Endometrial cancer develops in the lining of the uterus, known as the endometrium, and is the most common gynecologic cancer in the United States. A total hysterectomy, which involves the surgical removal of the uterus and cervix, is a primary treatment for endometrial cancer.
Understanding Endometrial Cancer Recurrence
Endometrial cancer can recur even after a total hysterectomy. This happens because microscopic cancer cells might have spread beyond the uterus before surgery, remaining undetectable. These cells can then grow and form new tumors.
The likelihood of recurrence varies; approximately 15% to 20% of individuals with early-stage endometrial cancer experience recurrence after hysterectomy. Factors influencing this risk include the original cancer’s stage, grade, and specific type. Higher-grade cancers, such as serous or clear cell carcinomas (Type 2), are generally more aggressive and carry a greater recurrence risk compared to endometrioid types (Type 1). Recurrence is also more likely if the cancer had spread to lymph nodes or deeply into the uterine wall before surgery.
Where Endometrial Cancer Can Recur
Endometrial cancer can recur in various locations: local, regional, or distant. Local recurrence means the cancer returns in or near the original site, most commonly the vaginal cuff (the top of the vagina where the uterus was removed). Regional recurrence involves nearby areas such as the pelvis or regional lymph nodes. Distant recurrence signifies the cancer has spread to other parts of the body far from the original site. Common distant recurrence sites include the lungs, liver, bones, and other organs.
Post-Hysterectomy Monitoring and Follow-Up
Following a hysterectomy for endometrial cancer, regular monitoring is important to detect any recurrence early. The typical follow-up schedule involves more frequent visits during the first two to three years after treatment, as most recurrences happen within this timeframe. These appointments usually include a physical examination, a pelvic exam, and a review of any new or concerning symptoms.
Specific tests may be utilized if symptoms arise or if there is a higher risk of recurrence. While routine Pap tests from the vaginal cuff and imaging scans are not always recommended for asymptomatic individuals, they may be used to investigate symptoms. Blood tests, such as CA-125, can be monitored, particularly if levels were elevated before treatment, as rising levels might indicate recurrence. It is important for individuals to report any new or persistent symptoms, such as abnormal vaginal bleeding, pelvic pain, or unexplained weight loss, to their healthcare provider.
Treatment Approaches for Recurrent Endometrial Cancer
If endometrial cancer recurs, treatment strategies are tailored to the recurrence location, disease extent, prior treatments received, and the individual’s overall health. Treatment modalities can be local or systemic.
For localized recurrences, such as those in the vaginal cuff, radiation therapy (including external beam radiation or brachytherapy) may be used and can be curative. Surgery may also be an option if the recurrence is confined to a specific area and can be fully removed.
For more widespread or distant recurrences, systemic therapies are often employed. Chemotherapy, which uses drugs to kill cancer cells throughout the body, is a common approach, often involving combinations of drugs like carboplatin and paclitaxel. Hormone therapy may be effective for cancers that are sensitive to hormones like estrogen and progesterone.
Targeted therapy, which focuses on specific features of cancer cells, and immunotherapy, which helps the body’s immune system fight cancer, are increasingly utilized, particularly for advanced or recurrent cases. These treatments may be used alone or in combination, depending on the tumor’s characteristics and the individual’s needs.