The uterus has two layers: an outer muscle layer (called the myometrium) and a thin lining inside (called the endometrium) that sheds each month during a woman’s period or that thickens to support a baby as it grows during pregnancy. The lower part of the uterus is called the cervix; it keeps a baby inside the uterus until it stretches during labor to allow the baby to pass through.
Endometrial cancer (sometimes called uterine cancer) begins in the lining of the uterus and as it grows, it can work its way into the muscle of the uterus.
The primary treatment for endometrial cancer is surgery. Before surgery, we perform a few other tests. These may include:
- Blood tests to determine anemia and check kidney and liver function
- Chest x-ray
- CT scan of abdomen and pelvis and possibly chest
- Colonoscopy (depending on age and symptoms)
- Consultation with urologist for possible cystoscopy (depending on age and symptoms)
- Consultation with primary care physician or specialist to determine your risk for surgery (depending on age and your medical history and symptoms)
You will also have a teaching visit with one of our nurses to tell you what to expect, how to prepare for surgery and recovery, and to answer any questions you may have. The day before surgery, we ask you to clean out your intestines (called a bowel prep). This helps your surgeon to safely move the intestines out of the way during surgery or operate on them if needed.
The surgery for endometrial cancer includes total hysterectomy (removal of the uterus and cervix), bilateral salpingoophorectomy (removal of both tubes and ovaries if present), and lymph node dissection.
Lymph nodes are found throughout the body as part of the filtration system. They catch cancer cells that break off from the original tumor.
Finding cancer cells in the lymph nodes tells us that the cancer has begun to spread. For patients with endometrial cancer, we check lymph nodes deep in the pelvis near the large blood vessels that come from the heart. Occasionally, we will take some other biopsies or remove your appendix.
The pathologist looks at all tissues we remove to see if the cancer has spread. This tells us the stage of the cancer and whether you have risk factors for the cancer to spread or return.
Staging, Risk Factors and Other Treatment
All gynecologic cancers, including endometrial cancer, are staged. Staging is a way of talking about how far a cancer has spread from where it started and helps guide our recommendations for treatment. Most endometrial cancers are early cancers (Stage I) and have not spread outside the uterus. Patients with Stage I cancers do quite well and are often cured. Stage IV cancers are most advanced, but can still be treated, many with good results.
The stage of endometrial cancer is determined by the pathology results after surgery. The pathologist can tell how far into the muscle the cancer has invaded: less than halfway through the muscle (Stage IA) or more than halfway through the muscle (Stage IB) and whether there are cancer cells in any of the other tissues. The pathologist also tells us about risk factors including the grade and cell type of the tumor .
Tumor grade describes how similar the cells of the cancer are to normal cells of the endometrium. Cancer cells that are well-differentiated (Grade 1) look the most like normal cells and are generally less aggressive cancers. Poorly-differentiated cells (Grade 3) look very unlike normal cells and may be more aggressive. Grade 2 cells are intermediate.
Most endometrial cancers are adenocarcinomas. Other cell types (like serous papillary cancers) may be more aggressive and are treated with chemotherapy even in early stage cancers.
Women with Stage IA cancers (that invade less than halfway through the muscle of the uterus) and without risk factors need no other treatment for their cancer. We do see these patients often for the first few years to perform Pap smears and pelvic exams to make sure that there are no signs of cancer.
If you have Stage IB cancer (invades more than halfway through the uterus) or any significant risk factors (Grade 3, aggressive cell type, cancer cells in blood or lymph vessels of the uterus), we will recommend further treatment. The options for treatment include radiation therapy, chemotherapy or a combination, depending on your specific stage and risk factors.
Women with Stage II-IV cancer usually receive a combination of chemotherapy and radiation.
Radiation is a form of energy and is similar to the radiation you receive when you have a chest x-ray or CT scan. However, this form of energy is stronger and is concentrated on a specific area to kill potential cancer cells. Radiation can be delivered from outside the body (called external beam radiation) or inside the body in a tampon-like container (called intracavitary radiation) depending on your specific stage and risk factors. In both cases, the radiation is given in small doses over several days (25 days for external beam radiation and 3-5 days for intracavitary radiation). Radiation is given by a specialist called a Radiation Oncologist who will review the pathology report and recommend external, internal or both types of radiation. Most radiation treatment is done as an outpatient.
Chemotherapy may also be used for endometrial cancer in more advanced stages. In some cases, combined radiation and chemotherapy are used. When chemotherapy is used, it is usually given in small doses each week and is well tolerated with few side effects.