Endometrial Cancer treatment

Surgical treatment 

Surgery is the main treatment for endometrial cancer. A hysterectomy with bilateral adnexectomy (removal of the uterus with ovaries and fallopian tubes) is usually performed.  

In some cases, the disease can spread to the lymph nodes. Thus, a biopsy of the nodes near the tumour (sentinel nodes) can be done during this surgery, or they can be removed (lymphadenectomy). 

The surgery is minimally invasive in most cases. It is done conventionally or via robot-assisted laparoscopic surgery. In specific cases, the operation must be performed as open surgery.   

Radiotherapy  

Radiotherapy is administered in addition to surgery, after considering the risk factors for recurrence obtained after anatomical pathology and imaging tests.  

2 types of radiation therapy may be given:  

• External radiotherapy: This must be intensity modulated. External radiotherapy makes it possible to avoid pelvic and lymph node recurrences. 

• Brachytherapy: This is a type of local radiotherapy that treats only a specific part of the body. It is usually applied inside or near the tumour. For endometrial cancer, it is administered to prevent recurrence in the vaginal vault (upper part of the vagina).  

 
Both types of radiation therapy are usually given, although brachytherapy can be given exclusively.  

Radiotherapy as exclusive treatment offers good results in the few cases of patients who cannot be operated on. It is also useful in people with metastases and can alleviate pain and prevent bleeding, among other processes. 

Pharmacological treatment 

Pharmacological treatment of endometrial cancer is based around chemotherapy and hormone therapy.  

Chemotherapy may be necessary after surgery, depending on the stage of the disease and other risk factors. In these cases, it can be administered at the same time as radiotherapy or sequentially. The treatment of endometrial cancer is decided and planned by a multidisciplinary team in a tumour committee.  

Chemotherapy has an important role in the treatment of recurrent or metastatic disease. The most commonly used drugs are combinations of platinum salts and taxanes.  

Hormone therapy can be given only to people with low-grade tumours, also called endometrioid tumours, which is the most common type; as well as for patients with no symptoms associated with endometrial cancer.  

The molecular study of endometrial cancer has made it possible to identify different subgroups of cancer, with different prognoses. This has led to the development of new drugs, directed at different therapeutic targets for each subgroup. 

For example, immunotherapy with dostarlimab or pembrolizumab has shown benefits in treating those tumours with an alteration called microsatellite instability, which is detected in 30% of endometrial cancers.  

Also, the combination of pembrolizumab and lenvatinib has been shown to be more effective than chemotherapy in patients previously treated with chemotherapy.