Treatment of uterine cancer

A total abdominal hysterectomy removal of the womb through an abdominal incision), with or without removal of the ovaries, is the treatment of choice for stage 1 and 2 disease, although a more extensive operation may be chosen for more advanced stage 2 cases and this may followed by a course of pelvic radiotherapy – external beam radiotherapy over five weeks.

 

An albeit retrospective, non-randomised study of 20,000 patients with the disease has recently reported that adjuvant radiotherapy after hysterectomy appears to improve the survival rates for women with stage 1C/Grades 1,3,4 )J.Am. Med. Assoc 2006; 295: 389-97).

 

With such therapy, for stage 1 disease, the five year survival rates are 73%, whereas the survival for those women presenting with stage 2 tumours is 56%. In stage 3 disease where the disease has spread beyond the ability of the surgeon to obtain a clear margin, then radical pelvic radiotherapy is chosen and a brachytherapy boost (see cancer of the cervix section for explanation of brachytherapy) may be given if it is deemed that the cervical and high vaginal regions are at especially high risk, given an individual patient’s situation. The five year survival rates for stage 3 cases are considerably less good than those of the first two stages and are around 30% survival at five years.

 

Plowman Oncology London (e-mail: postmaster@pnplowman.demon.co.uk)

The modern radiation system is with high energy linear accelerators and using conformal technology The long term follow-up of radically radiated patients is not as good as surgery (perhaps 40% cure) but, recently, the use of chemotherapy together with both surgery and radiotherapy has led to improved results all round and may allow conservative therapy to substitute operation in some cases – for one has always got radical cystectomy to fall back on if follow-up cystoscopy shows persisting tumour (but against this argument one may be risking that usually sound first principle of oncology which is to go for first time cure).

 

Many clinical trials are currently in progress. There is no doubt that modern chemotherapy, using drugs such as cis-platinum and gemcitabine can cause a good regression in transitional carcinoma of the bladder and for younger and fitter patients many would now employ it in conjunction with local therapy (surgery or radiotherapy), but frequently in a clinical trial context.

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