Treatment of Stage II Endometrial Cancer

Your doctor will probably remove your Stage II endometrial cancer completely by surgery. If you have Stage IIA cancer, you will probably have a simple hysterectomy. If you have Stage IIB cancer, you will probably have a radical hysterectomy. You might also have a bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection (see below).

• Simple hysterectomy (total hysterectomy) - The surgeon removes the uterus and cervix but not the structures next to the uterus (parametria and uterosacral ligaments) or the pelvic lymph nodes (bean-shaped structures, which help fight infection). The uterus is removed through a surgical incision in the front of the abdomen or through the vagina. This operation is usually combined with bilateral salpingo-oophorectomy.
  

If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using laparoscopy, a method of examining the inside of the abdomen and pelvis through a tube (laparoscope) inserted into a very small surgical incision, the operation is called a total laparoscopic hysterectomy.

• Radical hysterectomy - Like a simple hysterectomy, this operation removes the entire uterus. But unlike simple hysterectomy, the tissues next to the uterus (parametria and uterosacral ligaments) and the upper part (about 1 inch) of the vagina next to the cervix are also removed. This operation is usually combined with bilateral salpingo-oophorectomy.

Other surgical procedures may be done during or after a simple or radical hysterectomy.

• Bilateral salpingo-oophorectomy (BSO) - The surgeon removes both ovaries and both fallopian tubes (the two hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization). A BSO is usually performed during a hysterectomy. 
• Laparoscopic lymph node sampling - The doctor controls small surgical instruments through a tube (laparoscope). This procedure lets the surgeon remove lymph nodes without making a large incision in the abdomen. This technique can shorten the time needed for the patient to recover from surgery.
• Pelvic and para-aortic lymph node dissection - The surgeon removes lymph nodes from the pelvis and the area next to the aorta (the main artery from the heart) to find out if they contain cancer cells that have spread from the endometrial tumor. This procedure is usually done through the incision in the abdomen that was made for the hysterectomy. The lymph nodes may also be removed by laparoscopic surgery in women who have had a vaginal hysterectomy.
  

Your doctor might give you external beam radiation therapy (EBRT) or internal radiation therapy before your surgery to shrink the tumor, or after your surgery to reduce the risk that your cancer will come back. If you cannot have surgery, you might be treated with radiation therapy instead.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. EBRT can harm both the cancer cells and nearby healthy tissue. Most women are treated with EBRT for a few minutes 5 days a week for 4 or 5 weeks as an outpatient.
• Internal radiation therapy (brachytherapy or interstitial radiation therapy) - Small pellets (or “seeds”) that contain radioactive materials are placed in your body through the vagina so that they are in or near the tumor. The radioactive pellets release their radiation slowly over time. Brachytherapy lets the doctor use a higher dose of radiation than EBRT without damaging nearby areas, such as the bladder and rectum, but it can only be used to treat a small area of the body. This procedure is done about 4 to 6 weeks after hysterectomy in the radiation suite of a hospital or cancer care center. You may need several treatments.

Your doctor might recommend that you take hormone therapy, possibly a combination of tamoxifen and megestrol.

• Provera ^® (medroxyprogesterone acetate) - Medroxyprogesterone acetate is a progesterone, or female hormone, that is involved in women’s monthly cycles and pregnancies. It stops cancer cells from growing, which kills them. Medroxyprogesterone acetate is taken in pill form, usually once a day. The dose depends on your weight and type of cancer.
• Megace ^® (megestrol acetate) - Megestrol acetate is a progesterone, or female hormone, that is involved in women’s monthly cycles and pregnancies. It stops cancer cells from growing, which kills them. Megestrol acetate is taken in pill or liquid form by mouth. Megestrol acetate pills are usually taken four times a day. The dose depends on your weight and type of cancer.
• Tamoxifen - Tamoxifen blocks estrogen, the female sex hormone made by the ovaries that is responsible for the development of female sex characteristics, such as a uterus and breasts. The cancer cells that need estrogen to divide stop growing and this kills them. Tamoxifen is usually taken in pill form twice a day with an 8-ounce glass of water. The dose depends on your weight and type of cancer. Tamoxifen is sometimes used to treat advanced or recurrent endometrial cancer.
  

This content has been reviewed and approved by Myo Thant, MD.