Endometrial or uterine cancer is one of the most common gynecologic cancers in women and has one of the highest survival rates if caught early. More than 52,000 new cases were reported in 2014. Early detection & treatment by a CIGC advanced trained specialist is essential for the best recovery.
Endometrial cancer develops from the lining of the uterine cavity called the endometrium. Endometrial cancer is one of the most common gynecologic cancers in women, with roughly 52,000 new cases reported in 2014, according to the National Cancer Institute. The incidence of uterine cancer would be higher if it were not for the number of hysterectomies performed for non-cancerous reasons. Like the uterus itself, endometrial cancer is also sensitive to female hormones.
Most women with uterine cancer become aware of a medical problem because of unanticipated bleeding (not associated with menstruation), usually occurring after menopause. Fortunately, 80 percent of women diagnosed after developing abnormal bleeding will have cancer limited to the uterus (Stages I and II) and a high proportion are cured. Women who experience bleeding or discharge not related to menstruation, particularly in women who have already entered menopause, should consult a doctor right away. Endometrial cancer can also sometimes cause pelvic pain or pain during intercourse as well as difficult or painful urination. Many other conditions have similar symptoms, but patients should consult a doctor if they experience these symptoms.
HOW IS ENDOMETRIAL CANCER DIAGNOSED?
Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap smear test. For this reason, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. There are two procedures typically used to evaluate endometrial tissue. An endometrial biopsy is when a small sample of tissue is obtained from the endometrium and evaluated under a microscope. Although it can be conveniently performed in the office, the method is less preferable because the biopsy is done blindly and it can potentially miss a small area of cancer. The more preferred method of obtaining a sample of the uterine lining is a hysteroscopy, D&C. During a hysteroscopy, a small area is inserted inside the uterine cavity and the entire cavity is visualized. Then a sample of uterine lining is obtained by gentle scraping (D&C). This procedure is performed in the operating room since general anesthesia or some type of sedation is needed. The benefit of this procedure is that if a polyp or other growth in the uterine cavity is noted, it can be removed at the same time. Once endometrial tissue is checked under a microscope, a precise diagnosis can be made. Following a diagnosis of uterine cancer, additional tests are performed on the cancer cells to determine the grade of the cancer, in order to provide optimal treatment. In addition, a doctor must accurately determine whether cancer has spread into the tissue of the uterus or the surrounding tissues. The stage of the uterine cancer can only be determined after surgical treatment.
WHAT DOES THE CANCER “TYPE” TELL ME?
There are several types of endometrial cancer, which vary based on their appearance under the microscope. The most common type of endometrial cancer is adenocarcinoma. Other variants that behave more aggressively include serous carcinoma, uterine clear cell carcinoma and mixed type. Treatment outcomes can also be affected by the appearance of cancer when examined under the microscope. Doctors grade adenocarcinomas, as poorly, moderately or well-differentiated. These terms describe how closely the cancer resembles normal cells of the uterus. In general, the less differentiated the cells, the more aggressive the cancer. More poorly differentiated cancers have a higher rate of recurrence. Doctors need to understand the precise type of cancer in order to determine the best treatment plan.
HOW DO I KNOW IF ENDOMETRIAL CANCER HAS SPREAD?
In addition to the type and grade of the cancer, the stage or extent of spread of cancer is the most useful predictor of survival and is relevant for treatment planning. Surgery must be performed to fully evaluate the stage of endometrial cancer. Because hysterectomy is the typical treatment, staging is usually completed during a hysterectomy. The stage of the cancer describes the extent to which it has spread beyond the endometrium, if any. Stage I: Cancer does not spread outside the body of the uterus. Stage II: Cancer involves the body of the uterus and the cervix. Stage III: Cancer extends outside of the uterus, but is confined to the pelvis. Stage IV: Cancer involves the bladder or bowel or distant sites. Recurrent: Cancer has returned after initial treatment.
IS THERE A CONNECTION BETWEEN HORMONE THERAPY OR BREAST CANCER TREATMENT AND ENDOMETRIAL CANCER?
Endometrial cancer may develop in breast cancer patients who have been treated with Tamoxifen. A patient taking this drug should have a pelvic exam every year and report any vaginal bleeding (other than menstrual bleeding) as soon as possible. Women taking estrogen alone have an increased risk of developing endometrial cancer. This is because endometrial cancer is highly sensitive to estrogen. Taking estrogen in combination with progesterone does not increase a woman’s risk of this cancer.
Different types of treatment are available for patients with endometrial cancer. Three types of treatment are used: surgery, radiation therapy, and chemotherapy. Surgery is the most common treatment and the only cure for endometrial cancer. Surgical removal of the uterus and ovaries is required in order to remove the cancer. Laparoscopic surgery offers women all of the benefits of minimally invasive surgery, including short to no hospital stay, minimal pain and fast recovery. After laparoscopic surgery, women feel less sick, which enables them to have a brighter, more optimistic outlook. This positive outlook helps women through the rest of the cancer treatment and recovery process.
WHAT IS THE STAGING SURGERY FOR UTERINE CANCER?
Endometrial cancer is typically limited to the uterus, with most patients having complete removal of the cancer with hysterectomy. Staging is performed at the time of the laparoscopic procedure to determine if the cancer has spread, and involves removal of the tubes and ovaries, node dissection, or removal of the lymph nodes during the procedure. The removal of lymph nodes does not add time or additional complications to the surgical procedure. Node dissection within pelvis and aortic area is crucial for evaluating the stage of cancer.
WILL I NEED ADDITIONAL TREATMENT AFTER SURGERY?
Radiation and chemotherapy after surgery is called adjuvant therapy. Adjuvant therapy is not required in the vast majority of uterine cancer patients with early stage disease and with minimal invasion into the uterine muscle. Treatment after surgery depends on the following factors:
- Lymph Node status – positive or negative for cancer
- Depth of the cancer invading or not into the muscle of the uterus and cervix
- Cancer cells in the lymph spaces of the uterus
- Involvement of the ovaries and tubes
- Grade of the cancer and cell type
WHY IS LAPAROSCOPIC SURGERY BETTER FOR UTERINE CANCER?
Laparoscopic hysterectomy with staging for uterine cancer has been shown to be as effective as standard open surgery with a much faster recovery and fewer complications. Laparoscopic hysterectomy can be performed in almost all patients with cancer confined to the uterus, and allows patients to be up and around much faster.
If radiation or chemotherapy is required, these treatments can be started much sooner after surgery, minimizing delay in therapy.
In addition, laparoscopic surgery limits adhesion formation, which is a significant benefit if radiation therapy is required. Adhesions, or scar tissue, “trap” the bowel in the pelvis, and may increase injury to the bowel during radiation therapy, since it is not able to move in and out of the radiated field as would normally occur if adhesions were not present. This will increase the dose of radiation to the bowel, and can increase the incidence of bowel injury, resulting in poor bowel function and possible obstruction.
Finally, laparoscopic surgery also allows patients to cope with their illnesses easier, since they are not hospitalized for an extensive period of time, and their recovery allows them to go about normal activities. Patients who feel well typically face their future treatment and recovery with a more hopeful outlook and experience faster recoveries, both physical and psychological, from their cancer.
It is not necessary for patients to undergo large, vertical incisions with prolonged hospital stays and increased chances of surgical or post-operative complications. The greatest barrier for most oncologists in successfully completing these procedures laparoscopically is lack of surgical technique and experience. It is NOT better to open a patient up with a 12 to 15 inch incision so that it is possible to “feel” inside. Since most cases of uterine cancer are limited to the uterus, the open approach does not provide patients with this disease the best care possible, but does expose them to unnecessary pain and complications.
WHY CIGC FOR UTERINE CANCER
Once diagnosed with uterine cancer, choosing a minimally invasive GYN surgeon is one of the most important decisions you will make. Ensuring your treatment and recovery are managed well will mean a better experience, limiting pain and complications. When choosing a treatment option, CIGC surgeons work with patients to choose the least invasive procedure possible.
Learn the benefits of laparoscopic procedures
Patients of laparoscopic procedures have a short hospital stay or none at all, minimal pain, and a fast recovery. Since recovery is so easy and fast, patients feel less sick afterward, which contributes greatly to an optimistic outlook. Feeling better physically and mentally makes the rest of the cancer treatment and recovery process more tolerable. At the end of treatment, patients get to walk away with minimal scarring.
Know your options
Our surgeons assess uterine cancer patients on a case-by-case basis to choose the best treatment options. There are many different types of treatment options, and the type of surgical procedure needed depends on the stage and grade of cancer. We will offer you peace of mind by helping you understand your condition and options.
CIGC surgeons do not perform open hysterectomies, including patients with uterine cancer. Open surgeries are known to be painful, have a relatively high risk of complications, and have an extended recovery period. CIGC surgeons also do not perform robotic surgeries. Surgeries in which robotic technology performs the procedure is extremely expensive and has a high risk of complications. At CIGC, we perform minimally invasive, advanced laparoscopic hysterectomies. This type of hysterectomy is far superior to the aforementioned: it leaves you with minimal cosmetic scarring, has a recovery period of only a few days, and has a low risk of complications. Hear why our patients prefer our laparoscopic procedures.
CIGC surgeons are laparoscopic surgical specialists who have dedicated their careers to the performance of minimally invasive GYN surgery. Our commitment to surgery means that we have worked on a higher volume of cases, more difficult cases, and use advanced techniques and procedures learned in extensive training sessions. We strive to complete even the most complex surgeries with low complication rates.
Surgery is the only medicine practiced by our surgical specialists. We partner with OB/GYNs. The focus for OB/GYNs is obstetrics. At CIGC the sole focus of our practice is surgery. Increased surgical volume is important to develop and maintain surgical expertise.
We know that our customers are picky when choosing their surgeons, and we think doing extensive research is important. When you are exploring uterine cancer treatment options, get to know our surgical specialists and see why they are the best in the industry.
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