Endometrial Cancer

Most endometrial cancers treated with minimally invasive procedures

Endometrial Cancer | Johns Hopkins Medicine

Of 3,730 women with endometrial cancer in the Society of Gynecologic Oncology Clinical Outcomes Registry (SGO-COR), 88.8% underwent minimally invasive procedures, reported Amanda Nickles Fader, MD, of Johns Hopkins Hospital, Baltimore, and colleagues.

“When you have surgery with a gyn-oncologist who is specially trained in this type of surgery, we see that women have a very high lihood of having the appropriate surgery, the minimally invasive surgery, and we thought that this benchmark of an 80% rate of minimally invasive surgery in these patients is very feasible and should be recognized as the standard of care,” Dr. Nickles Fader said in an interview.

Coinvestigator Summer B. Dewdney, MD, of Rush University Medical Center, Chicago, who was instrumental in creating and running the SGO-COR registry, said these findings are encouraging.

“We’re happy to see that rate. It’s the rate that it should be because minimally invasive surgery is the standard of care for endometrial cancer,” Dr. Dewdney said.

She added, however, that data supplied to the registry come from gynecologic oncologists who are highly motivated to participate and follow best practice guidelines, which could skew the results slightly toward more favorable outcomes.

Results of the registry-based study are detailed in an abstract that was slated for presentation at the Society of Gynecologic Oncology’s Annual Meeting on Women’s Cancer. The meeting was canceled because of the COVID-19 pandemic.

Assessing adherence to guidelines

In 2015, the SGO Clinical Practice Committee and the American College of Obstetricians and Gynecologists issued a practice bulletin, which stated that “minimally invasive surgery should be embraced as the standard surgical approach for comprehensive surgical staging in women with endometrial cancer.”

Similarly, National Comprehensive Cancer Network guidelines for uterine cancer state that “minimally invasive surgery is the preferred approach when technically feasible” for treatment of endometrial cancer confined to the uterus.

Despite these recommendations, the overall rate of minimally invasive endometrial cancer surgery in the United States is reported be around to 60%, Dr. Nickles Fader and colleagues wrote.

With this in mind, the investigators set out to determine the rate of minimally invasive surgery in women with apparent stage I, II, or III endometrial cancer who underwent hysterectomy with or without staging from 2012 to 2017 at a center reporting to SGO-COR.

The team identified 3,730 women treated at 25 SGO-COR centers; 12 of which were university-affiliated centers and 13 of which were nonuniversity based. Most patients (83.2%) had stage I disease, 4.

7% had stage II cancer, and 12.1% had stage III disease. The median patient age was 57 years. Most patients (88%) were white, and two-thirds (67.1%) were obese. In all, 80.4% of samples had endometrioid histology, and 77.

7% were either grade 1 or 2.

Factors associated with minimally invasive surgery

The data showed that 88.8% of patients underwent a minimally invasive hysterectomy, composed of robotic-assisted procedures in 73.9% of cases, laparoscopy in 13.4%, and vaginal access in 1.6%.

The proportion of patients who underwent a minimally invasive procedure was significantly higher at nonuniversity centers, compared with academic centers (92.6% vs. 82.7%; P

Source: https://www.mdedge.com/hematology-oncology/article/220749/gynecologic-cancer/most-endometrial-cancers-treated-minimally

New Drug Combo Improves Survival of Women with Rare Uterine Cancer

Endometrial Cancer | Johns Hopkins Medicine

The results of the trial, published online ahead of print on March 27 in the Journal of Clinical Oncology, show that the drug extended the length of time to tumor progression by four to eight months in the seven-year trial. The researchers say this may lead to new national guidelines for treating this cancer subtype, known as uterine serous carcinoma.

Uterine serous carcinoma makes up less than 10 percent of all cancers of the endometrium, or lining of the womb, diagnosed in the United States each year, but it accounts for more than a third of the 10,000 endometrial cancer deaths annually.

The aggressive carcinomas often don’t cause symptoms until they’ve begun to spread throughout the body.

As a result, the average time that standard chemotherapy and surgical treatments can keep the tumor from growing or spreading—known as progression-free survival—is only about eight months.

“The fact that these tumors grow rapidly, but also have a propensity to spread to lymph nodes and other organs very early, is a double whammy for women,” says Amanda Fader, M.D., associate professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine, and first author of the new study.

Fader and her colleagues knew that about 30 percent of all uterine serous carcinomas test positive for HER2/neu, a receptor protein that is also overexpressed in about 10 percent of all breast cancers. Trastuzumab binds to and blocks HER2/neu, keeping it from driving tumor growth, and has been shown to be effective in so-called HER2 positive breast cancers.

From August 2011 through March 2017, Fader, Alessandro Santin, M.D., professor of gynecology and obstetrics at Yale University, and collaborators at 11 other cancer treatment centers in the U.S.

randomly assigned 61 women with uterine serous carcinoma, being seen at the participating institutions, to receive either the standard chemotherapeutic regimen—a combination of the drugs carboplatin and paclitaxel—or those drugs plus trastuzumab.

Some 41 of the patients had stage 3 or 4 uterine serous carcinoma—known as advanced disease—and 17 had recurrent uterine serous carcinoma. All tested positive for the HER2/neu receptor.

Among all patients, the 28 controls receiving only the standard carboplatin and paclitaxel combination had an average progression-free survival time of eight months, and the 30 who received trastuzumab in addition had an average progression-free survival time of 12.6 months. However, the difference was even more profound in the 41 patients with advanced disease, whose progression-free survival time went from an average of 9.3 months to 17.9 months with the addition of trastuzumab.

“Even an improvement of a few months may be quite meaningful for women with these cancers,” says Fader, who is also affiliated with the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Among patients with recurrent disease, progression-free survival time increased from an average of six months to 9.2 months. The difference, Fader says, may be that these patients have been heavily treated in the past, are more ly to have overall poorer health and are more ly to have mutated or heterogeneous tumors, or tumors with different levels of HER2 expression.

Follow-up studies of the women who remain alive—who now number 35—continue, the researchers say, to track the impact of trastuzumab on overall survival time even after tumor progression. But the results of the trial, they add, were strong enough to warrant submission to the National Comprehensive Cancer Network, which guides the design of standard treatment plans around the country.

Fader cautions that a larger study of the drug combination, or other combinations, is needed to confirm the findings and potentially extend survival even more.

She notes that using trastuzumab to selectively treat uterine serous carcinoma that express HER2/neu is part of a broader trend at Johns Hopkins and other cancer centers to use the tools of tailored therapy, or precision medicine, the molecular and genetic makeup of tumors and patients.

Other authors of the paper are Dana M.

Roque of the University of Maryland; Paul Celano of Greater Baltimore Medical Center; William Lowery of Walter Reed Medical Center; Eric Siegel of the University of Arkansas for Medical Sciences; Natalia Buza, Pei Hui, Osama Abdelghany, Stefania Bellone, Masoud Azodi, Babak Litkouhi, Elena Ratner, Dan-Arin Silasi, Peter E. Schwartz and Alessandro D. Santin of the Yale University School of Medicine; Setsuko K. Chambers of the University of Arizona; Angeles Alvarez Secord and Laura Havrilesky of Duke University School of Medicine; David M. O’Malley and Floor Backes of The Ohio State University School of Medicine; Nicole Nevadunsky of Montefiore Medical Center; Babak Edraki of John Muir Medical Center; Dirk Pikaart of the Penrose Cancer Center–St Francis; and Karim S. ElSahwi of Meridian Health.

The study trial was funded by Genentech-Roche. The drug used in this research was also provided by Genentech-Roche, which makes one brand of trastuzumab.

COI: Amanda Fader has reported a consulting or advisory role for Merck, which also makes HERher2- blocking drugs. Fader no longer holds that role.

Source: https://www.hopkinsmedicine.org/news/newsroom/news-releases/new-drug-combo-improves-survival-of-women-with-rare-uterine-cancer

Endometrial Cancer

Endometrial Cancer | Johns Hopkins Medicine

Linkedin Pinterest Gynecological Conditions Diagnosis and Screening for Gynecologic Conditions

Endometrial cancer is the most commonly diagnosed gynecologic cancer. About 50,000 American women are diagnosed with the disease every year. Endometrial cancer is also the most common form of uterine cancer, so it is frequently referred to as uterine cancer.

What You Need to Know

  • Endometrial cancer starts in the lining of the uterus — the endometrium.
  • Being overweight or obese greatly increases a woman’s chance of developing endometrial cancer. Other risk factors include age, family history, a diagnosis of polycystic ovary syndrome and prior use of the breast cancer treatment drug tamoxifen.
  • Symptoms include abnormal vaginal bleeding, pain during intercourse, difficult or painful urination, and pain in the pelvic area.
  • Endometrial cancer is highly treatable when found early.

The lining of the uterus is called the endometrium. Cancer of the endometrium is the most common cancer of the female reproductive organs.

Cancer of the endometrium is different from cancer of the connective tissue or muscle of the uterus, which is called uterine sarcoma. About 80 percent of all endometrial cancers are adenocarcinomas. This means the cancer occurs in the cells that develop the glands in the endometrium. Endometrial cancer is highly curable when found early.

Uterine carcinosarcoma is a very rare type of uterine cancer, with characteristics of both endometrial cancer and uterine sarcoma. It is also known as a malignant mixed mesodermal tumor.

Types of Endometrial Cancer

Endometrial cancers are usually grouped into one of four categories:

  • p53 mutation
  • POLE mutation
  • Copy number high
  • Copy number low

Clinical trials are being used to assess treatments for cancers found within each of these groups, including novel immunotherapy trials.

Endometrial Cancer Prevention

The exact cause of endometrial cancer is not known. However, doctors believe that avoiding the known risk factors when possible, using oral contraceptives or other forms of hormonal birth control, controlling obesity and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

Endometrial Cancer Causes and Risk Factors

The following factors may increase a woman’s risk of developing endometrial cancer:

  • Obesity
  • Diet high in animal fat
  • Family history of endometrial, ovarian and/or colon cancers (hereditary nonpolyposis colorectal cancer)
  • Starting monthly periods before age 12
  • Late menopause
  • Infertility (inability to become pregnant)
  • Never having children
  • Being treated with tamoxifen for breast cancer
  • Hormonal imbalance — having too much estrogen and not enough progesterone in the body
  • Estrogen replacement therapy for treatment of effects of menopause
  • Diabetes
  • Personal history of breast cancer
  • Personal history of ovarian cancer
  • Prior radiation therapy for pelvic cancer
  • Personal history of polycystic ovary syndrome or atypical endometrial hyperplasia

The risk for endometrial cancer increases as women get older, and it is most common in white women.

Endometrial Cancer Symptoms

Consult a doctor if you experience any/all of the following symptoms:

  • Bleeding or discharge not related to your periods (menstruation) — over 90 percent of women diagnosed with endometrial cancer have abnormal vaginal bleeding
  • Postmenopausal bleeding
  • Difficult or painful urination
  • Pain during intercourse
  • Pain and/or mass in the pelvic area

Did you know that up to one-third of cancer deaths in women are attributed to excess body weight? Director of Gynecologic Oncology Amanda Fader and oncology dietitian Mary-Eve Brown discuss the correlation between the two. Learn what you can do to reduce your risk.

Diagnosis of endometrial cancer includes a review of your medical history and a general physical exam. It may also include one or more of the following.

  • Internal pelvic exam: This is done to feel for any lumps or changes in the shape of the uterus.
  • Pap test (also called Pap smear): This test involves microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer and to show noncancerous conditions, such as infection or inflammation. However, the Pap test does not detect endometrial cancer.
  • Endometrial biopsy: This procedure uses a small, flexible tube that is put into the uterus to collect an endometrial tissue sample. The sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.
  • Dilation and curettage (also called D&C): Your doctor may recommend a D&C if an endometrial biopsy is not possible or if further diagnostic information is needed. This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
  • Transvaginal ultrasound (also called ultrasonography): This ultrasound test uses a small instrument, called a transducer, which is placed in the vagina. The doctor may do a biopsy if the endometrium looks too thick.

Endometrial Cancer Treatment

Specific treatment for endometrial cancer will be determined by your doctor(s) :

  • Your overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

The choice of treatment depends on the stage of cancer — whether it is only in the endometrium, or if it has spread to other parts of the uterus or body. Most people will be treated with surgery first. Some may need additional therapy. Generally, treatment for people with cancer of the endometrium includes one or more of the following.

  • Surgery:
    • Hysterectomy — surgical removal of the uterus
    • Salpingo-oophorectomy — surgery to remove the fallopian tubes and ovaries
    • Pelvic lymph node dissection — removal of some lymph nodes from the pelvis
    • Para-aortic lymphadenectomy — removal of lymph nodes that surround the aorta, the main artery of the heart
    • Laparoscopic lymph node sampling — removal of lymph nodes through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly)
    • Sentinel lymph node mapping — use of fluorescent imaging to identify potentially cancerous lymph nodes that would otherwise go undetected
  • Radiation therapy: the use of X-rays, gamma rays and charged particles to fight cancer. Brachytherapy and external beam radiation are the most common radiation therapies used to treat endometrial cancer. Novel techniques in image-based brachytherapy with directed magnetic resonance (MR) guidance offer better patient outcomes and fewer side effects.

  • Chemotherapy: the use of anticancer drugs to treat cancerous cells

  • Immunotherapy: the process of activating the immune system’s natural ability to fight cancer

  • Hormone therapy: medication or surgical procedures that interfere with hormone activity

Gynecologic cancers can often be difficult to treat, with traditional therapies – surgery, chemotherapy, radiation – becoming less effective with the recurrence of disease. Immunotherapy has been showing promise in this area, though, particularly for endometrial cancer.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometrial-cancer

References: Endometrial Cancer

Endometrial Cancer | Johns Hopkins Medicine

Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, et al. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113:163-169.

Alektiar KM, Abu-Rustum NR, Fleming GF. Cancer of the uterine body. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg‘s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015: 1048-1064.

Alvarez EA, Brady WE, Walker JL, et al. Phase II trial of combination bevacizumab and temsirolimus in the treatment of recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2013;129(1):22-27.

Amant F, Moerman P, Neven P, et al. Endometrial cancer. Lancet. 2005; 366:491-505.

American Cancer Society. Cancer Facts and Figures 2015. Atlanta, Ga: American Cancer Society; 2015.

American Cancer Society. Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society; 2016.

American Cancer Society. Cancer Facts and Figures 2017. Atlanta, Ga: American Cancer Society; 2017.

American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2014-2015. Atlanta, Ga: American Cancer Society; 2015.

American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;106(2):413-425.

American Joint Committee on Cancer. Uterine Cancer. In: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010: 403-409.

Barlin JN, Puri I, Bristow RE. Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol. 2010;118(1):14-18.

Beining RM, Dennis LK, Smith EM, Dokras A. Meta-analysis of intrauterine device use and risk of endometrial cancer. Ann Epidemiol. 2008;18:492-499.

Boggess JF, Kilgore JE. Uterine cancer. In: Niederhuber JE, Armitage JO, Doroshow JH,. Kastan MB, Tepper JE, eds. Abeloff‘s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014: 1575-1591.

Cardenes HR, Look K, Michael H, Cerezo L. Endometrium. In: Halperin EC, Perez CA, Brady LW, eds. Perez and Brady's Principles and Practice of Radiation Oncology. 5th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2008: 1610-1628.

Chao KSC, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd edition. Philadelphia, Pa: Lippincott Williams and Wilkins; 2011.

Colombo N, McMeekin DS, Schwartz PE, et al. Ridaforolimus as a single agent in advanced endometrial cancer: results of a single-arm, phase 2 trial. Br J Cancer. 2013;108(5):1021-1026.

Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynecol Obs. 2003;83:79-118.

Emons G, Günthert A, Thiel FC, et al. Phase II study of fulvestrant 250 mg/month in patients with recurrent or metastatic endometrial cancer: a study of the Arbeitsgemeinschaft Gynäkologische Onkologie. Gynecol Oncol. 2013;129(3):495-499.

Freedman DM, Curtis RE, Travis LB, Fraumeni Jr JF. New Malignancies Following Cancer of the Uterine Corpus and Ovary. In: Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. (eds).

New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. National Cancer Institute. NIH Publ. No. 05-5302. Bethesda, MD, 2006. Accessed on 4/18/2014 at http://seer.cancer.

gov/archive/publications/mpmono/MPMonograph_complete.pdf.

Howlader N, Noone AM, Krapcho M, et al (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, November 2013 SEER data submission, posted to the SEER web site, April 2014.

Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(3):744-751.

Kim MK, Yoon BS, Park H, et al. Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study. Int J Gynecol Cancer. 2011;21(4):673-677.

Kosary CL. Cancer of the Corpus Uteri. In: Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

Kushi LH, Doyle C, McCullough M, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30-67.

Leslie KK, Sill MW, Fischer E, et al. A phase II evaluation of gefitinib in the treatment of persistent or recurrent endometrial cancer: a Gynecologic Oncology Group study. Gynecol Oncol. 2013;129(3):486-494.

Malzoni M, Tinelli R, Cosentino F, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol. 2009;112:126-133.

McCullough ML, Patel AV, Patel R, et al. Body mass and endometrial cancer risk by hormone replacement therapy and cancer subtype. Cancer Epidemiol Biomarkers Prev. 2008;17:73-79.

Minig L, Franchi D, Boveri S, et al. Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women. Ann Oncol. 2011;22(3):643-649.

Moore SC, Gierach GL, Schatzkin A, Matthews CE. Physical activity, sedentary behaviours, and the prevention of endometrial cancer. Br J Cancer. 2010;103(7):933-938.

Nag S, Scruggs GR. Clinical Aspects and Applications of High-Dose Rate Brachytherapy. In: Halperin EC, Perez CA, Brady LW, eds. Perez and Brady's Principles and Practice of Radiation Oncology. 5th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2008: 560-582.

National Cancer Institute. Physician Data Query (PDQ). Endometrial cancer treatment. 4/23/2014. Accessed at www.cancer.gov/cancertopics/pdq/treatment/endometrial/healthprofessional on January 22, 2015.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms. V.2.2015. Accessed at www.nccn.org on January 9, 2015.

Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomized trial. Lancet. 2010;375(9717):816-823.

Online Mendelian Inheritance in Man, OMIM. Lynch syndrome. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD). Accessed at www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=120435 on August 24, 2009.

Pellegrino A, Signorelli M, Fruscio R, et al. Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy [sic] in obese women with stage I endometrial cancer. Arch Gynecol Obstet. 2009;279:655-660.

Perrone AM, Casadio P, Formelli G, et al. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol Oncol. 2008;111:62-67.

Powell MA, Sill MW, Goodfellow PJ, et al. A phase II trial of brivanib in recurrent or persistent endometrial cancer: an NRG Oncology/Gynecologic Oncology Group Study. Gynecol Oncol. 2014;135(1):38-43.

Rahaman J, Cohen CJ. Endometrial cancer. In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E, eds. Cancer Medicine. 6th ed. Hamilton, Ontario: B.C. Decker; 2003: 1809-1823.

Ray-Coquard I, Favier L, Weber B, et al. Everolimus as second- or third-line treatment of advanced endometrial cancer: ENDORAD, a phase II trial of GINECO. Br J Cancer. 2013;108(9):1771-1777.

Richter CE, Qian B, Martel M, et al. Ovarian preservation and staging in reproductive-age endometrial cancer patients. Gynecol Oncol. 2009;114(1):99-104.

Rosai J. Uterus-corpus. In: Rosai J, ed. Rosai and Ackerman's Surgical Pathology. 9th ed. Philadelphia, PA. Elsevier, 2004. 1565-1635.

Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011;204(6):466-478.

Schmeler KM, Lynch HT, Chen LM, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med. 2006;354:261-269.

Simpson AN, Feigenberg T, Clarke BA, et al. Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol. 2014;133(2):229-233.

Wright JD, Barrena Medel NI, Sehouli J, Fujiwara K, Herzog TJ. Contemporary management of endometrial cancer. Lancet. 2012;379(9823):1352-1360.

Source: https://www.cancer.org/cancer/endometrial-cancer/references.html

Uterine Sarcoma

Endometrial Cancer | Johns Hopkins Medicine

Linkedin Pinterest

Endometrial cancer is the most commonly diagnosed gynecologic cancer. About 50,000 American women are diagnosed with the disease every year. Endometrial cancer is also the most common form of uterine cancer, so it is frequently referred to as uterine cancer.

What You Need to Know

  • Endometrial cancer starts in the lining of the uterus — the endometrium.
  • Being overweight or obese greatly increases a woman’s chance of developing endometrial cancer. Other risk factors include age, family history, a diagnosis of polycystic ovary syndrome and prior use of the breast cancer treatment drug tamoxifen.
  • Symptoms include abnormal vaginal bleeding, pain during intercourse, difficult or painful urination, and pain in the pelvic area.
  • Endometrial cancer is highly treatable when found early.

The lining of the uterus is called the endometrium. Cancer of the endometrium is the most common cancer of the female reproductive organs.

Cancer of the endometrium is different from cancer of the connective tissue or muscle of the uterus, which is called uterine sarcoma. About 80 percent of all endometrial cancers are adenocarcinomas. This means the cancer occurs in the cells that develop the glands in the endometrium. Endometrial cancer is highly curable when found early.

Uterine carcinosarcoma is a very rare type of uterine cancer, with characteristics of both endometrial cancer and uterine sarcoma. It is also known as a malignant mixed mesodermal tumor.

Endometrial Cancer Diagnosis

Diagnosis of endometrial cancer includes a review of your medical history and a general physical exam. It may also include one or more of the following.

  • Internal pelvic exam: This is done to feel for any lumps or changes in the shape of the uterus.
  • Pap test (also called Pap smear): This test involves microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer and to show noncancerous conditions, such as infection or inflammation. However, the Pap test does not detect endometrial cancer.
  • Endometrial biopsy: This procedure uses a small, flexible tube that is put into the uterus to collect an endometrial tissue sample. The sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.
  • Dilation and curettage (also called D&C): Your doctor may recommend a D&C if an endometrial biopsy is not possible or if further diagnostic information is needed. This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
  • Transvaginal ultrasound (also called ultrasonography): This ultrasound test uses a small instrument, called a transducer, which is placed in the vagina. The doctor may do a biopsy if the endometrium looks too thick.

Disparities seen in access to minimally invasive surgeries for uterine cancer

Endometrial Cancer | Johns Hopkins Medicine

Despite years of evidence showing the advantages of minimally invasive hysterectomies, access to the surgeries remains limited for uterine cancer patients nationwide—particularly for poor and minority women.

A recent study by Johns Hopkins researchers revealed wide racial and economic disparities in access to minimally invasive surgeries for hysterectomies in treating uterine cancer. Additionally, the study found that hospitals categorized as “low-volume” performed the surgeries very rarely. The findings are published in the January 2016 issue of Obstetrics and Gynecology.

More than 54,000 women are diagnosed with uterine cancer each year in the U.S., the researchers say, and surgery alone cures 60 to 70 percent of women with early-stage disease.

Over the last decade, a number of medical experts have considered minimally invasive procedures to be the standard of care for nonmetastatic uterine cancer.

Research has demonstrated that minimally invasive hysterectomies (either laparoscopic or robotic-assisted surgeries) result in fewer complications, higher quality of life, and equal rates of survival when compared to open procedures that call for making large surgical incisions into the abdomen.

Researchers found that open hysterectomies requiring large incisions were more than twice as ly as minimally invasive surgeries to result in complications such as infections, pneumonia, blood clots, major blood loss, and longer hospital stays.

The Hopkins team analyzed data from more than 1,000 hospitals in 45 states, on 32,560 patients who underwent either minimally invasive hysterectomies or open hysterectomies for uterine cancer between 2007 and 2011. Researchers saw that 33.6 percent of patients who underwent surgery for nonmetastatic uterine cancer had minimally invasive surgeries, with the percentage rising from 22 percent in 2007 to 50.8 percent in 2011.

“We were encouraged to see that utilization of minimally invasive surgery for endometrial cancer rose significantly since 2007, but we still have a long way to go to provide most patients access to these procedures,” says Amanda Fader, director of the Johns Hopkins Kelly Gynecologic Oncology Service and member of The Sidney Kimmel Comprehensive Cancer Center.

Fader's team found that black and Hispanic women were less ly to receive minimally invasive surgeries, along with patients who were on Medicaid or uninsured. In addition, the study revealed that minimally invasive procedures occurred only 23.

6 percent of the time in hospitals considered low-volume, which in this sampling performed fewer than 10 hysterectomies for uterine cancer annually.

In contrast, patients treated at medium- and high-volume hospitals were up to four times as ly to undergo minimally invasive procedures.

“At Johns Hopkins, we perform minimally invasive surgeries in approximately 91 percent of early-stage endometrial cancers,” Fader says. “A small percentage of women with a very large uterus or severe cardiopulmonary disease may not be able to undergo minimally invasive procedures, but this is rare.”

Fader notes that the proliferation of robotic surgical equipment in hospitals has helped to increase minimally invasive surgeries, but she places less importance on whether a surgeon uses a robot or traditional laparoscopy.

“The goal is to increase the overall rate of minimally invasive surgery for these patients, irrespective of the specific type of procedure offered,” she says.

Read more from Hopkins Medicine

Posted in Health

cancer, women's health

Source: https://hub.jhu.edu/2015/12/18/access-limited-to-minimally-invasive-hysterectomies/