Diagnosis and Treatment

You may not be ready to deal with an endometrial cancer diagnosis.This is a normal reaction that many of us went through this ourselves. This can be a diagnosis that is not easy to talk about or explain to other people. The most important thing to remember is that you are not alone. 

You are in charge of this experience, and it’s OK if you want to prioritize your own needs before you talk to others. Maybe rather than sharing this with others, you just want information to guide you. We understand and we hope our resources and being able to see and hear from other women who have received the same news is helpful to you.

We just ask this of you. If you haven’t found a doctor yet, please consider scheduling an appointment with a gynecologic oncologist to talk through your options.

Remember, You are not alone.

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You may have been experiencing symptoms that included unexplained bleeding, pain during intercourse, or severe cramping during your period. If you had not already been seeing your gynecologist annually, these symptoms may have alerted you to suspect something was wrong. These symptoms are common occurrences for women during menstruation, however, if they are not normal for you, it is important to notify your doctor. This is your first step towards learning more about a diagnosis.

After meeting with your doctor, they will have a plan for understanding the cause of your symptoms.

The plan for understanding the cause of your symptoms, should include the following:

Pelvic Exam: On your initial visit, you will likely have an internal pelvic examination when your Gynecologist will palpate or “feel” for any abnormalities. It is okay to have a pelvic examination even if you are bleeding at the time of your visit.

Ultrasound: The first test you may have had is an ultrasound on the outside of your pelvis or inside of your vagina. An ultrasound provides a detailed picture of your reproductive parts. In most cases an ultrasound alone cannot “see” everything that is going on.

The only way to be sure that cancer is causing your symptoms is to get a sample of tissue from your endometrium, or the lining of the uterus. 

Doctors can do this with one of two different tests:

1. Biopsy: This procedure usually happens in a clinic or doctor’s office.  It begins with what feels like a pap smear. The doctor uses a speculum to see into your cervix then place a small tube into your uterus to collect a sample of tissue.
2. Dilation and Curettage (D&C): This procedure typically happens in an operating room. The doctor uses small tools to open the entry to your cervix and can then take a larger sample of tissue from the inner lining of the uterus.

With one of these tests, a doctor uses the tissue sample from your uterus to examine if cells are growing abnormally, which is confirmation of cancer. Because this started in the uterus, it is called “Endometrial”, “Uterine” or “Womb” cancer.

Next it is important to know the stage and grade of your cancer so you and your care team can identify the treatment plan that will work best for you.

The stage of cancer refers to how far the cancer cells have spread outside the uterus. The process of tests are called “staging.”

During surgery, your care team looked in your pelvic region to see if there were any cancer cells outside of your uterus. They may have also done additional imaging – such as an MRI or a CT scan – to look at detailed pictures of other organs and ensure there are no cancer cells in other places.

The stages of endometrial cancer cancer are:

Stage 1: Cells found only inside the uterus.

Stage 2: Cells found to have spread to the cervix (opening of the uterus).

Stage 3: Cells found to have spread to lymph nodes or other areas in the pelvis or abdomen.  

Stage 4: Cells found to have spread to lungs or other organs.

The grade of endometrial cancer is a scoring system to predict how fast the cancer might grow and if it is likely to spread. You might hear members of your care team describe grade as how “aggressive” the cancer is. A doctor will determine the grade by looking at the cancer cells from your biopsy, D&C, or your surgery under a microscope.

The grade of cancer comes in 3 ratings:

Grade 1: Low Grade

Grade 2: Intermediate Grade

Grade 3: High Grade

The type or histology of the cancer refers to which kinds of cancer cells are growing, and how the cells use the female hormone, estrogen. This helps your care team determine treatment options for you, and identify the risk of the cancer spreading or coming back. 

Histology types include: Endometrioid, Serous or Papillary Serous, Carcinosarcoma, Mucinous, or Mixed

Now it is time for treatment. During this time you will meet a group of healthcare providers that will help guide you through your treatment process. This group of providers is referred to as your care team.

Endometrial cancer treatment plans include one or more of the following: surgery, radiation, hormone therapy, and chemotherapy.

Surgery
Surgery that removes your uterus, cervix, fallopian tubes, and ovaries – or a total hysterectomy – is the most common treatment for endometrial cancer.

Hysterectomy
Hysterectomy should be done in a minimally invasive way, with small incisions with small instruments and a camera to enter your body (laparoscopy or robotic surgery). This allows for the full surgery you need and a speedy recovery. If you are not offered a minimally invasive surgery, there should be a specific reason for this that you understand. If you are not satisfied with the reason, seek a second opinion. The surgeon may also remove lymph nodes from other parts of your pelvis or abdomen to check if the cancer has spread to those areas.  

Radiation
Radiation therapy uses x-rays or other types of radiation to kill cancer cells or stop them from growing.

Radiation therapy may be suggested before or after surgery.

Before surgery (also called neoadjuvant therapy): Your care team may recommend radiation to help make the cancer smaller. 

After surgery (also called adjuvant therapy): Your care team may recommend radiation to kill any remaining cancer cells they weren’t able to remove, or those that have spread to other areas in the pelvis or abdomen.

Radiation therapy may be external or internal.

External radiation: A machine directs radiation toward an area of your body. The procedure itself does not hurt. It only takes a few minutes each day at a clinic, hospital, or office, and is typically recommended every day for about six weeks.  

Internal radiation (also called brachytherapy): A small capsule that holds radiation is placed inside your vagina. After the capsule is inserted, your care team may recommend that you remain at the hospital for monitoring (this makes it an inpatient procedure), or you may be able to go home (making it an outpatient procedure).

Hormone Therapy
Some types of endometrial cancer – those with receptors for the female hormone, estrogen, that are low grade – can be controlled by using hormones. This is primarily used in young women who wish to have children in the future or women whose surgery will not be safe. In these cases, hormones taken in a pill are shot block receptors that keep the cancer cells from receiving the estrogen it would use to grow.

Chemotherapy
Chemotherapy uses pharmaceutical drugs to kill cancer cells. It is usually given by injection into a vein. The drugs travel through your bloodstream. It targets cancer cells throughout the body, and also affects healthy cells. To keep the damage to healthy cells low, chemotherapy usually happens in cycles, alternating with rest periods. Cycles of chemotherapy typically begin in the months following surgery and usually occur in a hospital or doctor’s office.

Knowing what to expect from treatment is important so you, your care team, and your caregivers can work together to make the best decisions for your well-being. There are many questions that arise during treatment that you will want answers to. 

Common questions include: 

Will you be cured of cancer? 
What are your chances of being cured? 
If there is no cure, will treatment help you live better or longer? 

While the answer to these questions may not be readily available, the goal(s) of treatment will be aligned with the treatment options available to you, the stage, and grade of cancer. Your care team will work closely with you so that you clearly understand your specific goals.

Depending on the specifics of your cancer, your doctor can order multiple tests to measure how you are progressing through treatment.