A National Cancer Institute-designated Comprehensive Cancer Center

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Endometrial/Uterine Cancer

About Endometrial/Uterine Cancer
Uterine cancer is one of the more common cancers in women. It can technically be divided into endometrial cancer, or cancer of the uterine lining, and uterine sarcoma, which is a cancer arising from the myometrium, or muscle tissue of the uterus.

Endometrial cancer is defined as a disease in which cells of the endometrium become malignant, forming a tumor or tumors.

Risk Factors

Studies suggest the following may be risk factors for developing uterine cancer:
 
  • Age: Diagnosis often occurs after age 50; the average age at diagnosis is 60.
 
  • Race: White women are more likely to get uterine cancer.
 
  • Endometrial hyperplasia: A profusion of abnormal endometrial cells, manifesting as heavy menstrual bleeding or bleeding between periods or postmenopausal bleeding.
 
  • Early first menstruation: before age 12
 
  • Late menopause: after age 52
 
  • Exposure to high levels of estrogen: Oral contraceptives and hormone replacement therapy. Estrogen used without progesterone increases risk significantly compared to estrogen alone.
 
  • Never having been pregnant
 
  • Family history of the disease
 
  • Long-term tamoxifen therapy
 
  • Obesity and/or diabetes: These conditions promote increased estrogen levels.
 
  • History of colorectal cancer
 
 

Diagnosis

If a woman has symptoms that suggest uterine cancer, a doctor may perform one or more of the following exams or tests:

 

  • Pelvic exam: The doctor will check for abnormalities such as lumps in the uterus.
 
  • Pap smear: The doctor collects cells from the cervix, which are examined by a medical laboratory for abnormalities. Although a Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why a doctor collects samples of cells from inside the uterus in a procedure called a biopsy.
 
  • Transvaginal ultrasound: The doctor inserts an instrument into the vagina that aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor may recommend a biopsy.
 
  • Biopsy: The doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor's office. In some cases, however, a woman may need to have a dilation and curettage, often referred to as a D&C. A D&C is typically a same-day surgery with anesthesia. A pathologist examines the tissue to check for cancer cells, hyperplasia and other conditions.
 
Staging

If uterine cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

 

The doctor may order blood and urine tests and chest X-rays. The woman also may have other X-rays, computed tomography scans, an ultrasound test, magnetic resonance imaging, sigmoidoscopy or colonoscopy.

 

In most cases, the most reliable way to stage uterine cancer is to remove the uterus (hysterectomy). After the uterus has been removed, the surgeon can look for obvious signs that the cancer has invaded the muscle of the uterus. The surgeon also can check the lymph nodes and other organs in the pelvic area for signs of cancer. A pathologist uses a microscope to examine the uterus and other tissues removed by the surgeon.

 

These are the main features of each stage of the disease:

 

  1. Stage I – The cancer is only in the body of the uterus. It is not in the cervix.
  2. Stage II – The cancer has spread from the body of the uterus to the cervix.
  3. Stage III – The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells.
  4. Stage IV – The cancer has spread into the bladder or rectum. Or it has spread beyond the pelvis to other body parts.
 

Treatments

City of Hope uses a multidisciplinary approach to combat uterine cancer. Our surgeons, medical and radiation oncologists and researchers collaborate closely throughout treatment to ensure uterine cancer patients receive the best care possible.
 
Surgery remains the preferred method for treatment of uterine cancer. Because most endometrial cancers are found early, surgery offers an excellent chance at curing the patient.
 
Most surgeons will recommend a hysterectomy (removal of the uterus) or, for a more complete removal, a hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). The predominant technique utilized is the abdominal hysterectomy. As the name implies, the incision and access to the uterus is via an abdominal incision. This allows for a better view and easier dissection of the necessary areas. As an alternative, hysterectomy can also be performed via a vaginal incision, and a laparoscopic approach is also possible. Laparoscopic surgeries allow for smaller incisions, less bleeding and less postoperative pain.
 
City of Hope is one of a few institutions to operate four da Vinci S HD Surgical Systems – the most advanced robotic technology available. Our team possesses a thorough knowledge of robotics, due in part to our large volume of patients and expertise across a variety of procedures.
 
The robotic surgical approach means smaller incisions, reducing trauma to the patient and assisting in quicker healing. This means that women may feel better and return to their normal lives sooner. Robotic systems use highly advanced imaging navigation, high-definition monitors and fine optics so surgeons can operate with more precision than ever before.
 
In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area.
Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, the doctor may suggest radiation treatments for the small number of women who cannot have surgery.

Doctors use two types of radiation therapy to treat uterine cancer:
 
  • External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.
    • Intensity-modulated Radiotherapy (IMRT) has evolved as a technique that can treat certain areas such as the tumor or areas at risk of recurrence while sparing adjacent normal tissues from high-dose irradiation.IMRT is an advanced form of radiotherapy that produces high-dose volume of radiation, which may have an irregular shape that better conforms to the clinical target volume. By having a better conformation of the target volume, normal pelvic tissues (e.g., small bowel, bladder, rectum) are relatively spared. The potential advantage of IMRT in these treatments, in the post-operative setting, is the ability to shape a dose distribution that delivers a lower dose to abdominal cavity contents (e.g., small and large bowel), which in turn will make it possible to reduce side effects from treatment.
  • Internal radiation: In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.
 
Some patients need both external and internal radiation therapies.

Hormonal Therapy
Hormonal therapy involves substances that prevent cancer cells from getting or using the hormones they may need to grow. Hormones can attach to hormone receptors, causing changes in uterine tissue. Before therapy begins, the doctor may request a hormone receptor test. This special lab test of uterine tissue helps the doctor learn if estrogen and progesterone receptors are present. If the tissue has receptors, the woman is more likely to respond to hormonal therapy.
 
Hormonal therapy is called a systemic therapy because it can affect cancer cells throughout the body. Usually, hormonal therapy is a type of progesterone called a progestin. The two most commonly used progestins are:
 
  • medroxyprogesterone acetate (Provera tablets or Depo-Provera injectable)
  • megestrol (Megace tablets)

The doctor may use hormonal therapy for women with uterine cancer who are unable to have surgery or radiation therapy. Also, the doctor may give hormonal therapy to women with uterine cancer that has spread to other areas of the body. It is also given to women with uterine cancer that has recurred.
 
Chemotherapy
If there is evidence of spread beyond the endometrium, chemotherapy may be needed. Combinations of doxorubicin, cisplatin/carboplatin and paclitaxel have proven useful. Ifosfamide and 5-FU are also used.

Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center , which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
Women’s Cancer Network
800-444-4441
The Women’s Cancer Network is an interactive Web site developed by the Gynecologic Cancer Foundation, which is dedicated to informing women around the world about gynecologic cancer. Its goal is to assist women who have developed cancer, as well as their families, to understand more about the disease, learn about treatment options and gain access to new or experimental therapies.
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
National Comprehensive Cancer Network (NCCN)
888-909- NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 21 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.

Research/Clinical Trials

City of Hope is at the forefront of some of the nation’s most promising uterine cancer research and treatment programs. We conduct vital research and clinical trials to improve treatment and quality of life for women living with the disease, and early detection and prevention of uterine cancer for all women. City of Hope's commitment to this crucial biomedical field will not only serve City of Hope patients, but the scientific knowledge generated here is shared with other top cancer centers across the country. This ensures that the most advanced therapies help women afflicted with uterine cancer everywhere, every day.
 
Current research in uterine cancer includes using intensity-modulated radiotherapy post-surgery, alone or in combination with chemotherapy, as well as investigational agents added to conventional chemotherapy.
 
To learn more about our clinical trials program and specifically about trials for uterine cancer, click here.

Media

Watch a highlight from this informative lecture on gynecological cancers. All women can benefit from this discussion on detection and treatment, as well as research, on ovarian and uterine cancers. Associated health issues including HPV (human papillomavirus) are also discussed.
 
Clip from "Ask the Experts - Women's Cancers and HPV"
Laparoscopic/Robotic Surgery for Uterine Cancer
Mihaela Cristea, M.D. | June 2012
 

Endometrial/Uterine Cancer - Our Approach

 
City of Hope is at the forefront of some of the nation’s most promising endometrial and uterine cancer treatment and research programs. Our comprehensive and aggressive approach to endometrial and other types of uterine cancer involves screening to facilitate early detection, surgical treatments, including minimally-invasive robotic surgery, advanced therapies including intense-modulated-light radiotherapy and investigational chemotherapy drugs, as well as psychosocial, supportive and palliative care.

Our Gynecologic Oncology program delivers these services using the latest technology, providing the most effective, strategic and targeted care.

Endometrial/Uterine Cancer Team

Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 
The Positive Image Center is where licensed cosmetologists support and assist patients with building and maintaining self-confidence in their appearance. Services are free and provide a forum in which patients can access wig fittings and stylings and discuss cosmetic techniques.
 
Cooper Finkel Women’s Health Center
Many gynecological cancer and breast cancer  services at City of Hope are provided at the Rita Cooper Finkel and J. William Finkel Women's Health Center. Here, women receive the highest quality care, whether seeking prevention and screening services or coping with a cancer diagnosis.
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.

To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
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