women s health issues
Cancer of the Uterus
Treatment of Uterine Cancer
Surgery to remove the uterus, fallopian tubes, and ovaries Removal of nearby lymph nodes For more advanced cancer, radiation therapy with or without chemotherapy Treatment (surgical removal of the uterus) is the mainstay of treatment for women who have endometrial cancer. Doctors can remove the uterus, fallopian tubes, and ovaries using one of the following methods: Making an incision in the abdomen (open surgery) Using a thin viewing tube (laparoscope) inserted through a small incision just below the navel, then threading instruments through the laparoscope, sometimes with robotic assistance (laparoscopic surgery) Removing the tissues through the vagina (vaginal surgery) These methods usually take about 1 to 2 hours and require a general anesthetic. Afterward, vaginal bleeding and pain may occur. Recovery may take up to 6 weeks. Forlaparoscopic surgery,thin instruments and a small video camera are inserted through tiny incisions near the navel. The camera sends an image of the abdomen's interior to a monitor. While looking at the monitor, surgeons hold the instruments in their hands and use them to cut and sew tissue. Forrobotic-assisted laparoscopic surgery,laparoscopy is done in the usual way. But robotic arms, rather than surgeons, hold the instruments. Surgeons use hand controls to manipulate the arms of the robot. The camera used provides a 3-dimensional, highly detailed (high-definition) image of the interior that is displayed on a console. Surgeons sit at the console to view this image and use a computer that translates their hand movements into precise movements of the instruments. After laparoscopic or vaginal surgery, hospital stays are shorter than after open surgery (which involves a larger incision). Also, women usually have less pain and fewer complications and can return more quickly to normal activities. For uterine cancer, total hysterectomy is usually done (the entire uterus including the cervix is removed). For uterine cancer, nearby Overview of the Lymphatic System are usually removed at the same time as hysterectomy. These tissues are examined by a pathologist to determine whether the cancer has spread and, if so, how far it has spread. With this information, doctors can determine whether additional treatment (chemotherapy, radiation therapy, or a progestin) is needed after surgery. instead of removing all the lymph nodes. A What Is a Sentinel Lymph Node? is the first lymph node that cancer cells are likely to spread to. There may be more than one sentinel lymph node. These nodes are called sentinel lymph nodes because they are the first to warn that cancer has spread. A sentinel lymph node dissection involves Identifying the sentinel lymph node (called mapping) Removing it Examining it to determine whether cancer cells are present To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance, usually into the cervix. These substances travel to the lymph nodes near the uterus and map the pathway from the uterus to the lymph node (or nodes) nearest the uterus. During surgery, doctors check for lymph nodes that look blue or green or that give off a radioactive signal (detected by a handheld device). Doctors remove this node (or nodes) and send it to a laboratory to be checked for cancer. If the sentinel lymph node or nodes do not contain cancer cells, no other lymph nodes are removed (unless they look abnormal). If the cancer has not spread beyond the uterus, hysterectomy plus removal of the fallopian tubes and ovaries (salpingo-oophorectomy) usually cures the cancer. If cancer has spread to the cervix (stage II) or to nearby tissues, the vagina, or lymph nodes (stage III), radiation therapy, sometimes with chemotherapy, is required. Surgery to remove the uterus, fallopian tubes, and ovaries is usually also done. For very advanced cancer (stage IV), treatment varies but usually involves a combination of surgery, radiation therapy, chemotherapy, and occasionally hormone therapy with a progestin (a synthetic medication similar to the hormoneprogesterone). Radiation therapy may be given after surgery in case some undetected cancer cells remain. If the cancer has spread to the cervix or beyond the uterus, radiation therapy is usually recommended after surgery. In some cases (as when cancer has spread to the cervix, an ovary, or lymph nodes), surgery plus radiation therapy results in a better prognosis. If the cancer has spread to distant organs or recurs, chemotherapy, or sometimes immunotherapy, may be used instead of or sometimes with radiation therapy. These medications reduce the cancer’s size and control its spread in more than half of women treated. For sarcoma of the uterus (a more aggressive form of endometrial cancer), treatment is hysterectomy plus removal of the fallopian tubes and ovaries (salpingo-oophorectomy) and usually chemotherapy. If surgery is not possible, radiation and/or chemotherapy is used. Treatment with hysterectomy, chemotherapy, and/or radiation therapy usually makes it impossible for women to become pregnant or to carry a pregnancy to term. However, if being able to have children is important to them, women should talk to their doctor and get as much information as possible about how treatment affects fertility and whether they are eligible for treatments that do not make future pregnancy impossible. If endometrial cancer is in a very early stage, fertility preservation treatment can sometimes be used. Magnetic resonance imaging (MRI) is done to determine whether the tumor has spread, and a fertility specialist is consulted. Fertility preservation treatments include Use of a progestin (a synthetic medication similar to the hormoneprogesterone) to shrink the tumor instead of a hysterectomy Sometimes hysterectomy without removing the ovaries Progestin can be taken by mouth or be given through an Intrauterine Devices (IUDs) (IUD) that releases a progestin ( When a hysterectomy is done, menstruation stops because the uterus has been removed. However, if the ovaries are not removed and women are premenopausal, a hysterectomy does not cause menopause because the ovaries continue to produce hormones. Also, when the ovaries are not removed, a woman can use her eggs (and advanced fertility treatments, including having someone else carry the pregnancy) to have children. When ovaries are removed, menopausal symptoms such as hot flashes and vaginal dryness may occur. If they become bothersome, hormones such asestrogen, a progestin, or both may relieve them. 