Stage II Uterine Cancer

Overview

Stage II uterine cancer involves the main body of the uterus and the cervix. Stage IIA cancer involves the uterus and only the surface lining of the cervix. Stage IIB cancer involves the uterus and extends into deep layers of the cervix.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of Stage II uterine cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Optimal treatment of patients with Stage II uterine cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving gynecologic oncologists and radiation oncologists.

Surgery

Surgery for Stage II uterine cancer generally consists of hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) and removal of the pelvic and para-aortic lymph nodes. Surgery alone can be used to treat some patients with Stage IIA disease; however, most patients with Stage II cancer will also be offered adjuvant radiation therapy.

Following standard treatment for Stage II uterine cancer with a hysterectomy, some patients will experience recurrence of their cancer. This is because some patients with Stage II cancer have microscopic cancer cells (micrometastases) that have spread outside the uterus and therefore were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. The presence of these micrometastases causes recurrence following treatment with surgery alone. Following surgery, patients may benefit from additional treatment (adjuvant therapy) to decrease the risk of cancer recurrence. There is a progressive increase in local and distant cancer recurrences in patients with Stage IIA and IIB disease and in patients with well, moderately and poorly differentiated cancers following treatment with surgery alone. To learn more about surgery, go to Surgery for Uterine Cancer.

Adjuvant Therapy

Adjuvant therapy is the delivery of cancer treatment following local treatment with surgery and may include chemotherapy, radiation therapy, hormonal therapy, and/or biologic therapy.

Radiation therapy is the most commonly used adjuvant therapy for early-stage uterine cancer.The objective of adjuvant radiation therapy is to kill cancer cells that were not removed by surgery for a maximum probability of a cure. Radiation therapy, unlike chemotherapy, is considered a local treatment. Cancer cells can only be killed where the radiation is delivered to the body. If cancer exists outside the radiation field, the cancer cells are not destroyed by the radiation.

Women who are candidates for adjuvant radiation therapy may be treated with external beam radiation therapy to the pelvis and/or vaginal brachytherapy.[1]

Adjuvant External Beam Radiation Therapy: External beam radiation therapy (EBRT) is given via machines called linear accelerators, which produce high-energy external radiation beams that penetrate the tissues and deliver the radiation dose deep into the areas where the cancer resides.

Adjuvant Brachytherapy: Brachytherapy treatment involves the placement of a radioactive isotope into the vagina in order to treat the “vaginal cuff” region. The vaginal cuff is the part of the vagina that was closest to the uterus; it is a common site of uterine cancer recurrence.

Treatment of Stage II uterine cancer with surgery followed by adjuvant brachytherapy and external beam radiation therapy has been reported to cure 60-80% of patients.

Neoadjuvant Radiation Therapy

Neoadjuvant therapy is treatment given before surgery. Neoadjuvant radiation therapy is an accepted treatment for women with Stage IIB uterine cancer although there is very little published information on outcomes of this treatment approach. The goal of neoadjuvant therapy is to reduce the extent of cancer before surgery with the hope that this approach will allow the surgeon to remove all of the cancer.

Strategies to Improve Treatment

The progress that has been made in the treatment of Stage II uterine cancer has resulted from the development of multi-modality treatments and doctor and patient participation in clinical trials. Future progress in the treatment of Stage II uterine cancer will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration aimed at improving the treatment of uterine cancer.

Minimally invasive surgery: Traditionally, surgery for uterine cancer has been performed using a procedure known as a laparotomy. During a laparotomy, the surgeon makes a large incision in the abdomen in order to view and remove the uterus and other organs. A less invasive approach to surgery is laparoscopy, in which the surgeon makes only a few small incisions in the abdomen and views the inside of the abdomen using a small camera.  Minimally invasive surgery may also be performed using robotics, in which a surgeon remotely operates a machine that holds the surgical instruments. Potential benefits of minimally invasive surgery include faster recovery time and less pain. Studies conducted thus far suggest that minimally invasive surgery is a safe and effective alternative to laparotomy for selected women with uterine cancer. Other studies are underway.[2]

Adjuvant chemotherapy: Chemotherapy is commonly used in the treatment of advanced uterine cancer. The question of whether it also benefits women with high-risk early-stage cancer is being addressed in ongoing clinical trials.[3]

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.

References


[1] Cannon GM, Geye H, Terakedis BE et al. Outcomes following surgery and adjuvant radiation in stage II endometrial adenocarcinoma. Gynecologic Oncology. 2009;113:176-180.

[2] Humphrey MM, Apte SM. The use of minimally invasive surgery for endometrial cancer. Cancer Control. 2009;16:30-37.

[3] Lu KH. Management of early-stage endometrial cancer. Seminars in Oncology. 2009;36:137-144.

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