• Endometrial Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Treat Endometrial Cancer

    Endometrial cancer is the most common gynecologic disease diagnosed in women in the United States. The gynecologic team at the Gynecologic Cancer Treatment Center at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) knows that you and your health are anything but common. We create a unique treatment plan for every patient, and consider all aspects of your health history and your future when making our recommendations.

    You can feel confident in the treatment at DF/BWCC, as our specialists focus exclusively on gynecologic cancers. If you need surgery, you will see a surgeon who specializes in gynecologic cancer surgery. If your treatment includes chemotherapy, you will work with a medical oncologist who treats only gynecologic cancer patients. If you require radiation therapy, you will work with a radiation oncologist who specializes in gynecologic cancers.

    For referring physicians

    Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating with you in the care of your patient.

    If you are a referring physician and have a patient with endometrial cancer, we look forward to working with you.

    Find out more about how to refer a patient to DF/BWCC.

    Personalized, multidisciplinary approach

    Our multidisciplinary team includes experienced surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, and social workers who treat, counsel, and care for each patient with dedication and compassion.

    Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care. Each patient has access to a social worker for extra support and guidance if needed. Your medical team will meet regularly to review your health and treatment options and ensure you receive the best care available.

    Endometrial cancer treatment by stage

    The treatment of endometrial cancer depends on the stage of the disease at the time of diagnosis. Surgery is generally performed for all stages of the disease, and the majority of patients undergo surgery to remove the uterus and cervix upfront (so long as the patient is in good health). In early stages, minimally-invasive surgery may be the only treatment required. In later stages with more extensive cancer, more involved and extensive surgeries to remove disease outside the uterus and cervix may be required, in combination with chemotherapy and radiation therapy.

    • If you are diagnosed with stage I endometrial cancer, surgery to remove the cancerous tumor may be the only treatment necessary. During surgery, your uterus and cervix, and possibly both ovaries and fallopian tubes, may be removed. For women with this stage, the cure rate after surgery is usually better than 90 percent. A biopsy of your lymph nodes may also be performed to check for cancer cells. Other therapies may be suggested in addition to surgery, such as radiation therapy or chemotherapy; certain types of uterine cancer pathologies, such as clear cell and serous, even if diagnosed at an early stage, may require other treatment after surgery. Your doctor will carefully monitor your health for new growths (called watchful waiting).
    • If you are diagnosed with stage II endometrial cancer, surgery to remove your uterus and cervix, and possibly both ovaries and fallopian tubes, is the first step. Depending on your case, radiation therapy could follow your surgery to eliminate any remaining cancer cells. Chemotherapy is rarely necessary if certain pathologies such as clear cell and serous are diagnosed.
    • If you are diagnosed with stage III endometrial cancer, you will likely receive a combination of surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes, followed by radiation and, if necessary, chemotherapy.
    • If you are diagnosed with stage IV endometrial cancer, surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes is not always required. Instead, combinations of chemotherapy, hormonal therapies, and clinical trials (and sometimes radiation therapy) will be discussed. We highly encourage late-stage endometrial patients to pursue targeted or biologic therapies which may be offered through clinical trials.

    Surgery

    Our surgical team is recognized internationally as one of the best for the treatment of gynecologic cancers, and consistently ranks as one of the top in the country for surgical care. We perform over 1,500 gynecologic surgeries each year, so our patients can be reassured they will receive the highest level of surgical care from one of the most experienced teams available.

    Surgery is performed to determine the stage of cancer, and this may be adequate treatment if you have early-stage endometrial cancer. Surgery generally includes:

    • Removal of the uterus and the cervix (hysterectomy)
    • Removal of one or both of the ovaries and fallopian tubes (unilateral or bilateral salpingo-oophorectomy)
    • Taking a small sample of your pelvic lymph nodes or tissue (biopsy) to examine for cancerous cells under a microscope

    Gynecological oncologists at Dana-Farber/Brigham and Women's Cancer Center use the most advanced technology available to perform surgery with exacting precision. Our skilled surgeons regularly perform leading-edge, minimally-invasive surgeries, such as:

    • Laparoscopy: A procedure performed through small incisions in the abdomen, rendering more extensive surgeries unnecessary
    • Robot-assisted hysterectomy: The benefits of robot-assisted radical hysterectomy are multiple; the procedure provides a safer, less invasive approach to the open (traditional) hysterectomy procedure and offers patients better outcomes, shorter hospital stays, faster recoveries, and enhanced safety. This procedure, which Dana-Farber/Brigham and Women's Cancer Center was the first New England hospital to offer, allows our experts to carefully perform complex robotic surgeries in place of more invasive procedures.

    Endometrial cancer in younger women

    Removing your uterus will affect your fertility and ability to have children in the future. Most endometrial patients are diagnosed later in life, and are less concerned with fertility preservation. However, if you are a young woman with an advanced stage of endometrial cancer requiring surgery and would still like to have children, we will carefully review your treatment and surgery options before and after treatment. We will work with you to customize the best surgical approach that strives to maintain good pregnancy outcomes later on. DF/BWCC has dedicated reproductive and fertility specialists who can discuss all fertility concerns before and after treatment, as well as options to consider, such as embryo (egg) freezing or harvesting.

    Surgery takes place in the operating suites at Brigham and Women's Hospital, whose gynecologic cancer program is widely recognized as one of the best in the country. Post-surgical care and other inpatient care are provided by the DF/BWCC team at Brigham and Women's Hospital.

    hysterectomyHysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision. 

    After surgery, your surgical samples are carefully examined by pathology experts in the Women's and Perinatal Pathology Division. Their evaluation will be shared with all members of your treatment team in a weekly meeting where further treatment (if necessary) and management of your tumor will be decided.

    Read our post-operative guidelines for gynecologic surgery.

    Find out more about your hospital stay at Brigham and Women's Hospital.

    Chemotherapy

    Medical oncologists are medical doctors who study and treat cancers. Sometimes treatment involves chemotherapy (drugs that eliminate cancer cells or stop them from dividing) or hormonal therapy, and sometimes treatment will involve clinical trials. Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient centers in the country — designed by patients, for patients.

    Chemotherapy for endometrial cancer is generally reserved for stages III and IV (as needed) unless certain pathologies of uterine cancer are diagnosed, including uterine carcinosarcomas, clear cell cancers or serous cancers. Chemotherapy drugs are usually administered after surgery to eliminate remaining cancer cells or keep them from returning. On occasion, chemotherapy drugs will be given as supplemental treatment to radiation therapy (called "radiation sensitizing" chemotherapy) that can help make the radiation work better.

    Throughout your treatment, your medical oncologist will work closely with your team of nurses, nutritionists, and social workers to minimize the toxicities and side effects of chemotherapy, maintain your quality of life, and optimize your results. We encourage you to be actively involved in the decision-making process when it comes to choices about chemotherapy treatment.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to eliminate cancer cells or stop cancer growth. Radiation therapy for endometrial cancer is given by our experienced team of radiation oncologists. They are pioneers in the field, regularly setting standards for treatment and safety nationwide. Our experts administer radiation in a dedicated-radiation suite built specifically for gynecologic patients. This suite features state-of-the-art equipment and the latest imaging techniques to treat your endometrial cancer.

    Radiation therapy may be delivered at any stage of endometrial cancer to eliminate any remaining cancer cells in the body or lymph nodes after surgery. Occasionally, radiation therapy is given in early stages or in complex cases where the cancer is spreading throughout the body. Recurrent cases of endometrial cancer (cancer that has returned after initial treatment) are treated with radiation as a palliative therapy to relieve symptoms and improve quality of life.

    Akila Viswanathan, MD, MPHAkila Viswanathan, MD, MPH, radiation oncologist and image-guided brachytherapy expert 

    Radiation treatment for endometrial cancer could include the following:

    • In brachytherapy or cylinder brachytherapy, radioactive material is directly implanted in or near the tumor or vagina via a tiny needle, wire, or other device. Our radiation oncologists at DF/BWCC are among a limited few in the nation to deliver this type of radiation with image-guided techniques.
    • DF/BWCC is one of the few treatment centers in the U.S. to offer image-guided brachytherapy using real-time, 3D imaging as an alternative to surgery or non-image-guided radiation for some patients with endometrial cancers. This technique offers many benefits, including preservation of healthy tissue, prevention of unnecessary hysterectomies, and better eradication outcomes. Given our advanced radiation technologies, patients with recurring endometrial cancer or cancer deemed incurable can now be treated with radiation — and with more success.
    • 3D imaging radiation therapy called intensity-modulated radiation therapy (IMRT) uses computer images to find and target the cancerous tumor. Radiation is externally delivered and aimed at the tumor, firing thin radiation beams from different angles. This reduces the damage to the surrounding healthy tissue.
    • Our physicians developed an innovative approach for providing radiation therapy called fractionation, a series of lower-dose radiation primarily given to endometrial patients who have had their uterus removed. This process results in better outcomes, less scar tissue, and a lower risk of vaginal toxicity.
    • Radiation oncologists at DF/BWCC are currently pioneering therapies using gel spacers with great success. Radiation therapy is delivered to a targeted location in the cervix while using a gel spacer, a small, removable sponge-like material injected with gel, strategically placed inside the body to block radiation from nearby healthy tissue or surrounding organs.

    Revolutionary imaging therapies

    For cases of endometrial cancer that require complex imaging treatment, you will be cared for in an innovative operating and research environment developed specifically at Brigham and Women's Hospital (BWH) in 2011. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists uses the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI, and OR technologies in one operating room. BWH is one of the few hospitals in the United States to operate an AMIGO suite.

    Hormone therapy

    Hormone therapy is a treatment that blocks the action of naturally occurring hormones in order to stop cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Sometimes hormones can cause certain cancers to grow. If tests show that the cancer cells have hormone receptors, drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

    Because endometrial cancer can thrive off the female hormones estrogen and progesterone, our doctors may occasionally suggest progesterone hormone therapy or estrogen blocking therapy to treat your cancer. (In the case of endometrial cancer, progesterone can have an "anti-growth" effect on cancer cells.) This treatment is less common, but may be suggested for early stages of endometrial cancer. Hormone therapy, however, may also be an option for patients who may not be candidates for standard surgical procedures.

    Clinical trials

    DF/BWCC offers one of the largest and most active clinical trial programs available, including clinical trials for women with endometrial cancer. The clinical trials conducted at Dana-Farber have had a profound impact on the type of care administered worldwide.

    Clinical trials for endometrial cancer may be available at any stage of the disease. However, for some women with advanced stages of endometrial cancer, taking part in a clinical trial is the best treatment option. The genetics of endometrial cancer are better understood than other gynecologic cancers, so there are a number of clinical trials testing therapies that target specific genetic pathways (the paths that lead to cancer on a cellular level). If you qualify for a clinical trial, your doctor will carefully discuss all options and the best time to begin a trial (before, during, or after cancer treatment).

    Clinical trials are part of the cancer research process; they are regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials lead to new discoveries and improve cancer care, but some may have significant anti-cancer benefits.

    Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). Trials also include targeted therapy or therapies using drugs to identify and attack the specific endometrial cancer cells.

    Find out more about clinical trials at DF/BWCC. Detailed information about clinical trials is available from the NCI Web site. For all nationally run clinical trials, please visit ClinicalTrials.gov.

    Questions to ask your doctor about clinical trials

    If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.

    Next: Our Endometrial Cancer Specialists 

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