Endometrial cancer

Endometrial cancer (lining of the uterus) is the fourth most common form of cancer in women and the most common type of genital cancer. It usually occurs after menopause (the average age of women diagnosed with endometrial cancer is 68) and is associated with several risk factors, including obesity, diabetes, tamoxifen treatment and, more rarely, a genetic predisposition.

Diagnosis

The most common symptoms are abnormal vaginal bleeding after menopause or bleeding between periods (known as metrorrhagia) in women who have not reached menopause.

Less frequent symptoms include:

  • Excessively long or heavy periods in women who have not reached menopause, often associated with metrorrhagia;
  • White/yellow discharge (leukorrhea), sometimes associated with blood;
  • Signs of infection of the lining of the uterus: pain and fever.

 

These symptoms may be due to other causes and are not necessarily signs of endometrial cancer. However, if you have any of them, especially bleeding after menopause, even if it is only slight and does not reoccur, you should consult your gynecologist. She or he will carry out the tests needed to determine the causes of your symptoms.
A clinical examination and a transvaginal ultrasound scan will be carried out.

Diagnoses are confirmed by a biopsy, which may be performed alone during a standard gynecological examination, or in conjunction with a hysteroscopy, either during a consultation or, if a general anesthetic is needed, as an outpatient surgery.

Patients who are found to have endometrial cancer will be given an MRI scan of the abdomen and pelvis in order to evaluate the size of the tumor and how far it has penetrated into the underlying uterine muscle, and to detect any suspect lymph nodes in the area. In some cases, the scan may also include the chest.

These tests are used to determine the histologic type of the tumor and the stage of the disease, so your healthcare team can decide on the best treatment to offer.

A full anesthesia assessment may be needed, especially for patients who have other health problems (obesity, diabetes, high blood pressure, etc.).

 

Treatment

Every case is discussed at a multidisciplinary team (MDT) meeting, during which a group of specialists (surgeons, radiation therapists, oncologists, anatomopathology physicians, radiologists, nuclear medicine physicians) analyzes each patient’s test results and scans in order to decide on the most appropriate treatment program.

The medical team may ask if you would be prepared to take part in a clinical trial. As well as giving patients the opportunity to benefit from a new form of treatment, clinical trials may be used to improve understanding of how cancer arises and develops, or to evaluate patients’ quality of life and see how it can be improved.

Surgery, sometimes combined with radiotherapy, is the main form of treatment.

 

Surgery

Treatment most frequently involves surgery to remove the womb, fallopian tubes and ovaries (total hysterectomy). In some cases, it may also be necessary to remove the lymph nodes draining the womb, either level with the true pelvis or in the abdomen, beside the main blood vessels (lumbar-aortic lymph nodes). 

At the IUCT Oncopole, these operations are usually performed using a type of keyhole surgery called celioscopy or robot-assisted celioscopy.

This type of surgery is not only as effective in treating the cancer as traditional surgery, it avoids the need for a large incision in the abdominal cavity (laparotomy), thereby reducing:

  • Postoperative pain;
  • The time spent in hospital;
  • The risk of postoperative complications;
  • The length and discomfort of convalescence.

 

In some cases, it may be decided to carry out a sentinel lymph node biopsy, which involves locating and removing the first lymph nodes into which the tumor drains. If these nodes are free of cancer, the other nodes are usually healthy and do not need to be removed. This reduces the risks and possible consequences of extensive lymph node removal.

 

Radiotherapy and brachytherapy

Radiotherapy uses ionizing radiation to destroy cancer cells. Two radiotherapy techniques are used to treat endometrial cancer: external radiotherapy and brachytherapy, generally in combination.

External radiotherapy: Before treatment can begin, a scan has to be taken in order to define the area to be treated (preparation stage). A medical physicist then calculates the dose of radiation you will receive and how it should be distributed (dosimetry stage). This is why there is always a waiting period between the decision to use radiotherapy and the start of treatment.

A course of radiotherapy usually lasts 5 to 6 weeks and involves 25 radiotherapy sessions, provided from Monday to Friday (5 sessions a week). Each session lasts 15 minutes. Radiation is invisible and the treatment is completely painless, so you will not feel a thing. Radiotherapy does not make you radioactive and you do not have to take any precautions with respect to the people around you when the session is over.

Brachytherapy: This is a form of internal radiotherapy in which radiation is applied directly to the area being treated. It involves placing an applicator in the vagina and then injecting a radioactive material (iridium) through the applicator in order to target a high dose of radioactivity precisely at the vaginal opening. Brachytherapy is administered after surgery, either alone, in which case you will have one session a week for four weeks, or in conjunction with external radiotherapy, in which case you will have just one session of brachytherapy. Treatment is provided as an outpatient procedure: you come to the IUCT for the session (approximately 30 minutes) and then go home afterwards. You do not need to have an empty stomach. At the start of each session, you will be asked to lie in the gynecological position, so the doctor can insert the applicator and a urinary catheter into your vagina. This is painless. X-rays are used to check the position of the applicator and the spread of the radiation. Treatment lasts a few minutes and is painless. The applicator is removed at the end of the session.