Uterine Cancer In Treatment

Treatments For Uterine Cancer

Uterine cancer, including endometrial cancer and uterine sarcoma, can be treated in several different ways, including surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy, and immunotherapy. Depending on your individual situation, your treatment team may recommend a combination of therapies to treat your cancer.

Uterine sarcoma usually spreads more quickly and is harder to treat than endometrial cancer. Uterine sarcomas, particularly uterine leiomyosarcomas, differ from endometrial cancer in that they are often found after a hysterectomy performed for other reasons.

Surgery

Surgery is the most common treatment for uterine cancer. Usually, it involves removal of the uterus (hysterectomy) and sometimes evaluation of the lymph nodes (lymphadenectomy).

Hysterectomy is performed in most women with uterine cancer and can be done through a single large abdominal incision (open procedure) or several small incisions (minimally invasive approach). Minimally invasive hysterectomy is often called laparoscopic hysterectomy and referred to as robotic-assisted hysterectomy when it is performed with the help of robotic technology. For further explanation of each type, you can watch our video presentation here. Although the fallopian tubes and ovaries are usually removed as well, ovaries may be spared in younger women.
Lymph node dissection (or lymphadenectomy)is a surgical procedure to remove lymph nodes in the pelvic area to check the tissue for signs of cancer spread. Sometimes, the surgeon removes only the lymph node(s) most likely to be affected by cancer, a procedure known as sentinel lymph node biopsy. Sentinel lymph node mapping is an imaging technique that helps target nodes for removal.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays and other types of radiation to kill cancer cells or keep them from growing. Radiation therapy is often given after surgery, with or without chemotherapy, to decrease the risk that the cancer comes back (recurs). There are two types of radiation therapy and sometimes they are used together:

External beam radiation therapy uses a machine outside the body to send radiation toward the cancer. The treatment is usually given every day for about six weeks. You can be treated at a clinic, hospital, or radiation oncology office.
Internal radiation therapy involves placing a small cylinder of radioactive material inside the vagina for a few minutes. This procedure can be performed on an inpatient or outpatient basis, depending on the recommendation of your treatment team. This type of radiation is referred to as brachytherapy.

Chemotherapy

Chemotherapy (chemo) is the use of drugs that kill cancer cells. Some are given into a vein while others are taken by mouth as pills. These drugs are systemic, meaning they go into the bloodstream and reach throughout the body. . Chemotherapy is sometimes used as initial treatment but more commonly given after surgery, with or without radiation.

In most cases, a combination of chemo drugs is used. Combination chemotherapy tends to work better than one drug alone. Chemo is often given in cycles: a period of treatment, followed by a rest period. The drugs may be given on one or more days in each cycle. These may include:

Paclitaxel (Taxol®)
Carboplatin (Paraplatin®)
Doxorubicin (Adriamycin®) or liposomal doxorubicin (Doxil®)
Cisplatin (Platinol®)
Docetaxel (Taxotere®)
ifosfamide (Ifex®)

Hormone Therapy

Hormone therapy involves taking medications to block the growth of uterine cancer. Hormone therapy may be an option if you have advanced endometrial cancer or a certain type of uterine sarcoma that has spread beyond the uterus. Hormone therapy is also sometimes used in selected young women who have not completed childbearing. Like chemotherapy, hormone therapy is a systemic treatment. The types of hormone therapies used most often for uterine cancer include:

Progestins: Man-made versions of the hormone progesterone. Progestins help slow down the growth of endometrial cancer cells. The most common are medroxyprogesterone acetate (Provera®) and megestrol acetate (Megace®).
Tamoxifen: Prevents estrogen in your body from stimulating the growth of the cancer cells and is usually used to treat advanced or recurrent endometrial cancer.
Aromatase inhibitors: Drugs that can stop estrogen from being made by fatty tissue in the body. They work to lower the overall amount of estrogen in the body. Examples include, letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®).
GnRH (gonadotropin-releasing hormone) Agonists: Work by lowering estrogen in women who still have their ovaries. Examples are goserelin (Zoladex®) and leuprolide (Lupron®). These drugs may be helpful in preserving fertility in pre-menopausal women.

Targeted Therapy

Targeted drug treatments focus on specific weaknesses or mutations present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die while leaving most healthy cells alone. Targeted drug therapy may be combined with chemotherapy and can be used for treating advanced and recurrent endometrial cancers. Like some chemotherapy, targeted therapies are given by infusion.

Targeted therapies for endometrial cancer include bevacizumab (Avastin®) and trastuzumab (Herceptin®). Entrectinib (Rozlytrek®) and larotrectinib (Vitrakvi®) are targeted therapies that may be used for endometrial cancers and uterine sarcomas with a certain marker (NTRK fusion) when other treatments have failed.

Other drugs known as mTOR inhibitors, which include Everolimus (Afinitor®) and Temsirolimus (Torisel®), can help treat advanced or recurrent cancers.

There are many new treatments on the horizon including Antibody Drug Conjugates (ADCs) and PARP Inhibitors.

Immunotherapy

Immunotherapy helps your own immune system fight against cancer cells. Some cancer cells produce proteins that signal to immune cells at certain checkpoints, telling them that they are normal cells to avoid attack. Immunotherapy interferes with this mechanism, allowing the immune system to recognize and kill cancer cells. Immunotherapy may be considered for endometrial cancer if the cancer is advanced and other treatments have not helped.

The main immunotherapy drug used for endometrial cancer is pembrolizumab (Keytruda®). Pembrolizumab can be used for cancers that come back after treatment with chemotherapy or if your tumor tested positive for MMR deficiency (dMMR) or is high MSI (MSI-H).

Pembrolizumab can be used with lenvatinib (Lenvima®) targeted the