Endometrial cancer treatments

The treatment of endometrial cancer is primarily based on surgery, which can be more or less extensive depending on the stage of the tumor. This surgery can be supplemented with radiotherapy, Curietherapy, and chemotherapy. In the event of a secondary lesion (metastasis), hormone therapy or immunotherapy may also be proposed. The choice of these complementary treatments will depend on the extent of the endometrial cancer, as well as the risk factors of relapse, determined by molecular biology analyzes, which Institut Curie and its somatic genetics laboratory specialize in.

Thanks to its expertise in gynecological cancers, Institut Curie has developed an algorithm to aid in decision-making for the European Society of Gynecological Oncology (ESGO).

In the event of very early endometrial cancer and if there is a desire for pregnancy, progestogen treatment can be discussed in a multidisciplinary consultation meeting aimed at preserving fertility. In this context, supportive care is discussed within the framework of the PREFERRED network.
 

Endometrial cancer surgery

Management of patients with early-stage endometrial cancer usually begins with surgery. Performed by an experienced surgeon, the procedure, called total hysterectomy (removal of the uterus and cervix) with bilateral adnexectomy (removal of the ovaries and tubes), consists of removing the tumor and carrying out precise staging of the pathology to determine possible adjuvant treatments. The choice of the procedure type is discussed in a multidisciplinary consultation meeting, which brings together different doctors from various disciplines to define the best treatment strategy.

As part of the staging, it is usually recommended to remove the lymph nodes from the pelvis. At Institut Curie, only the removal of the lymph node closest to the tumor, called the sentinel node, is the preferred approach, when possible. This technique avoids removing the entire lymph node chain if it is not invaded by cancer cells.

Radiotherapy and Curietherapy of endometrial cancer

A radiotherapy treatment of the cancer of the uterine body often complements surgery in order to eliminate possible cancer cells with the help of ionizing radiation. It can also replace it when surgery is impossible or if the endometrial cancer is locally advanced.

External radiotherapy and Curietherapy can be used separately or be combined.

Curietherapy consists of introducing a radioactive source, often iridium, with an applicator. The precision of Curietherapy makes it possible to release very high and precisely targeted doses of irradiation, thus limiting side effects.

Chemotherapy for endometrial cancer 

Chemotherapy can be proposed in addition to surgery and radiotherapy in order to reduce the risk of relapse depending on the initial presentation of the cancer (initial stage, histological type, molecular biology analysis)

Two drugs are primarily combined in chemotherapy against endometrial cancer - a platinum salt (carboplatin) and a taxane (paclitaxel) to act upon the mechanisms of cell division.

Hormone therapy to treat endometrial cancer

Hormone therapy can be used to treat metastatic endometrial cancers when cancer cells express the estrogen receptor

Hormone therapy thus makes it possible to stop the stimulation of female sex hormones on the development of cancer cells.

Immunotherapy to treat endometrial cancer

Immunotherapy can be used to treat metastatic endometrial cancers in combination with chemotherapy. Genetic alterations linked to Lynch syndrome (altered genes MSH1, MSH6, MLH1, or PMS2) generally promote a good response to immunotherapy.