Endometrial Cancer

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Endometrial Cancer A Womans Guide

• Improving Outcomes with Prevention and Patient
  Awareness

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About this presentation

• This presentation is intended to help women take
  an active role in their health care. It does not
  replace the judgment of a health care
  professional in diagnosing and treating disease.

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GCF mission statement

• The mission of the Gynecologic Cancer Foundation
  (GCF) is to ensure public awareness of
  gynecologic cancer prevention, early diagnosis
  and proper treatment.
• In addition the GCF supports research and
  training related to gynecologic cancers.
• GCF advances this mission through public and
  private funds that aid in the development and
  implementation of programs to meet these goals.
• GCF gratefully acknowledges The Elizabeth
  Gillespie Fund for Life for their support of this
  educational presentation. www.fundforlife.org

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Information hotline [phone]

• A list of specially trained gynecologic
  oncologists practicing in your local area can be
  received by phone, fax or mail
• Free educational brochures on gynecologic
  health are available

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Womens Cancer Network www.wcn.org

• Confidential ovarian, endometrial, cervical and
  breast cancer risk assessment
• Comprehensive womens cancer information
  including gynecologic, breast and colon
• Find-A-Doctor
• Information on current Phase III clinical trials

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Endometrial (Uterine) CancerDiagnosis
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New cancer diagnoses in the United States

• 2006 Statistics

Source American Cancer Society.
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The female reproductive tract

• Vulva
• Vagina
• Cervix
• Uterus
• Fallopian tubes
• Ovaries

WebMD 2002
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What is endometrial cancer?

• In the United States, endometrial cancer is the
  most common cancer of the female reproductive
  organs
• It is the most common type of cancer of the
  uterus
• It is an abnormal growth of cells in the lining
  of the uterus, called the endometrium

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What is endometrial cancer?
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What are factors that increase your risk of
developing endometrial cancer?

• Obesity
• Estrogen excess
• Tamoxifen use
• Heredity
• Families with high number of endometrial, colon
  and ovarian cancer should consider genetic
  counseling
• Diabetes and High blood pressure
• Diabetes and high blood pressure are often
  associated with endometrial cancer

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What are the symptoms?

• 90 of women with endometrial cancer experience
  abnormal bleeding
• Vaginal bleeding or spotting after menopause
• Late menopause
• New onset of heavy menstrual periods
• Bleeding between periods
• A watery pink or white vaginal discharge
• Pain in the lower abdomen or pelvis can occur

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How is endometrial cancer diagnosed?

• Endometrial biopsy
• Sampling of the endometrial lining
• Performed during an office visit
• Has excellent (97) accuracy compared to dilation
  and curettage
• Recommended test to evaluate most abnormal
  bleeding
• Dilation and Curettage (DC)
• Scraping of the endometrial lining
• Performed in the operating room
• Often done if an office biopsy is not feasible

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How is endometrial cancer diagnosed?
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What do I find out from endometrial sampling?

• The results from endometrial sampling for
  abnormal bleeding most often show one of the
  following
• Benign polyps
• Precancerous change called hyperplasia
• Endometrial cancer

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What is endometrial hyperplasia?

• Abnormal thickening of the endometrial lining
• Hyperplasia which contains abnormal cells is
  pre-cancerous
• Often treated by hysterectomy
• Has similar risk factors as endometrial cancer

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What are the different types of endometrial
cancer?

• Type I Endometrioid cell type
• Often occurs in the presence of hyperplasia
• Related to hormones
• Excellent overall prognosis
• Type II Serous, Clear cell and other cell types
• Often occurs in the presence of a thin
  endometrium
• Not related to hormones
• More likely to spread

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How do I lower my risk?

• Maintain a healthy weight
• If you take an estrogen supplement, also take
  progesterone
• Review your family history

Be Informed
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What do I do if I have abnormal bleeding?

• See your gynecologist immediately
• Request endometrial sampling
• Office endometrial biopsy, or
• Dilation and curettage
• Recognize that a Pap test will NOTdetect disease
  in the uterus

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Endometrial (Uterine) CancerTreatment
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What should I do if I have just been diagnosed
with endometrial (uterine) cancer?

• Make an appointment with a gynecologic oncologist
• www.wcn.org to find a specialist in your area, or
• Call 1.800.444. 4441
• Discuss
• Results of endometrial sampling
• Discuss treatment options
• Ask about clinical trials
• See the Clinical Trials section of the Womens
  Cancer Network at www.wcn.org.

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What is the purpose of surgery for endometrial
cancer?

• Surgery removes the primary tumor with a
  hysterectomy and removal of the adjacent
  fallopian tubes and ovaries
• Surgery also defines the extent of disease by
  sampling those areas at risk for microscopic
  spread of the cancer. Cancer staging sampling
  often includes removal of the
• Regional lymph nodes
• Pelvic washings (fluid wash in the abdominal
  cavity)
• Omentum (a fatty layer in the upper abdomen)
• The extent of staging biopsies is dependent on
  features of the uterine tumor, such as the cell
  type and the depth of the invasion into the
  uterine muscle

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What is the purpose of surgery for endometrial
cancer?
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What is the purpose of surgery for endometrial
cancer?
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Are there alternatives to surgery?

• In selected cases, younger patients can undergo
  hormonal treatment long enough to complete
  childbearing prior to a hysterectomy
• Surgery is then generally recommended after
  childbearing is complete

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What are the options in surgical approach?

• Total Abdominal Hysterectomy
• The uterus and cervix are removed through an
  abdominal incision
• Radical Hysterectomy
• In addition to the uterus and cervix, the tissue
  next to the cervix and upper vagina is removed as
  well
• Laparoscopic-Assisted Vaginal Hysterectomy
• The uterus and cervix are taken out through the
  vagina with the assistance of a laparoscope, a
  thin camera placed through the abdominal wall via
  a small incision

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How is the surgical approach determined?

• Some factors that may affect surgical approach
  include your
• Pelvic anatomy on examination
• Prior surgical history
• Other medical conditions
• Tumor cell type

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What are the risks of surgery?

• Risk of a major side effect following surgery is
  lt5 and includes the following
• Pain
• Bleeding
• Infection
• Blood clots
• Difficulty urinating or constipation
• Shortening of the vagina
• Wound problems

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What happens after surgery?

• All tissue removed during your procedure are
  processed and evaluated
• A pathology report is generated within 1-2 weeks
  from the day of your procedure
• This final pathology determines your
• Stage of disease
• Prognosis, and
• The need for any additional treatment

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Endometrial cancer What is the importance of
Surgical Staging?
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What additional treatment may be required after
surgery?

• Additional treatment following surgery is
  sometimes required in order to reduce the
  opportunity for disease re-growth
• Additional treatment after surgery is called
  adjuvant treatment
• May include radiation and chemotherapy
• The need for adjuvant treatment is based on the
  final results of your pathology, including the
  surgical staging results

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What is radiation treatment?

• Radiation therapy uses a high-energy source to
  kill cancer cells or stop them from growing
• External beam pelvic radiation
• Administered on an outpatient basis for a few
  minutes each day for 5-6 weeks
• Internal radiation therapy (Brachytherapy)
• Small amount of radioactive material placed for a
  short period of time in the vagina

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What are the side effects of radiation?

• Side effects occur more frequently with external
  beam pelvic radiation, and include short and long
  term effects
• Short term side effects may occur during
  treatment
• Dry reddened skin in the treatment area
• Fatigue
• Diarrhea
• Loss of appetite
• Long term side effects can occur in the years
  following radiation treatment
• Discomfort or bleeding with urination or bowel
  movements
• Bowel obstruction
• Narrowing of the vagina

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What about chemotherapy?

• Chemotherapy is given intravenously (injected
  into a vein) and provides whole-body treatment
• Chemotherapy is the use of drugs to kill cancer
  cells
• The same drugs can also kill normal cells and
  cause side effects
• Nausea
• Hair loss
• Fatigue
• Increased risk of bleeding and infection

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Re-establishing wellness

• Restoring wellness is a gradual process
• Some women find strength from
• Friends and family
• Support groups
• Spiritual work
• Counseling
• Exercise
• The challenges and the journey are different for
  each woman with endometrial cancer

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Who is your treatment team?

• Gynecologic Oncologist
• Specializes in comprehensive surgical management
  and chemotherapy treatment for female
  reproductive cancers, including endometrial
  cancer
• Medical Oncologist
• Specializes in administering chemotherapy to
  treat cancer
• Radiation Oncologist
• Specializes in using radiation therapy

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Who is your treatment team?

• Oncology Nurse
• Specializes in cancer care and can work with you
  on every aspect from understanding your
  diagnosis and treatment to providing
  emotional/social support
• Social Worker
• Trained in counseling and practical assistance,
  community support programs, home care, and
  insurance entitlements
• Hospital Chaplain, Religious Advisor
• Skilled with the use of prayer, counseling and
  faith-based support for people facing illness

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How do I get my friends to have endometrial
sampling?

• Tell her its important if bleeding problems
  occur
• Help her find the right health care provider
• Help her get an appointment
• Offer her a ride
• Empower her with information Tell your friend
  about the importance of health prevention and
  early diagnosis

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GCF Resources
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GCF Resources

• Endometrial Cancer Survivor Courses

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Endometrial cancer presentation participants

• GCF gratefully acknowledges the following
  individuals who contributed to this educational
  presentation
• Ginger J. Gardner, MD, Editor
• Bobbie S. Gostout, MD
• Katherine Y. Look, MD
• Karen H. Lu, MD
• David G. Mutch, MD
• James W. Orr, Jr. MD
• Karl C. Podratz, MD, PhD

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GCF supporting organization

• This educational effort was undertaken by the
  Gynecologic Cancer Foundation with support from
  The Elizabeth Gillespie Family Fund for Life.
• For more information The Elizabeth Gillespie
  Fund for Life www.fundforlife.org

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• Gynecologic Cancer Foundation
• 230 W. Monroe
• Suite 2528
• Chicago, IL 60606
• 800.444.4441
• www.thegcf.org