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Endometrial Cancer

By Ashlyn Seeley Everett, M.D., radiation oncologist at Alliance Cancer Care, and Gabrielle Hawkins, M.D., obstetrician-gynecologist at Tennessee Valley Gynecologic Oncology

What is endometrial cancer?

Endometrial cancer is the most common gynecologic cancer in women.  The endometrium is the layer of tissue lining the uterus, which is the organ where women carry babies.  The endometrium can develop abnormal and cancerous cells.

What are the risk factors for endometrial cancer?

Risk factors include being female, increasing age, obesity, some medications taken for breast cancer treatment, excess estrogen exposure, and some inherited genetic syndromes such as Lynch syndrome.

What are the symptoms of endometrial cancer?

Common symptoms of endometrial cancer are spotting or bleeding between periods or after menopause.  Some patients may have pain in the pelvic area or pain with sexual intercourse.

What testing is done to diagnose endometrial cancer?

If your doctor suspects endometrial cancer, you will likely have an endometrial biopsy and/or transvaginal ultrasound.  The ultrasound looks for thickening in the endometrium or lining of the uterus.  An endometrial biopsy is performed in the clinic and then reviewed by a pathologist to look for cancerous cells.  If your doctor suspects endometrial cancer but your biopsy is negative, you may have a procedure called a dilatation and curettage (D&C).  This is a surgical procedure for sampling the endometrial tissue to look for signs of cancer.

What are treatment options for endometrial cancer?

SURGERY – Standard treatment for endometrial cancer involves surgery.  You should have surgery with an experienced surgeon, typically a gynecologic oncologist, who is a specialist in gynecologic cancers.  Surgery involves the removal of the uterus and cervix, ovaries, and fallopian tubes for a total hysterectomy.  Your surgeon may also take a sampling of lymph nodes, called a sentinel lymph node biopsy.

After surgery, a pathologist will look at your cancer under the microscope to determine the final stage and grade of your cancer.  The stage of cancer is determined by how deep the cancer has invaded, or if it has spread to lymph nodes or other parts of the body.  The grade of your cancer is a measure of how aggressive it looks under the microscope.  Higher-stage or more aggressive tumors will require additional treatment.

Based on the stage and grade of your cancer, your doctor may recommend additional treatment(s).  You may be recommended to have vaginal brachytherapy, external beam radiation treatment, or chemotherapy.  Some patients will receive a combination of these options.

VAGINAL BRACHYTHERAPY – Vaginal brachytherapy is a unique form of radiation treatment specific to endometrial cancer.  Endometrial cancer most often comes back in the vagina after surgery; therefore, we recommend brachytherapy to decrease the risk of recurrence for certain patients.  This form of treatment is delivered by a radiation oncologist.

EXTERNAL BEAM RADIATION TREATMENT – External beam radiation treatment is a form of radiation treatment focused on the pelvis to eliminate any microscopic cancer cells after surgery.  This form of treatment is delivered by a radiation oncologist.

CHEMOTHERAPY – Chemotherapy is often given for higher-stage or more aggressive types of endometrial cancer.  Chemotherapy is typically given through an IV and delivers medicine into your bloodstream that circulates throughout the body to kill cancer cells.  This treatment is typically delivered by a gynecologic oncologist, but it can also be given by a medical oncologist.

What are the side effects of treatment?

Side effects of treatment are variable depending on the type of treatment you receive.

SURGERY – Side effects of surgery are related to the operation itself.  Some pain after surgery is normal and can be controlled with pain medications.  Other possible side effects include fatigue, incision problems, fevers, nausea, constipation, blood clots in the legs or lungs, or swelling in the legs, also called lymphedema.

RADIATION – External beam radiation therapy is a painless treatment.  The treatments are typically delivered once daily, Monday through Friday over several weeks.  Treatments are given in small “doses” to minimize side effects; however, you are likely to have some side effects, which gradually build up during treatment.  Patients commonly experience fatigue, burning with urination, and diarrhea with this treatment.  You will not lose your hair, have extreme nausea or vomiting, or have low blood counts.

BRACHYTHERAPY – Vaginal brachytherapy for endometrial cancer typically causes some burning with urination on the day of and possibly the day after treatment.  Long-term, vaginal brachytherapy can cause vaginal dryness and scarring called fibrosis.  Fibrosis can lead to narrowing of the vaginal canal, and painful intercourse if not managed appropriately.  Your doctor will discuss how to prevent fibrosis, and maintain normal function after treatment. 

What kind of recovery is involved after treatment?

Recovery from treatment depends on the type of treatment you receive.

SURGERY – Recovery from surgery is about 6-8 weeks.  There will be restrictions on how much you are allowed to lift following surgery, but the exact amount and timeframe are usually surgeon/practice specific.  Most surgeons also recommend “pelvic rest” or nothing in the vagina after surgery, to allow the incision at the top of the vagina to heal.  You will have an individualized discussion with your surgeon about the timing for returning to work, but, on average, this can be 4-6 weeks after surgery.  Additionally, fatigue is a symptom that can linger after major surgery, but resting when needed typically relieves this symptom.

EXTERNAL BEAM RADIATION – Recovery from radiation treatment typically takes about 4-6 weeks.  Side effects typically build up throughout radiation, and then take a few weeks to resolve.  You will likely be back to your usual activities about a month after you complete radiation.

BRACHYTHERAPY – If you are receiving brachytherapy alone, most patients have minimal recovery time.  Many patients continue normal activities, and have no “recovery time.”

What happens after treatment?

After you complete your treatment course, you will be monitored very closely by your team of doctors.  You will likely have a doctor visit for a pelvic exam every 3 months, which is the most important method to detect if cancer has come back.  Your doctor may choose to order a scan, such as a computed tomography (CT) scan.

You will continue to see your doctor at regular intervals until around 5 years, at which time, you can resume annual visits.

What happens if the tumor comes back or spreads?

If your cancer comes back or spreads, there are likely treatment options available to you.  This is a highly personalized situation, but treatments can include chemotherapy, radiation, and/or brachytherapy radiation.

Where can I find more information?

If you were diagnosed with endometrial cancer and would like to discuss treatment with one of our expert physicians, please contact Dr. Hawkins’s office at 256-265-4600 or Dr. Everett’s office at 256-319-5400 to schedule a consultation.

Check out these helpful websites:

The National Cancer Institute’s page on Endometrial Cancer

The American College of Obstetricians and Gynecologists page on Endometrial Cancer