Uterine Cancer Treatment
Early diagnosis and treatment of cancer of the lining of the uterus, referred to as endometrial cancer, is crucial because it can spread to other organs. Before beginning any treatment, you may want to consult with a second specialist in this area to have the diagnosis confirmed and to review all available treatment options. If the cancer is in an early stage, the most common treatment is to remove the uterus, fallopian tubes and ovaries in a surgical procedure called a hysterectomy and bilateral salpingo-oophorectomy. (The ovaries are removed because they secrete hormones which encourage cancer growth.)
Depending on the extent of the cancer, one of two kinds of hysterectomy may be performed:
- Total abdominal hysterectomy and bilateral salpingo-oophorectomy: removal of the uterus, fallopian tubes and ovaries through an incision in the abdomen. Lymph nodes in the pelvis may also be removed.
- Radical hysterectomy: the parametrial (a portion of the uterus) and paravaginal supporting structures are removed. Radical hysterectomy is not commonly needed for this disease.
When caught early, the cure rate is more than 90 percent, so early diagnosis is very important. If a woman ignores the symptom of abnormal bleeding over a long time, the survival rate decreases. If the abnormal uterine bleeding is caused by uterine cancer, the longer it goes untreated, the deeper the tumor grows into the wall of the uterus or spreads to surrounding areas.
In addition to surgery, other treatments for cancer of the endometrium include:
- Radiation therapy: the use of high-dose X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or before or after surgery.
Uterine Cancer Treatment (cont'd)
- Chemotherapy: the use of drugs to kill cancer cells. Chemotherapy is put into the body by inserting a needle into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body and can kill cancer cells outside the uterus. Drugs used in treating uterine cancer may include doxorubicin, cisplatin and paclitaxel. Chemotherapy is not used very often with uterine cancer.
- Hormone therapy: the use of female hormones, usually taken by pill, to kill cancer cells. In cancer treatments, hormones such as progesterone (which occur naturally in the body to regulate growth of specific cells or organs) may be used to stop the growth of cancer cells.
Surgery is the most common treatment for sarcoma of the uterus: usually total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy (removal of lymph nodes if cancer has spread to them). Other therapies — radiation, chemotherapy and hormone therapy — used to treat this disease are similar to those used for uterine cancer.
The treatments used against uterine cancer must be very powerful. It is rarely possible to limit the effects of cancer treatment so that only cancer cells are destroyed. Normal, healthy cells may be damaged at the same time. That's why the treatment often causes side effects.
Hysterectomy is major surgery that requires one to several days in the hospital, depending on the type of surgery performed. For several days after surgery, you may have problems emptying your bladder and having normal bowel movements. Normal activities, including sex, can be resumed in about one to two months.
After a hysterectomy, you no longer have menstrual periods. If your ovaries are removed, you will have symptoms of menopause, and they can initially be more severe than from natural menopause.
Although health care professionals say that sexual desire and the ability to have sex are not generally affected by hysterectomy, many women have an emotionally difficult time after a hysterectomy because their primary female organs have been removed. It means the loss of fertility and may, for some women, highlight the aging process. If you experience these feelings of loss or depression, you may want to seek professional counseling. In addition, you may need to take hormones, such as estrogen, to replace those that are no longer produced because the ovaries were removed.
During radiation therapy, you may notice a number of side effects, which usually disappear when treatment is completed, including skin reactions (redness or dryness) in the area being treated, tiredness, diarrhea, and frequent and uncomfortable urination. Treatment can also cause dryness, itching and burning in the vagina. Sex may be painful, and some women are advised not to have sexual relations during treatment time. Most women can resume sexual activity within a few weeks after treatment ends.
Uterine Cancer Treatment (cont'd)
Anti-cancer drugs — chemotherapy — also travel through the bloodstream to almost every area of the body. Chemotherapy is used for only a minority of women with uterine malignancies. Drugs used to treat cancer may be given in different ways: some are given by mouth; others are injected into a muscle, a vein or an artery. Chemotherapy is most often given in cycles: a treatment period, followed by a rest period, then another treatment period, and so on. Many of the side effects of chemotherapy have been reduced over the years because the drugs have been refined or drugs for the side effects are better used. The side effects of chemotherapy depend on the drugs given and the individual response of the patient. Chemotherapy commonly affects cells that rapidly divide. Cancer cells divide more rapidly than normal cells, but other cells that divide rapidly are hair cells, blood-forming cells and cells lining the digestive tract. As a result, patients may have side effects such as hair loss, lowered blood counts, nausea or vomiting. Most side effects end after treatment is stopped.
Loss of appetite can be a serious problem for women receiving radiation therapy or chemotherapy. Women who eat well are better able to withstand the side effects of treatment. So, nutrition is an important part of the treatment plan. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. Many women say that eating several small meals throughout the day is easier than eating three large meals.
The side effects that patients have during all of these cancer therapies vary from person to person and may even be different from one treatment to the next. Your health care professional will try to plan treatment to keep problems to a minimum, and fortunately, most side effects are temporary. It’s important to tell your health care professional about your reactions and side effects because he or she may be able to adjust treatments to help you feel better.
Regular follow-up exams are very important for any woman who has been treated for cancer of the uterus. The health care professional will want to watch you closely for several years to be sure that the cancer has not returned. Most follow-up examinations include a regular pelvic exam and a chest X-ray.
Copyright 2003
National Women's Health Resource Center Inc. (NWHRC ).