Endometrial Cancer Treatment

Endometrial cancer is the most common gynecologic cancer in the United States. The most common presenting symptom is postmenopausal bleeding. The primary treatment is surgery, a total hysterectomy and bilateral salpingo‑oophorectomy. Radiation therapy plays a critical role after surgery when certain risk factors are present: deep myometrial invasion (>50%), lymphovascular space invasion, high tumor grade (G3), serous or clear cell histology, positive margins and cervical or fallopian tube involvement.

Endometrial Cancer’s Symptoms

• Abnormal vaginal bleeding
• Bleeding between periods in premenopausal women
• Unusual watery or blood-tinged vaginal discharge
• Pelvic pain or pressure
• Pain during intercourse
• Unexplained weight loss or palpable pelvic mass

Causes / Risk Factors

• Estrogen excess without progesterone (endogenous or exogenous)
• Obesity (increased conversion of androgens to estrogen in fat tissue)
• Late menopause (after age 55)
• Early menarche (before age 12)
• Nulliparity (never given birth)
• Polycystic ovary syndrome (PCOS)
• Tamoxifen use for breast cancer (slightly increased risk)
• Lynch syndrome (hereditary non‑polyposis colorectal cancer)
• Type 2 diabetes and hypertension
• Age (most common after menopause, average age 60)

Vaginal Cuff Brachytherapy

After hysterectomy, the top of the vagina is the most common site of local recurrence. Vaginal cuff brachytherapy (a form of radiation therapy) is recommended for patients with certain risk factors to reduce the risk of a local recurrence. Brachytherapy delivers radiation directly to this area from inside the vagina. We place a small, cylinder‑shaped applicator into the vagina for 15‑20 minutes. The treatment is painless, outpatient and typically given over 3-5 sessions, 1-2 times weekly.

The treatment is well tolerated. Most women experience no side effects; a small number note temporary vaginal dryness or mild irritation. Patients are provided with a vaginal dilator after their course of treatment to help decrease the risk of scar tissue formation in the vagina.

Endometrial Cancer Treatment for Higher‑Risk Patients (Stage II‑III)

Patients with stage II or stage III may require pelvic external beam radiotherapy. This course of radiation therapy is typically given over 5 weeks using intensity‑modulated radiation therapy (IMRT). IMRT is a more advanced radiation technique utilized to help decrease the radiation dose to surrounding normal tissues, including the small bowel, bladder, and rectum. After pelvic radiation therapy, some patients may need vaginal cuff brachytherapy to further reduce the risk of a local recurrence.

Side effects of treatment may include temporary diarrhea, urinary frequency, and fatigue which typically resolve within 1‑2 months after treatment ends. We use IMRT, daily imaging and bladder filling to help minimize side effects.

Palliative Treatment for Recurrent Endometrial Cancer

For an isolated recurrence at the vaginal cuff or in pelvic lymph nodes (without widespread disease), radiation therapy may be recommended as a curative option. The treatment typically involves a combination of pelvic radiation therapy and brachytherapy.

For patients with metastatic disease, a shorter course of radiation therapy may be utilized to help with symptom management including bleeding or pain.

Call 847-698-0600 ext. 112 to schedule a consultation. Our radiation oncologists specialize in gynecologic cancers and will help you achieve the best possible outcome.