in combination to maximize the results. Chemotherapy is also combined with radiation therapy and hormonal therapy in metastatic cancer, or cancer that has spread to distant organs, inoperable cancers and in those who cannot have surgery because of other medical conditions.
Hormone Therapy
Hormone therapy is the use of drugs to block the enhancing effects of certain hormones on cancerous growths. In the case of endometrial cancer, the enhancing effects of estrogen are removed by progestins like medroxyprogesterone and megestrol; anti-estrogens like tamoxifen; gonadotropin-releasing hormone agonists like goserelin and leuprolide; and aromatase inhibitors like letrozole, anastrozole and exemestane.
According to the ACS, hormone therapy is used in advanced uterine cancer especially when the cancer has spread to other organs. They are, however, not very effective in high-grade cancers or those lacking receptors for progesterone.
References
- National Institutes of Health/MedlinePlus: Endometrial Cancer
- National Cancer Institute: Endometrial Cancer Treatment
- American Cancer Society: Endometrial Cancer: Treatment Options by Stage
- American Cancer Society: Endometrial Cancer: Radiation Therapy
- American Cancer Society: Endometrial Cancer: Hormone Therapy
