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21.05.2014

Endometrial cancer is the most common gynecologic disease diagnosed in women in the United States. Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating with you in the care of your patient. If you are a referring physician and have a patient with endometrial cancer, we look forward to working with you. Our multidisciplinary team includes experienced surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, and social workers who treat, counsel, and care for each patient with dedication and compassion. Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care. The treatment of endometrial cancer depends on the stage of the disease at the time of diagnosis. If you are diagnosed with stage I endometrial cancer, surgery to remove the cancerous tumor may be the only treatment necessary.
If you are diagnosed with stage II endometrial cancer, surgery to remove your uterus and cervix, and possibly both ovaries and fallopian tubes, is the first step. If you are diagnosed with stage III endometrial cancer, you will likely receive a combination of surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes, followed by radiation and, if necessary, chemotherapy. If you are diagnosed with stage IV endometrial cancer, surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes is not always required.
Our surgical team is recognized internationally as one of the best for the treatment of gynecologic cancers, and consistently ranks as one of the top in the country for surgical care. Surgery is performed to determine the stage of cancer, and this may be adequate treatment if you have early-stage endometrial cancer. Removing your uterus will affect your fertility and ability to have children in the future. Surgery takes place in the operating suites at Brigham and Women's Hospital, whose gynecologic cancer program is widely recognized as one of the best in the country.
After surgery, your surgical samples are carefully examined by pathology experts in the Women's and Perinatal Pathology Division. Chemotherapy for endometrial cancer is generally reserved for stages III and IV (as needed) unless certain pathologies of uterine cancer are diagnosed, including uterine carcinosarcomas, clear cell cancers or serous cancers. Throughout your treatment, your medical oncologist will work closely with your team of nurses, nutritionists, and social workers to minimize the toxicities and side effects of chemotherapy, maintain your quality of life, and optimize your results. Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to eliminate cancer cells or stop cancer growth.
Radiation therapy may be delivered at any stage of endometrial cancer to eliminate any remaining cancer cells in the body or lymph nodes after surgery. In brachytherapy or cylinder brachytherapy, radioactive material is directly implanted in or near the tumor or vagina via a tiny needle, wire, or other device.
3D imaging radiation therapy called intensity-modulated radiation therapy (IMRT) uses computer images to find and target the cancerous tumor.
Our physicians developed an innovative approach for providing radiation therapy called fractionation, a series of lower-dose radiation primarily given to endometrial patients who have had their uterus removed. For cases of endometrial cancer that require complex imaging treatment, you will be cared for in an innovative operating and research environment developed specifically at Brigham and Women's Hospital (BWH) in 2011.
Hormone therapy is a treatment that blocks the action of naturally occurring hormones in order to stop cancer cells from growing.
Because endometrial cancer can thrive off the female hormones estrogen and progesterone, our doctors may occasionally suggest progesterone hormone therapy or estrogen blocking therapy to treat your cancer.
Clinical trials are part of the cancer research process; they are regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started.
Ursula Matulonis, MD, Medical Director and Program Leader of Dana-Farber's Medical Gynecologic Oncology Program, answers patients' questions about uterine, ovarian, and cervical cancer. Know the warning signs and common symptoms of endometrial cancer and hear from endometrial cancer survivor Megan Elkins and Dana-Farber gynecologic oncologist Dr. Treatment options include surgery, radiation therapy, and chemotherapy. Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. Endometrial Ablation: This procedure is done as an alternative to a hysterectomy for women who experience abnormally heavy periods. Essure® Tubal Occlusion: For women who are not planning to have any more children, they may want to seek permanent birth control options. IUD Insertion: An IUD, intrauterine device, is a device that is used as a form of long-term birth control and is inserted by a physician. Loop Electrosurgical Excision Procedure (LEEP): This procedure uses a thin electrified wire hook to cut out and extract abnormal tissues in the cervix. NEXPLANON®  Insertion: NEXPLANON®  is a long term form of birth control that is inserted into the arm and is over 99 percent effective at preventing pregnancy for three years. Removal or Destruction of Condyloma: The Human Papillomavirus (HPV) causes Condyloma, or genital warts. Urodynamic Testing: This test is done to measure the function and efficiency of your bladder. Vaginal Rejuvenation: Either due to childbirth or aging, the vagina can become slack or loose. Vulvar Revision or Labiaplasty: This is a simplified surgical procedure that revises deformities or scarring of the labia, hymen or vagina, which can be caused by childbirth or trauma of the genital area.
At OB-GYN Women’s Centre of Lakewood Ranch, we know that by offering a wide variety of treatment options in the comfort of our office, we make procedures less stressful.
Colorectal cancer is not only the second leading cause of cancer deaths in the United States, but it is also the third most commonly diagnosed cancer in the US.


The American Gastroenterological Association developed new guidelines in 2008 and 2012 using a grading system for recommendations for assessment, development, and evaluation. The recommended screening strategies for colorectal cancer include tests based on the study of stool, which include the guaiac based fecal occult blood test and the immunochemical based fecal occult blood test. In patients aged fifty through seventy-five years of age, routine screening that is recommended for those individuals who have no history of adenomas, colorectal cancer, or inflammatory bowel disease, and those with a negative family history. The other option in this group is to have flexible sigmoidoscopy every 5 years with a high sensitivity stool test every 3 years. Patients aged seventy-six through eighty-four may have continued screening, but for those ages 85 and older, screening is not recommended.
Polyps are growths that arise from the lining of the large intestine, or colon, and protrude into the lumen, or interior portion, of the colon.
Patients with rectal or sigmoid polyps appear to be a low risk group, so if the most advanced lesions at the baseline colonoscopy are distal hyperplastic polyps less than ten millimeters, colonoscopy follow-up should be at five to ten year intervals. Patients who are found to have tubular adenomas at baseline colonoscopy are considered low risk if they have one to two adenomas that are less than 10 mm in diameter. High-risk adenomas are defined as tubular adenomas greater than or equal to ten mm in diameter, with patients considered high risk if they have 3 or more adenomas, adenomas with microscopic findings that have pre-cancerous signs or are dysplastic in nature.
A discussion with your physician after a baseline screening will help you understand your choices and the frequency at which screening by stool test, flexible sigmoidoscopy, or colonoscopy are recommended. If you would like to be screened for colon cancer call the expert doctors at Norwich GI today.
Smith Center for Women's Cancers Gynecologic Oncology Program, as our specialists focus exclusively on gynecologic cancers. Surgery is generally performed for all stages of the disease, and the majority of patients undergo surgery to remove the uterus and cervix upfront (so long as the patient is in good health).
During surgery, your uterus and cervix, and possibly both ovaries and fallopian tubes, may be removed. Depending on your case, radiation therapy could follow your surgery to eliminate any remaining cancer cells. Instead, combinations of chemotherapy, hormonal therapies, and clinical trials (and sometimes radiation therapy) will be discussed. We perform over 1,500 gynecologic surgeries each year, so our patients can be reassured they will receive the highest level of surgical care from one of the most experienced teams available. Most endometrial patients are diagnosed later in life, and are less concerned with fertility preservation.
Their evaluation will be shared with all members of your treatment team in a weekly meeting where further treatment (if necessary) and management of your tumor will be decided.
Sometimes treatment involves chemotherapy (drugs that eliminate cancer cells or stop them from dividing) or hormonal therapy, and sometimes treatment will involve clinical trials. Chemotherapy drugs are usually administered after surgery to eliminate remaining cancer cells or keep them from returning. We encourage you to be actively involved in the decision-making process when it comes to choices about chemotherapy treatment. Radiation therapy for endometrial cancer is given by our experienced team of radiation oncologists.
Occasionally, radiation therapy is given in early stages or in complex cases where the cancer is spreading throughout the body.
Radiation is externally delivered and aimed at the tumor, firing thin radiation beams from different angles. This process results in better outcomes, less scar tissue, and a lower risk of vaginal toxicity. Radiation therapy is delivered to a targeted location in the cervix while using a gel spacer, a small, removable sponge-like material injected with gel, strategically placed inside the body to block radiation from nearby healthy tissue or surrounding organs. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists uses the latest imaging tools to develop and deliver the safest, state-of-the-art therapies.
The clinical trials conducted at Dana-Farber have had a profound impact on the type of care administered worldwide. However, for some women with advanced stages of endometrial cancer, taking part in a clinical trial is the best treatment option. Not only can trials lead to new discoveries and improve cancer care, but some may have significant anti-cancer benefits.
Trials also include targeted therapy or therapies using drugs to identify and attack the specific endometrial cancer cells. Review some commonly asked questions about clinical trials and discuss them with your doctor. The doctor may also recommend removing the tubes and ovaries. Surgery combined with radiation therapy is another treatment option.
This procedure takes place so your OB-GYN can more closely examine your cervix, vagina and vulva. During the hysteroscopy, your OB-GYN will use a camera to look inside the uterus to diagnose any obvious uterine abnormalities. It’s a great birth control option for those women who are not interested in permanent birth control. It is done after abnormal Pap test results that have been confirmed by a cervical biopsy and to treat cell changes in the cervix. We are able to custom fit and insert the pessary in-office so you can start feeling better, sooner. During a vaginal rejuvenation procedure, the vagina is “tightened up” either for reconstructive or cosmetic purposes. Colon cancer screening is done because evidence has shown that it prevents significant morbidity and mortality. Guidelines are based upon risk factors, including family history, and are based upon evidence that lives are saved because of screening.


The other important strategy is based upon structural examination of the rectum and the colon, using flexible sigmoidoscopy and colonoscopy, which are both able to detect cancer and lesions that may be pre-malignant.
For patients between the ages of thirty and forty-nine, a review of family history is suggested to identify individuals who are at a higher risk of inherited syndromes. If a patient has one first-degree relative with colorectal cancer or adenoma diagnosed after the age of 60, they are considered to be at average risk and will fall under these guidelines, which include a high sensitivity stool test.
Colonoscopy is another screening method which may be provided as an alternative by providers who prefer this approach to screening, but patients should be informed of the risk of the procedure as compared to annual tests of the stool.
Patients with high-risk adenomas or polyps, especially those that are in the proximal portion of the colon, are at greater risk for development of colorectal cancer in the intervals between colonoscopy, and the screening recommendations for these patients reflect that risk. We create a unique treatment plan for every patient, and consider all aspects of your health history and your future when making our recommendations.
Your medical team will meet regularly to review your health and treatment options and ensure you receive the best care available.
Chemotherapy is rarely necessary if certain pathologies such as clear cell and serous are diagnosed. We highly encourage late-stage endometrial patients to pursue targeted or biologic therapies which may be offered through clinical trials. However, if you are a young woman with an advanced stage of endometrial cancer requiring surgery and would still like to have children, we will carefully review your treatment and surgery options before and after treatment. On occasion, chemotherapy drugs will be given as supplemental treatment to radiation therapy (called "radiation sensitizing" chemotherapy) that can help make the radiation work better.
They are pioneers in the field, regularly setting standards for treatment and safety nationwide. Recurrent cases of endometrial cancer (cancer that has returned after initial treatment) are treated with radiation as a palliative therapy to relieve symptoms and improve quality of life.
This technique offers many benefits, including preservation of healthy tissue, prevention of unnecessary hysterectomies, and better eradication outcomes. Hormone therapy, however, may also be an option for patients who may not be candidates for standard surgical procedures. The genetics of endometrial cancer are better understood than other gynecologic cancers, so there are a number of clinical trials testing therapies that target specific genetic pathways (the paths that lead to cancer on a cellular level).
It is often used for women with Stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. This includes women who are taking estrogen replacement therapy without progesterone therapy or women who have taken tamoxifen for more than 2 years.
That’s why at OB-GYN Women’s Centre of Lakewood Ranch, we offer minor surgeries and procedures in the comfort of our office. When you visit your OB-GYN physician, you will have the opportunity to discuss which of the two procedures will be the best for you. This non-surgical procedure works with your body to create a natural barrier against pregnancy and is proven to be 99 percent effective at preventing pregnancy. If your treatment includes chemotherapy, you will work with a medical oncologist who treats only gynecologic cancer patients.
In later stages with more extensive cancer, more involved and extensive surgeries to remove disease outside the uterus and cervix may be required, in combination with chemotherapy and radiation therapy. We will work with you to customize the best surgical approach that strives to maintain good pregnancy outcomes later on. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient centers in the country — designed by patients, for patients. Our experts administer radiation in a dedicated-radiation suite built specifically for gynecologic patients. Given our advanced radiation technologies, patients with recurring endometrial cancer or cancer deemed incurable can now be treated with radiation — and with more success.
If tests show that the cancer cells have hormone receptors, drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. If you qualify for a clinical trial, your doctor will carefully discuss all options and the best time to begin a trial (before, during, or after cancer treatment). By offering these procedures in-office, we save our patients the time and cost of hospitalization. Polyps are removed during colonoscopy, and they are examined under a microscope which will determine if the polyp is hyperplastic or adenomatous. If you require radiation therapy, you will work with a radiation oncologist who specializes in gynecologic cancers. Other therapies may be suggested in addition to surgery, such as radiation therapy or chemotherapy; certain types of uterine cancer pathologies, such as clear cell and serous, even if diagnosed at an early stage, may require other treatment after surgery. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed.
This suite features state-of-the-art equipment and the latest imaging techniques to treat your endometrial cancer. This can lead to overgrowth of the endometrium and cancer. Most cases of endometrial cancer occur between the ages of 60 and 70. Adenomatous polyps, or adenomas, are usually benign but may be a precursor to colorectal cancer.




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