Endometrial

Question 1

Early stage I & 2 endometrial cancer

Answer 1

Tumour is confined to the endometrial with invasion through different layers.

Surgery: main treatment for early stage endometrial cancer.

• Staging is done during surgery, where the surgeon looks at organs, lymph nodes and peritoneal washings to determine extent of disease.
• Treated with total hysterectomy (uterus and cervix) and bilateral-salpingo oophorectomy (ovaries and fallopian tubes).
• Some young patients maintain their ovaries for fertility.

Radiation: can be done by external beam or brachytherapy.

• May be offered after surgery for early stage endometrial cancer to reduce the risk of recurrence.
• Sometimes given before surgery for stage II
• May be the only course of treatment for those unable to undergo surgery

Chemotherapy:

• may be offered after surgery for early stage high grade cancer.
• some type of uterine cancers are treated with chemoradiation at the same time.
• Can also be given a few cycles before radiation then also after called the “sandwich technique”

Question 2

Advanced stage III & IV Endometrial carcinoma

Answer 2

Tumour has either spread through direct extension or into lymph nodes.

Surgery: main treatment for early stage endometrial cancer.

• Staging is done during surgery, where the surgeon looks at organs, lymph nodes and peritoneal washings to determine extent of disease.
• Surgery is the main treatment for stage III. A total hysterectomy + bilateral salpingo-oophorectomy is done along with removal of lymph nodes.
• Tumour debulking may be offered for stage IV disease where is has spread through the pelvis.

Radiation therapy: may be offered for advanced stages, as external beam, brachytherapy or both. Can be done in any of the following situations.

• Primary treatment if patient cannot have surgery
• After surgery
• To treat extensive pelvic disease
• To manage symptoms by controlling heavy vaginal bleeding
• Before surgery in certain cases.

Chemotherapy:

• Offered after surgery for stage III.
• Chemoradiation or the sandwich technique can be used similar to early stage treatment.

Hormonal therapy:

• Offered for stage III if surgery and radiation not possible.
• Or used to relieve symptoms of distant metastasis in stage IV cancer.