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August 6, 2009 – Vol. 3 • No. 12
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Although more common in post-menopausal women, up to 25 percent of the cases of uterine cancer occur in women under the age of 50.
Once you’ve been diagnosed with uterine cancer — often referred to as endometrial cancer — what are the next steps? What questions should you ask and what information should you seek before moving forward with your treatment?

The first step is a referral to a gynecologic oncologist, a physician that specializes in treating cancers involving the female reproductive system. Next, your gynecologic oncologist will determine if the cancer has spread to other parts of your body. There are a number of tests that are used at this stage: blood and urine tests, chest x-ray, magnetic resonance imaging (MRI) and CT scans, ultrasound, colonoscopy and sigmoidoscopy.

Staging
The extent of uterine cancer is defined as stages I through IV. Staging allows the doctor to determine if and where the cancer has spread, and helps establish the recommended treatment as well as the prognosis.

Stage I cancer is limited to the body of your uterus and hasn’t spread to the cervix — the lower part of the uterus — lymph nodes or distant sites.

Stage II cancer is found in both the body of your uterus and in your cervix, but still has not spread to lymph nodes or distant sites.

Stage III cancer has spread outside of the uterus and may involve pelvic area lymph nodes. The cancer has not spread to distant sites.

Stage IV cancer is the most serious because it means that the cancer has spread outside of the pelvic region and can affect the bladder, rectum, bones, lungs and other distant parts of your body.

Questions to ask your gynecologic oncologist

It’s a good idea to be well-prepared when you meet with your gynecologic oncologist — he/she is sure to be a wealth of information. Develop a series of questions you might like to ask, including:

• What causes uterine cancer?
• What increased my risk for uterine cancer?
• Does this type of cancer run in families?
• What kinds of tests do I need to determine the stage of the cancer?
• What types of treatments are available?
• What kinds of side effects can I expect from each treatment?
• What do you feel is the best course of action for me?
• Are there any alternatives to surgery? If so, what are they?
• What type of medicines will I need?
• Will the cancer affect my sexuality?
• How will it affect my day-to-day life?
• Can this type of cancer be cured?

Getting a second opinion

Before beginning treatment, you might want to seek a second opinion of your diagnosis, the stage of cancer, and the treatment being recommended. Check with your provider, as some insurance companies may cover, or even require, a second opinion. Don’t worry about a brief delay while you get this second opinion. It will not make the treatment any less effective.

There are a few ways to find a doctor for a second opinion:

• Your primary care physician may be able to refer you to a second specialist for uterine cancer.

• You can contact the Cancer Information Service, a service of the National Cancer Institute, at 1-800-4-CANCER (422-6237).

• You can access The American Board of Medical Specialties (ABMS) Web site at http://www.abms.org for a list of doctors and their specialties.

Treatments

Surgery is the treatment most often recommended for uterine cancer and typically involves a total hysterectomy — removal of the uterus and cervix — as well as removal of the Fallopian tubes and ovaries. Lymph nodes in the area are also taken during surgery, along with other tissue samples to help in staging.

Following surgery, there may be a number of other treatments recommended, particularly if the cancer has spread or is at risk of spreading to other parts of the body.

• Radiation is recommended if your doctor feels you are at a high risk of the cancer recurring. Radiation therapy is the use of high-dose X-rays to kill cancer cells.

• Brachytherapy, or internal radiation therapy, is often applied to the lining of the uterus. The advantage of brachytherapy is that it has fewer side effects than traditional radiation. Its drawback is that it treats only a small area of the body.

• If the cancer has spread to other parts of your body, hormone therapy may be recommended. The hormone progesterone, in its synthetic form called progestin, may stop the cancer from growing.

• Chemotherapy is another alternative and generally offered to women in stage III or IV. Chemotherapy is the use of drugs to kill cancer cells. It can be administered as a pill or intravenously. These drugs enter your bloodstream and then travel through your body, killing cancer cells outside the uterus.

Each of these treatments will have its side effects. Be sure to ask your doctor what you can expect and how to manage the side effects.

Approaches to hysterectomies

There are several approaches used for hysterectomies. Your doctor can help you decide which is best for you, depending on your medical history and the reason for your surgery
.
• Abdominal hysterectomy: Removal of the uterus through an incision in the lower abdomen. This is the most common approach, but requires a longer recovery time.

• Vaginal hysterectomy: Removal of the uterus through the vagina, which results in a shorter hospital stay and faster recovery.

• Laparoscopic hysterectomy: A minimally invasive surgery using a laparoscope that allows internal viewing of the pelvis through small incisions in the abdomen.

• Robotic surgery: A minimally invasive robotic-assisted procedure that decreases post-surgical complications, recovery time and hospital stays. It is often the preferred approach for overweight women.

For more information on the diagnosis and treatment of uterine cancer, please go to http://www.ahealthyme.com/topic/cancercenter.