Endometrial cancer recurrence is when the cancer returns after initial treatment is complete. While most people are treated successfully, the possibility of it coming back is a common concern. A recurrence means that a small number of cancer cells survived the first round of treatment and multiplied. This can happen months or even years after treatment has ended. Understanding the risks, signs, and available options can help in navigating this phase.
Understanding Recurrence Risk and Patterns
The likelihood of endometrial cancer returning is influenced by the specific characteristics of the original tumor. The cancer’s stage at diagnosis, its grade, and its histologic subtype are primary factors. The stage indicates how far the cancer has spread, while the grade describes how abnormal the cancer cells appear under a microscope. Higher-grade tumors and more advanced stages are associated with a greater chance of recurrence.
The histologic subtype, which identifies the specific type of cell the cancer originated from, is also a factor. Endometrioid adenocarcinomas are the most common type and are often less aggressive. Other subtypes, such as serous or clear cell carcinomas, have a higher tendency to return. The presence of cancer cells in the lymphovascular space—the network of blood and lymph channels—also suggests a higher risk of the cancer spreading and later recurring.
Recurrence is categorized into three main patterns based on where the cancer reappears. A local recurrence means the cancer has come back in the same area where it first started, such as the vaginal cuff (the top of the vagina after a hysterectomy) or nearby pelvic structures. This is the most common pattern of recurrence.
Regional recurrence involves the cancer appearing in the lymph nodes close to the original tumor site, such as those in the pelvis or around the aorta. Distant recurrence, or metastasis, occurs when the cancer travels to other parts of the body. The most common sites for distant recurrence are the lungs, liver, and bones. Understanding these patterns helps doctors anticipate where a recurrence might happen.
Signs and Symptoms of Recurrence
The signs that endometrial cancer has returned depend on the location of the new tumor growth. Being aware of these symptoms is important, as most recurrences are first detected because a person reports new or persistent changes in their body. Promptly discussing any new health issues with a doctor can lead to earlier detection.
For a local recurrence in the pelvic area, the most common sign is abnormal vaginal bleeding or discharge. This is similar to the initial symptom many experience with primary endometrial cancer. Other local symptoms can include pain in the pelvis, discomfort during intercourse, or changes in bladder and bowel habits, such as frequent urination or constipation.
When the recurrence is regional, affecting nearby lymph nodes, symptoms may be more generalized. These can include persistent pain in the lower back, abdomen, or hips. Swelling in one or both legs, a condition known as lymphedema, can also occur if the cancer is blocking the flow of lymph fluid.
A distant recurrence can produce a wide variety of symptoms depending on the organ affected. If the cancer has spread to the lungs, a person might experience a persistent cough, shortness of breath, or chest pain. Spread to the liver can cause abdominal pain, bloating, or unexplained weight loss. These symptoms can be caused by many other conditions, but they should not be ignored.
The Diagnostic Process and Follow-Up
Following initial treatment, a structured follow-up schedule is established to monitor for any signs of recurrence. These appointments are more frequent in the first two to three years, as this is when recurrence is most likely to happen. A common schedule involves visits every three to six months, gradually becoming less frequent. During these visits, the doctor will perform a physical and pelvic exam and discuss any new symptoms.
If a recurrence is suspected, tests are conducted to locate and confirm the cancer. Imaging tests are used to get a detailed view inside the body. A CT (computed tomography) scan can help identify tumors in the pelvis, abdomen, and chest. A PET (positron emission tomography) scan is often used to detect cancer cells throughout the body by highlighting areas of high metabolic activity. An MRI (magnetic resonance imaging) may be used for a more detailed look at soft tissues in the pelvis.
Blood tests may also be ordered, including a test for the CA-125 tumor marker. While not always elevated, a rising CA-125 level can sometimes indicate a recurrence, particularly in those who had high levels during their initial diagnosis.
The definitive way to confirm a recurrence is with a biopsy. This procedure involves taking a small sample of tissue from the suspected tumor, which is then examined by a pathologist. A biopsy confirms whether the cells are cancerous and provides information about the tumor’s characteristics, which is necessary for planning treatment.
Treatment Options for Recurrence
The treatment for recurrent endometrial cancer is tailored to the individual, taking into account the location and extent of the recurrence, the treatments previously received, and the person’s overall health. A team of specialists will collaborate to develop a comprehensive treatment plan.
Surgery may be an option for an isolated recurrence that is confined to a single, accessible area. If the cancer has returned locally in the pelvis, a surgeon may be able to remove the tumor. In some cases of widespread disease in the abdomen, a procedure called cytoreductive surgery may be performed to remove as much of the cancer as possible.
Radiation therapy uses high-energy rays to destroy cancer cells and is frequently used for local or regional recurrences. If the pelvic area was not previously treated with radiation, external beam radiation therapy may be recommended. For a recurrence in the vagina, a type of internal radiation called brachytherapy might be used, which delivers radiation directly to the site.
For cancer that has spread to distant parts of the body, systemic therapies that travel through the bloodstream are the primary approach. Common options include:
- Chemotherapy, using a combination of drugs like carboplatin and paclitaxel. If these drugs were used previously, other combinations may be selected.
- Hormone therapy, which is an option for cancers that test positive for estrogen or progesterone receptors. These treatments work by blocking the hormones that the cancer cells use to grow.
- Targeted therapy, which uses drugs that focus on specific abnormalities within cancer cells to stop them from growing and dividing.
- Immunotherapy, using drugs such as pembrolizumab and dostarlimab. These help the body’s own immune system recognize and attack cancer cells and are often used for cancers with specific genetic features, such as mismatch repair deficiency (dMMR).
Prognosis and Managing Life After Recurrence
The outlook after a recurrence of endometrial cancer varies significantly. It depends on several factors, including the location of the recurrence and the length of time since the initial treatment was completed. An isolated local recurrence often has a more favorable prognosis than a distant recurrence. The specific characteristics of the cancer cells also play a part in determining the prognosis.
Living with a recurrent cancer diagnosis can feel like a different journey than the first time. The focus often shifts toward managing the cancer as a long-term or chronic condition. The goal of treatment may be to control the cancer’s growth, manage symptoms, and maintain a good quality of life. This approach is sometimes referred to as palliative care, which is aimed at providing relief from the symptoms and stress of a serious illness.
Emotional and psychological support is an important part of managing life after a recurrence. Feelings of anxiety, fear, and uncertainty are common. Connecting with support groups, either in person or online, can provide a sense of community with others who have similar experiences. Open communication with the healthcare team, family, and friends is also helpful in navigating the emotional challenges.