For most women the treatment of endometrial begins with surgery and consists of hysterectomy often in combination with oophorectomy (removal of the ovaries) and lymphadenectomy (removal of the lymph nodes). At the completion of surgery, the uterus and other tissues that were removed are analyzed to determine if the endometrial cancer has spread outside of the uterus. Based on the extent of cancer a stage is assigned to the cancer and based on the stage the decision on whether or not further treatment is required is made.
For many women with early-stage endometrial cancer no further treatment is required. For women in whom the cancer has spread beyond the uterus, most frequently to the lymph nodes or the abdominal cavity, additional treatment in the form of chemotherapy often in combination with radiation are recommended. Even for women in whom the cancer is confined to the uterus sometimes additional treatment, either radiation or chemotherapy, is recommended. The decision to recommend additional treatment is based on a number of factors that increase the risk that the cancer will recur (come back). These factors include:
- Grade (how the cancer appears under the microscopic)
- Depth of invasion into the wall of the uterus
- Involvement of the cervix
- Spread to the lymphatic and vascular channels within the uterus
- Spread to the ovary or fallopian tube
- Occurrence of microscopic cancer cells outside of the uterus
For those women who require radiation there are two methods to deliver radiation. Most commonly brachytherapy, or intracavitary radiation, is utilized. Brachytherapy is a form of radiation in which the radiation is delivered to the top of the vagina in the location the uterus was prior to removal. Brachytherapy is administered by placing a small cylinder into the vagina and delivering a short treatment of radiation to the vagina. Women who receive brachytherapy are treated as outpatients and go home the same day after the treatment. The treatment typically lasts only a few minutes. Usually multiple treatments (most commonly three) are given usually once a week.
The second form of radiation is known as external beam radiation. External beam or whole pelvic radiation allows for the delivery of a larger dose of radiation to the entire pelvis including the location of where the uterus was as well as the region where the lymph nodes are located. In essence external beam radiation treats the entire area where uterine cancer cells most commonly are located. External beam radiation is delivered as daily treatments typically over the course of several weeks. Sometimes external beam radiation and brachytherapy are both administered. Similarly, chemotherapy may be given with either brachytherapy or external beam radiation.