Endometrial cancer is the most common of tumors that originate in the uterus mainly affecting women between the ages of 50 and 70 after menopause. These tumors are adenocarcinomas in 80% of cases with sarcomas accounting for only 5% of all malignant uterine tumors.
Endometrial cancer is usually diagnosed at an early stage because it causes uterine bleeding with abnormal frequency (from one menstrual cycle to another) or after menopause.
The causes of endometrial cancer are not fully known. Blood levels of estrogen (female hormones produced by the ovaries) can play an important role in its development. Endometrial cancer is more common in women in fact, when there is estrogen dominance. Examples are: women who are undergoing estrogen replacement therapy, suffering from obesity, have polycystic ovary syndrome, have never been pregnant, and experience menopause late or early the onset of menstrual cycle.
Other risk factors include: age, diabetes and Lynch syndrome; a disease that is predisposed to cancer of the uterus, ovary, and colon and stomach.
There is no real strategy for the prevention of cervical cancer. Weight control and eating a diet low in fat (animal) is recommended.
A comprehensive study of each case is necessary in order to administer an individualized treatment of endometrial cancer. The study includes the following:
- Patient’s medical history.
- Gynecological examination.
- Transvaginal Ultrasound: it is a well-tolerated, noninvasive technique. The specialist inserts a small probe into the vagina using ultrasounds in order to evaluate the uterus such as the epithelium lining of the uterine cavity (endometrium). A more complete study will be done if the lining has increased in size.
- Hysteroscopy: it is an endoscopic examination and is done as an outpatient procedure at iTAcC. It is performed with miniaturized instruments with no need for general anesthesia. The specialist can see directly inside the uterine cavity and take endometrial tissue samples in order to perform a biopsy. The pathology team will confirm the presence of a tumor or not.
- MRI of the pelvis is a noninvasive and does not use ionizing radiation. It is the most important tool for the anatomical study of the pelvis for evaluating the spread degree of the disease.
- CT (computed tomography) is an imaging technique that uses ionizing radiation. It is used to rule out the extension of the disease to other distant organs (i.e. liver, lungs) as well as to evaluate the disease spread locally or determine lymph node involvement.
- PET (Positron Emission Tomography) evaluates the activity of cellular lesions which aids in the diagnosis of metastatic disease and helps decide whether lesions seen in other imaging tests are malignant or benign.
Surgery, radiotherapy, chemotherapy and hormone therapy, either alone or in combination can be used within the context of a multidisciplinary treatment for uterine tumors. The clinical characteristics of the patient and the symptomology in addition to the biological features of the uterine tumor must be taken into account.
At iTAcC a multidisciplinary team of gynecologists, general surgeons, urologists, radiologists, pathologists, geneticists, medical oncologists, radiation oncologists, work together to diagnose and treat carcinoma of the uterus in a personalized way. The team may include medical professionals trusted by the patient in order to reach an overall treatment decision.
Surgery is the mainstay of treatment of uterine cancer. The hysterectomy is the removal of the uterus along with the surrounding tissue (parametrium) and the upper part of the vagina as well. A radical hysterectomy is often accompanied by a pelvic lymphadenectomy; in this case the fatty tissue surrounding the blood vessels of the pelvis which contains lymph nodes is removed. It is necessary on occasion to remove the fallopian tubes and ovaries as well during surgery. This is based on risk factors, age or the spread of the disease. This surgery is done normally through the vagina or by an abdominal incision (laparotomy). Today the laparoscopic approach is internationally accepted and means a shorter recovery time.
At iTAcC surgery can be performed with minimally invasive techniques. This procedure is important to the group of women with a certain degree of obesity as it helps to reduce the risk of surgery.
Minimally invasive surgery. The standard treatment is surgical removal of the uterus, fallopian tubes, ovaries, and nearby lymph nodes. It will be done with a minimally invasive approach (laparoscopy) whenever possible.
Intraoperative analysis consists of a macroscopic and/or microscopic examination of tissue during surgery. This allows the surgeon during surgery to determine if the tumor is malignant and its exact extent. This increases the ability to perform the most appropriate surgical procedure.
Radiation therapy may sometimes be used after surgery when the uterine tumor shows aggressive histological features or a high risk of recurrence exists. The specialist may recommend radiation therapy instead of surgery in certain cases where surgery is contraindicated .
When an indication exists for external radiotherapy at iTAcC, techniques with intensity-modulated radiotherapy (IMRT) are recommended in order to reduce damage to nearby healthy tissue and as well as the use of image guided radiotherapy techniques (IGRT) for decreasing the amount of irradiated healthy tissue.
A local treatment using brachytherapy is done in certain cases in order to reduce the likelihood of disease recurrence in the vaginal fundus. ITAcC specialists were trained in this technique by European and American institutions and have extensive experience which allows them to decide when this technique should be performed.
Postoperative chemotherapy may improve the prognosis of patients with endometrial tumors in advanced stages or when there is a high risk of distant disease recurrence. This occurs in poorly differentiated tumors (G3) or in the infiltration of blood vessels or lymphatic vessels as well as in patients with distant metastatic disease.
Hormone therapy can be used in cases of advanced disease or in those in which chemotherapy is contraindicated.
iTAcC has the means to monitor and control the progress of patients who have had a carcinoma of the uterus in order to rule out the possibility of disease recurrence.
Follow up is done as in the case of all oncological activity at iTAcC, in a personalised manner in cooperation of the doctors who have been involved in the diagnosis and treatment of each case. iTAcC is an open institution and works closely them.