Treatment of Stage III Endometrial Cancer

If your surgeon believes that all of the visible cancer can be removed, you will probably be treated with a simple or radical hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and para-aortic lymph node sampling (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 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.
• 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.
• 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 after your surgery to reduce the risk that your cancer will come back. If your surgeon does not believe it is possible to remove all visible cancer, you might be treated with radiation therapy to shrink the tumor enough so that surgery is possible. You might also be treated with radiation therapy and chemotherapy instead of surgery.

• 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 or 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 a hysterectomy in the radiation suite of a hospital or cancer care center. You may need several treatments.

You might also be treated with chemotherapy drugs to destroy cancer that is still left after surgery, slow the tumor's growth, or reduce symptoms. Several different chemotherapy drugs are sometimes used in combination to treat Stage III endometrial cancer. These include:

• Adriamycin^® (doxorubicin) - Doxorubicin belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over a period of about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Paraplatin ^® (carboplatin) - Carboplatin is a platinum chemotherapy drug that belongs to a group of drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Carboplatin is given as an injection in the vein over 15 to 60 minutes. The dose depends on your size but may be lowered or not given if your blood counts are low. It can also be injected into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.
• Platinol ^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends upon the type of cancer you have, your size, and how well your kidneys work.
• Taxol^® (paclitaxel) - Paclitaxel belongs to a group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because it affects cells during mitosis (cell division). It stops cells from dividing, which kills them. Paclitaxel is given by an injection into a vein, usually over a 3-hour period, every 3 weeks. Sometimes smaller doses are given once a week over shorter periods. The dose depends on your weight, how well your liver works, the side effects you have, and how often the medicine is given.
  

Your doctor might recommend that you take hormone therapy, possibly in combination with chemotherapy, especially if you cannot have surgery or radiation therapy.

• 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.