Endometrial (Uterine) Cancer

Is your treatment what more than 1,100 Oncologists recommend?

The information provided below is meant to help you understand the role of your uterine biology in the cancer treatment decisions, as well as the role of other tools used in determining your ability to receive chemotherapy or targeted therapy (precision medicine).

In 2016, there are 60,050 new cases of endometrial (uterine) cancer diagnoses in the United States (CA Cancer J Clin 2016; 66(1):7-30), this cancer is increasing due to increased life expectancy (older age) and obesity. Uterine cancer is the most common gynecologic malignancy and 75% of women diagnosed with endometrial cancer are postmenopausal. The lifetime average risk for developing endometrial cancer is about 2.6% for a woman.

Risk Factors

• Having excessive estrogen from being obese (6 fold higher)
• Nulliparity (woman who has never borne a child)
• Late menopause
• Older age >55 years old
• Ttamoxifen use (in breast cancer treatment) 3-7 fold higher
• Women with hereditary nonpolyposis colon cancer (Lynch syndrome) have about 20-60% lifetime risk of developing endometrial cancer

Uterine cancer begins in the uterine lining (endometrium) and is classified as either type I or type II.

• Type I composes of 85% of endometrial cancers and has endometrioid histology, the cause for type I is due to excess estrogen exposure
• Type II has papillary serous or clear cell carcinoma histology, the cause is unclear for type II

Treatment

Three different approaches to treating endometrial cancer are available.

• Surgery: A standard approach for endometrial (uterine) cancer is initial surgical staging with total hysterectomy (removal of the uterus), removal of both ovaries and possible surrounding lymph nodes if necessary, biopsy and washing of the pelvic, and examine of the abdominal cavity. Surgical approach with minimally invasive techniques: laparoscopic or robotic surgery is feasible and is an option for you to discuss with your gynecologic surgeon
• Radiation: upon completion your surgery, further treatment with radiation and/or chemotherapy will depend on the risks of recurrence.
• Chemotherapy (cisplatin, etc) with or without targeted therapy (precision medicine)

This website is designed to outline in detail your chemotherapy and/or targeted therapy options and offer you personalized information about the best options to yield optimal survival and quality of life. Treatment plans are based on the surgical stage, grade and the histologic subtypes of the endometrial cancer. You find the information from the pathology report from your treating physician and input into the questionaires for your report.

Multiple factors affect your treatment options including:

1. Cancer is recurring (you have had lung cancer before) or your cancer is a first time diagnosis: The treatment for recurrence is determined by what type of treatment you received for your first diagnosis. Certain chemotherapies can only be given once in your lifetime, so if you have already received one type of chemotherapy with your first cancer, then that chemotherapy will not be recommended for you again.
2. The characteristics of the tumor (grade and histology) will greatly affect treatment decisions
3. Cancer stage at the time of the diagnosis. Endometrial (uterine) cancer stages (it is surgically stage)
   • Stage I: tumor confined to the uterine body with <50% of the myometrium invasion (IA) or >50% of the myometrium invasion (IB)
   • Stage II: tumor invades the cervix but does not extend beyond the uterus
   • Stage III: tumor spreads to vagina and surrounding lymph nodes
   • Stage IV: tumor spreads to the bladder and bowel (IVA) or to other parts of body (IVB)

Even though the standard of treatment is outlined, your individual tolerability to the optimal uterine treatment plan will depend on your overall health, i.e. whether you have other illness (diabetes, heart disease, liver disease, arthritis, or kidney disease). All uterine cancer treatment are recommended based on expertise’s opinions from multiple national guidelines (NCCN, ASCO, ESMO, ASTRO). Another assessment tool that your treating physicians may use to determine your ability to tolerate treatment is called ECOG performance status as described below:

ECOG PERFORMANCE STATUS

Grade 0: Fully active, able to carry on all activity
Grade 1: Restricted in physically strenuous activity but ambulatory and able to carry out light house work, office work
Grade 2: Ambulatory and capable of all self-care but unable to carry out any work activities
Grade 3: Capable of only limited self-care, confined to bed or chair more than 50% of waking hours
Grade 4: Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair

(Am J Clin Oncol 1982: 5: 649-655)

Finally, chemotherapy and targeted therapies can result in unpleasant side effects such as hair loss, numbness of fingers or toes, cardiac toxicity, nausea, vomiting, diarrhea, abnormal liver function or low white blood cell count that could cause infection, and fatigue. However, advances in the oncology field have led to numerous supportive measures, such as white blood cell growth support (i.e. Neulasta) or anti-nausea medications (such as Zofran), that help to control most side effects when used as prescribed.

The best time to use this service (based on more than 1,100 cancer experts) is after you have learned the details of your cancer and treatment plan from your treating physicians, and would like to clarify and confirm that your treatment is the best option for your cancer.  This questionnaire is used mainly for drug treatment in medical oncology.