PD MD Heiko B. G. Franz
The plan of uterus cancer treatment is always individual. Since the vast majority of patients are elderly women with serious diseases (high blood pressure, diabetes, obesity), the choice of treatment method depends on overall health rather than disease stage.
Surgical invasion is the basic treatment method of uterus cancer treatment at early stages. The only exception is cases of serious pathologies, when surgical invasion is prohibited. According to statistics, 13% of patients with uterus cancer have contra-indications for operations.
Method of surgery for uterus cancer is defined by the following factors:
Conservative surgeries for uterus cancer are performed less frequently than, for instance, for breast cancer. It’s conditioned by the fact that most patients have this form of cancer after menopause.
Young women with atypical aplasia of endometrium (zero stage according to FIGO classification) can go through ablation of endometrium.
Besides, this manipulation can be prescribed in Stage I 1a of disease (endomentrium tumor that does not go beyond the edges of mucous membrane) and for elderly patients with serious coexisting illnesses that prohibit from performing serious surgical invasion.
Ablation of endometrium is total removal of mucous membrane of the uterus together with its basal germinative layer and adjacent surface of muscle coat (3-4 mm of myometrium) with the help of thermal, electric or laser processing.
Removed mucuous membraine of uterus cannot be restored, so a woman after endometrium ablation has secondary amenorrhea (absence of menstruation), and she becomes infertile.
At early stages of uterus cancer in young women, extirpation operations allow saving ovaries (only the uterus and fallopian tubes are removed). In such case, female reproductive glands are saved to prevent early climax disorders.
Supravaginal uterus removal (e.g. ablation of uterus), or subtotal hysterectomy is removal of gential organ corpus that saves uterine cervix. This operation has a wide range of advantages:
This operation is indicated for young women at early stages of cancer, and when there are no additional risk factors contributing to cancer of uterine cervix.
Uterus extirpation, or total hysterectomy is removal of uterus together with the cervix. As a rule, at Stage I of uterus cancer by FIGO classification (the tumor is located in uterus only), uterus with the cervix and appendages are removed.
At the second stage of disease, when there’s a higher risk of cancer development in lymph nodes, the operation is added with bilateral lymphadenectomy (removal of pelvic lymph nodes) and biopsy of para-aortic lymph nodes (excluding the cases when metastases of lymph nodes are located near aorta).
Classic, or open abdominal hysterectomy means the operation when a surgeon accesses the uterus by cutting lower part of the abdomen. This operation is performed under general anesthesia, and a patient is asleep.
Abdominal access allows performing various surgeries (starting from supracervical uterus amputation and finishing by removal of uterine appendages and lymph nodes).
The main disadvantage of this method is higher injury rate and a big scar on the abdomen.
Vaginal hysterectomy is uterus removal performed via back wall of the vagina. This method is suitable for parous women, and when the tumor is small. This surgery is easier to undergo, but in this case a surgeon has to operate without seeing the inner organs.
But this disadvantage is eliminated when laparoscopic method is applied. In this case, the surgery is performed with the help of special equipment. First, gas is blown into the abdominal area for the surgeon to access the uterus, then laparoscopic instruments and a small camera are advanced through tiny incisions to remove the uterus.
The operation can be viewed on the monitor which makes up for maximal accuracy and safety. Removal of uterus is performed via vagina, or a small cut in the front wall of the abdomen.
Laparoscopic approach allows performing any type of operation. This is the most optimal type of operation that is the easiest to bear. Besides, laparoscopic hysterectomy reduces the risk of complications.
Typically, ray therapy is applied on complex with other methods. This way of treatment can be used prior to operation to shrink the tumor and reduce the risk of metastases and/or after the operation to prevent recurrence.
There may be the following indications for ray therapy:
Besides, ray therapy can be prescribed as a part of complex treatment to cure inoperable stages of diseases, and for patients with severe comorbidities when surgery is contra-indicated.
In such cases, this method of treatment allows restricting tumor growth and decreasing the risk of cancer intoxication, which, in its turn, helps to boost patient’s quality of life.
For uterine cancer, external and internal radiation can be used. External radiation is performed on outpatient basis with the help of a special apparatus that directs a bundle of high-frequency rays on the tumor.
Internal radiation is performed on a stationary basis, and in this case, special granules are inserted into vagina and fixed with the help of an applicator to become the source of radiation.
Sometimes, mixed external and internal radiations are indicated.
Reproducing cells are the most sensitive to radiation, therefore, it destroys intensively multiplying cancer cells first and foremost. To prevent complications, targeted exposure of the tumor is performed.
However, some patients still develop side effects, such as:
If such symptoms appear, a patient should inform her doctor about it. Besides, during the first weeks of radiation therapy, a woman should obtain from sexual intercourse, because genitals are highly sensitive and painful.
Hormonal therapy is performed for hormone-dependent uterus cancer. In this case, the level of differentiation of cancer cells is evaluated with the help of special laboratory tests to define sensitivity of cancerous tumor to changes in endocrine profile.
In this case, antiestrogens (the compounds that somehow suppress activity of female hormones – estrogens), gestogens (analogues of female hormones – antagonists of gestogens), or their combination is used.
As a separate treatment method, hormonal therapy is prescribed for young women at initial stages of highly-differentiated hormonal-sensitive cancer of uterus, and in case of atypical hyperplasia of endometrium.
In such case, hormonal therapy is performed at several stages. The first stage is aimed at curing cancerous pathology that should be approved with endoscopy (atrophy of endometrium).
At the second stage, combined oral contraceptives help to restore normal menstruation. Further on, doctors rehabilitate function of ovaries and restore fertility according to an individual treatment plan.
Besides, hormonal therapy is combined with other methods of uterine cancer treatment in case of hormonal-sensitive uterine cancer.
On the contrary with other conservative uterus cancer treatment options, hormonal therapy is tolerated well by patients.
Hormonal changes can cause dysfunction of central nervous system, including problems sleeping, headache, easy tiredness, poor emotional background. Therefore, such treatment method should be prescribed carefully for the patients prone to depression.
Sometimes, hormonal therapy develops the symptoms in gastrointestinal tract (nausea, vomiting). Besides, there can be metabolic disorders (feeling of afflux, swelling, acne).
Less often, there can be symptoms connected with cardiac-vessel system, including high arterial pressure, fast heartbeat, difficulty breathing.
It should be noted that high blood pressure is not a contra-indication for hormonal therapy, but some drugs (for instance, Oxyprogesteroni caproa) can boost the effect of antihypertensives.
If there are any side effects, a woman should inform her doctor about it. The strategy of treatment of side effects should be individual.
Chemotherapy for uterine cancer is applied solely as a part of complex treatment in case of widespread disease stages.
CAP therapy (cisplatin, adriamycin, cyclophosphamide) is typically used as a supportive therapy.
Chemotherapy presupposes use of drugs that inhibit multiplying cells. Since antitumour drugs have complex action, not only cancerous tumor is affected, but all regularly renewed tissues, as well.
The most dangerous complication after chemotherapy is inhibition of proliferation of blood cell elements in bone marrow. Therefore, this type of cancer treatment is always accompanied by laboratory blood testing.
Antitumor drugs also affect epithelian cells of gastrointestinal tract which manifests into unpleasant symptoms: vomiting and diarrhea, and nausea. It also causes hair loss.
These symptoms are reversible and disappear when a person ceases using the drugs.
Besides, every antitumor drug has its own side effects, about which a patient is informed when treatment course is prescribed.
The efficiency of uterus cancer treatment is evaluated by the risk of recurrence. Most often, a tumor can reoccur during three years after primary treatment (it happens in every fourth patient). Later on, the frequency of recurrence is lower (up to 10%).
Uterus cancer usually reoccurs in vagina (more than 40% of cases), lymph nodes (about 30% of cases). Sometimes tumor can affect distant organs and tissues (28%).
The prognosis for uterus cancer depends on the stage of disease, level of cancer cell differentiation, patient’s age and presence of coexisting illnesses.
Recently, doctors have managed to reach a pretty high 5-year survival rate in patients with uterine cancer. However, it applies to women who sought for medical help at the first and second stage of disease. In this case, survival rate is 86-98% and 70-71% correspondingly.
Survival of patients at later stage of disease is stable (32% for 3rd stage and 5% for the 4th).
Anyway, the prognosis is positive in young patients with highly-differentiated hormonal-dependent tumors. Of course, a severe co-existing pathology makes the prognosis worse.