If you have uterine cancer, you might have a combination of surgery, radiation, hormonal therapy, or chemotherapy.
Your doctor may recommend surgery to remove the uterus, fallopian tubes, and ovaries, plus a sampling of the important lymph nodes as a first step. Then they’ll send tissue samples to a pathologist to look for abnormalities. We regularly use minimally invasive surgery for hysterectomy. After surgery you might have radiation with or without chemotherapy, depending on the pathology results.
Sometimes women are diagnosed with uterine cancer before they’re done having children. If you fall into this category, you might be eligible for nonsurgical management with hormonal therapy that can treat the cancer and preserve your fertility. Hormonal therapy is only utilized in women with early endometrial cancers associated with a favorable prognosis. Women treated with hormonal therapy require frequent monitoring and follow-up.
Young women with endometrial cancer may also be eligible to preserve their ovaries. Ovarian preservation allows for continued hormonal production by the ovaries and avoids symptoms of menopause.
Our gynecologic oncologists have done extensive large-scale safety studies for fertility-sparing surgeries in young women with uterine cancer. We also work with the experts at the Columbia University Fertility Center to find the best options for you.
The gynecologic oncologists at Columbia University are national leaders in developing and evaluating minimally invasive surgery for uterine cancer and other gynecologic conditions.
Hysterectomy, or surgical removal of the uterus, is the gold standard for treatment of uterine cancer. Often, a gynecologic oncologist will remove the ovaries and fallopian tubes at the same time, called salpingo-oophorectomy. Additionally, lymph nodes from the pelvis and abdomen are often sampled to determine if the cancer has spread beyond the uterus. The presence of cancer in the lymph nodes indicates the cancer has spread.
Some people with uterine cancer have other significant medical problems that make surgery unsafe. They might have radiation, sometimes in combination with chemotherapy, instead.
Abdominal (Open) Hysterectomy
Abdominal (open) hysterectomy uses a large incision to access tbe abdomen. Sometimes the incision is vertical, and sometimes it’s horizontal above the pubic bone, called transverse. If a doctor suspects cancer has spread outside the uterus or if the uterus is significantly enlarged, they’ll most likely recommend an abdominal hysterectomy.
Minimally Invasive Hysterectomy
Minimally invasive hysterectomy uses small incisions to insert a video camera and surgical tools into the abdomen. The doctor fills the abdomen with gas, then uses the camera to guide the instruments. During laparoscopic surgery, the doctor holds and manipulates the instruments. During robotic assisted surgery, a robot holds the instruments, whilst being controlled by a doctor.
Lymph Node Evaluation
At the time of hysterectomy, your doctor may also perform biopsies of the lymph nodes to determine whether the cancer has spread beyond the uterus. Lymph node evaluation may be performed by removing the lymph nodes in the pelvis, called a lymphadenectomy. At Columbia University, our gynecologic oncologists frequently use a less invasive technique called a sentinel lymph node biopsy, in which only the nodes at highest risk for cancer are removed.
Chemotherapy and Radiation Therapy
Sometimes cancer spreads beyond the uterus, most frequently to the lymph nodes or abdominal cavity. You’ll learn if this is the case after a pathologist examines tissues removed during surgery for abnormalities.
You may have radiation therapy, sometimes in combination with chemotherapy, if tests show the cancer has spread. You might also have additional treatment if you have factors that increase the risk for cancer to come back, including:
- Grade (how the cancer appears under the microscopic)
- Depth of invasion into the wall of the uterus
- Involvement of the cervix
- Spread to the lymphatic and vascular channels within the uterus
- Spread to the ovary or fallopian tube
- Occurrence of microscopic cancer cells outside of the uterus
Radiation therapy uses high-energy X-rays to destroy cancer cells. Radiation therapy may be part of your treatment plan based on the tumor size, extent, and location. If your doctors determine you are not a candidate for surgery, radiation is usually delivered in combination with chemotherapy with the goal to destroy tumor cells while preserving urinary and bowel function. Your radiation oncologist, who is part of your personal care team, will design an optimal treatment plan for you for the best possible results.
Your radiation treatment plan may include one or a combination of the following types of radiation therapy depending on your disease stage:
External Beam Radiation
External beam radiation is used to deliver radiation to the pelvis. We use conformal techniques to help minimize radiation dose to the bladder, bowel, and rectum while focusing the radiation on areas within the pelvis where tumor cells have or may have spread to.
Treatments are delivered daily as an outpatient over a few weeks. Each treatment lasts only a few minutes.
Brachytherapy, or internal radiation, is a treatment where a radioactive source is placed directly inside or very close to the tumor. It is then able to deliver very high doses of radiation while sparing surrounding normal tissues. There are many different types of applicators that may be used to deliver brachytherapy in the pelvis. Your radiation oncologist will meet with you to discuss whether brachytherapy should be part of your treatment plan and what type of brachytherapy would be most appropriate.
Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.
Your doctor uses the latest drugs and drug combinations to shrink the cancer or stop its growth.
Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why it can cause side effects like hair loss. Chemotherapy is given through an IV and in cycles across a few weeks, with each treatment followed by a rest period. Sometimes it comes in pill form.
You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The hope is to improve the quality of life and survivorship of cervical cancer patients. You can talk to your care team about whether a clinical trial is an option for you.
Gynecologic Oncology Survivorship Program
Once you’re finished with treatment, you’ll enter a period of surveillance to make sure the cancer doesn’t return, and if it does, to catch it early. Our experts in the Gynecologic Oncology Survivorship Program create an individualized Survivorship Plan for you. This plan is a comprehensive assessment that includes all the treatment you received, possible late side effects to watch for, a blueprint for future cancer screening, a surveillance plan, and a personalized plan for wellness activities to improve your lifestyle.
Surveillance for uterine cancer is tailored to you. It may include exams and testing. You’ll usually see your gynecologic oncologist instead of your regular gynecologist for these tests.
When cancer comes back after treatment, it’s called recurrence.
Cancer can recur anywhere in your body, including your abdominal cavity, lymph nodes, vagina, or in distant areas such as the lungs or liver. A variety of therapies are available for women with recurrent endometrial cancer, including chemotherapy, hormonal therapy, and immunotherapy. Our team of gynecologic oncologists uses precision medicine to test for specific molecular abnormalities in the cancer to develop a personalized treatment plan.
It’s important to communicate any of these symptoms of recurrence to your gynecologic oncology team:
- Abdominal pain
- Nausea or vomiting
- Changes in bowel or bladder habits
- Vaginal bleeding
- Shortness of breath