Cancer in Women Series

By Kathleen Settle, MD

Chesapeake Potomac Regional Cancer Center

. http://www.chesapeakepotomaccancer.com/

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Cancer in Women Series

Part 1 Endometrial Carcinoma
Endometrial carcinoma, also known as “cancer of the uterus,” is the most common gynecologic malignancy in the United States. There are roughly 40,000 new cases diagnosed each year. Endometrial Carcinoma (EC) is primarily a cancer of post-menopausal women with the average age of diagnosis being around 60. Risk factors for EC include obesity, diabetes, early onset of menstruation and/or late entry into menopause, unopposed estrogen therapy or Tamoxifen, lack of ovulation during menstrual cycles, and not bearing children.
The most common symptom is post-menopausal vaginal bleeding or discharge. Vaginal bleeding in post-menopausal women is not normal and women experiencing this symptom should be evaluated by a gynecologist and/or family physician. The majority of women (about 75%) with EC will be diagnosed with stage I disease, which has an excellent prognosis and is the focus of this article. Women with stage I endometrial cancer are treated with surgery and possibly, radiation therapy. The standard surgery is a total abdominal hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, fallopian tubes, and ovaries). A surgeon may also removed lymph nodes at the time of the procedure.
Determining a need for radiation therapy is directed by the surgeon's operative findings and the pathology report. Important features to review on a pathology report is grade (how aggressive the cancer appears?G1=less aggressive, G2=intermediate, G3=more aggressive), depth of invasion (how deeply did the tumor invade the uterus), location of the cancer (close to versus far from the cervix), and the presence of lymphovascular invasion (did the cancer invade blood vessels or lymphatic channels).
The above features help to determine a patient's risk of the cancer returning within their pelvis or at their vaginal cuff (the end of the vagina where the cervix used to be located).
If the woman is felt to be at high risk for recurrence, radiation therapy is recommended.
Radiation therapy involves the use of high-dose X-rays to kill cancer cells. When done from outside the body, it is called external beam radiation therapy (EBRT). EBRT is used to treat a patient's whole pelvis, if the lymph nodes are felt to be at a significant risk of harboring cancer cells.
Fortunately, the oncology community now has data showing that many stage I patients can be spared whole pelvis treatment. Instead, patients can be treated to just the vaginal cuff because it is the most likely site of cancer recurrence. The vaginal cuff is treated with intracavitary high dose-rate brachytherapy (also known as “HDR brachytherapy.” “cylinder radiation,” “vaginal cuff boost”). Brachytherapy is another form of radiation that involves the internal application of radiation. Generally, it has fewer side effects than EBRT. It is also more convenient, as it is delivered in 3-5 treatments versus 25-28 treatments with EBRT to the whole pelvis.
If you have been diagnosed with EC. Ask your surgeon, gynecologist, and/or family physician to refer you to a radiation oncologist for a consultation to determine if you would benefit from radiation therapy to prevent cancer recurrence.