Treatments for Uterine Cancer

There are different types of treatment for patients with uterine cancer, depending on the type of cancer (endometrial or sarcoma), stage of the cancer, whether you are a candidate for surgery, and your childbearing status. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, physicians at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principal investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for endometrial cancer include surgery, radiation therapy, chemotherapy, hormonal therapy and biologic therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery

Surgery is the primary treatment for endometrial (uterine) cancer.  After surgery, the tumor is carefully studied and the findings are summarized in a pathology report that your doctor will review with you at your post-operative visit.  A genetic screening test called IHC (immunohistochemistry) will be performed on newly diagnosed endometrial cancers as part of the pathology evaluation. The IHC test is used to determine if your endometrial cancer may be due to a hereditary risk for cancer called Lynch Syndrome and if genetic testing is indicated.  Genetic counseling and genetic testing may still be appropriate for women with endometrial cancer and another cancer type such as colon or ovarian cancer.

Total hysterectomy: The surgeon removes the uterus and the cervix. It may be done through the vagina, through an abdominal incision, or laparoscopically through several small incisions. In some cases, a radical hysterectomy is indicated, which would include removal of the uterus, cervix, fallopian tubes and ovaries and nearby lymph nodes. Some patients may be advised to receive radiation therapy or hormone therapy to kill any remaining cancer cells.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. That may include:

• Hormone therapy: This removes hormones or blocks their actions for tumors that have positive receptors for estrogen or progesterone. Drugs, surgery or radiation may be used to prevent hormones from stimulating the growth of cancer cells.
• Biologic therapy: Made in the laboratory from your own cells, this type of therapy, sometimes called immunotherapy, stimulates your immune system to fight the cancer.

Radiation Therapy

Radiation oncology has active trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated. Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.

Patients also can take part in studies with the Radiation Therapy Oncology Group, a group dedicated to radiation therapy trials, and receive new cancer therapies offered through clinical studies initiated by Siteman researchers and physicians.

MR-guided adaptive radiation therapy:  Siteman is the only center in the world performing MR-guided adaptive radiation therapy.  By using an MRI to guide the radiation therapy; Siteman radiation oncologists can adjust, or adapt, the radiation to the patient every day.

Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation directly to the tumors. The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps prevent damage to normal tissue. This type of radiation therapy is being studied in clinical trials.

Brachytherapy: This type of localized radiation allows a high-dose concentration of radiation immediately surrounding the radioactive source, with rapid fall-off of radiation exposer to adjacent tissues. In gynecologic cancers, the radiation source can be put inside an existing body cavity (intracavitary) or directly into tissue (interstitial). For endometrial cancer, intracavitary sources of radiation are used. Siteman Cancer Center has the largest Brachytherapy Center in the United States and sees more than 1,200 patients for gynecologic cancer as well as thousands more for other types of cancer.

Radiation oncologists here are the only ones in the country to offer Image-Guided Adaptive Brachytherapy (IGABT) and have set the protocols and standards of care for this highly specialized and target-specific treatment that allows for adapting both the dose and parameters of radiation beams. The team also is the only one in the region specializing in combined brachytherapy and Intensity-Modulated Radiation Therapy (IMRT).

Targeted Therapy

Targeted therapy uses drugs to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapy being studied in the treatment of endometrial cancer.

Targeted treatments are enhanced by the Washington University Genomics and Pathology Service (GPS), which offers genomic testing and next generation sequencing that can identify optimal treatment strategies for your specific cancer type and subtype.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.

Treatment for Uterine Sarcoma

Treatments for uterine sarcoma are basically the same, with an abdominal hysterectomy that removes the uterus, cervix, fallopian tubes, ovaries and regional lymph nodes standard, followed by radiation, chemotherapy and hormonal therapy as indicated. Siteman has a world renowned sarcoma expert and many sarcoma clinical trials available to patients.