According to the results of a study published in the Journal of Clinical Oncology, removal of the ovaries may not be necessary in young women treated with hysterectomy for early-stage endometrial (uterine) cancer.

Endometrial cancer is cancer of the lining of the uterus. Although it is the most frequently diagnosed gynecologic cancer in the United States, long-term survival rates are high for endometrial cancer that is detected and treated early.

Standard treatment for endometrial cancer includes hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries). The reason for removal of the ovaries is that they could potentially harbor undetectable areas of cancer. In addition, among premenopausal women, removal of the ovaries reduces estrogen levels; because endometrial cancer is an estrogen-sensitive cancer, a reduction in estrogen levels could improve treatment outcomes.

The downside of oophorectemy among premenopausal women is that it induces menopause. Afterwards, women may experience symptoms such as hot flashes and vaginal dryness, and problems such as bone loss.

To explore the effects of oophorectomy on cancer survival and overall survival, researchers evaluated information from 3,269 young women (45 years of age or younger) with Stage I endometrial cancer. The information was collected from a large U.S. cancer registry (the Surveillance, Epidemiology, and End Results [SEER] database).

All the women were treated with hysterectomy. Most of the women also had their ovaries removed, but 402 (12% of the total) did not. The researchers compared survival among the women who had their ovaries removed with survival among the women who did not have their ovaries removed. In the analysis they accounted for factors such as age, tumor grade, and tumor stage (IA, IB, or IC).

The results indicated that overall and cancer-specific survival were similar among women who did and did not have their ovaries removed.

The researchers concluded that preservation of the ovaries may be safe for premenopausal women with early-stage, low-grade endometrial cancer; ovarian preservation was not linked with an increased risk of cancer death. They note, however, that additional research “is clearly warranted.”

Reference: Wright JD, Buck AM, Shah M, Burke WM, Schiff PB, Herzog TJ. Safety of ovarian preservation in premenopausal women with endometrial cancer. Journal of Clinical Oncology. Early online publication January 26, 2009.

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Pelvic lymphadenectomy (removal of pelvic lymph nodes) may be valuable for staging in endometrial cancer; however, it does not improve survival rates in women with Stage I endometrial cancer, according to the results of a study published in the Journal of the National Cancer Institute.[1]

Endometrial cancer is a cancer of the uterus and is the most frequently diagnosed gynecologic cancer in the United States. Fortunately, long-term survival rates are high for cancers detected and treated early.

Standard treatment for endometrial cancer includes a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).

The most common site of cancer spread in early-stage endometrial cancer is to the pelvic lymph nodes. A pelvic lymphadenectomy is a surgical procedure in which the pelvic lymph nodes are removed and examined to see if they contain cancer. In the past researchers have been uncertain whether pelvic lymphadenectomy improves survival in early-stage endometrial cancer.

Researchers from Italy conducted a multicenter clinical trial in which 514 women with Stage I endometrial cancer were randomly allocated to receive pelvic lymphadenectomy (264) or no lymphadenectomy (250). The median number of lymph nodes removed in the lymphadenectomy group was 30. Early and late postoperative complications were more common in the lymphadenectomy group, with 81 of these patients experiencing complications compared with 34 in the non-lymphadenectomy group.

Pelvic lymphadenectomy did improve surgical staging, as 13.3% of women in the lymphadenectomy group were found to have metastases compared with 3.2% in the non-lymphadenectomy group. However, both the five-year disease-free survival and five-year overall survival were similar in both groups: five-year disease-free survival was 81% in the lymphadenectomy group and 82% in the non-lymphadenectomy group, and five-year overall survival was 86% in the lymphadenectomy group and 90% in the non-lymphadenectomy group.

Based on these results, the authors concluded: “Although systematic pelvic lymphadenectomy statistically significantly improved surgical staging, it did not improve disease-free or overall survival.”

Reference:

The 39^th Annual Meeting of the Society of Gynecologic Oncologists (SGO) was held in Tampa, Florida, from March 9 to 12, 2008, and was attended by more than 1,000 oncologists and other healthcare professionals.

Established to “promote and ensure the highest quality of comprehensive clinical care through excellence in education and research in gynecologic cancers,” the SGO Annual Meeting this year included numerous presentations on gynecologic cancers and novel therapies.

Endometrial Cancer

Endometrial cancer is the most common gynecologic cancer diagnosed in the United States. It originates in the inner lining of the uterus called the endometrium. Many endometrial cancers occur in obese women and result from estrogen exposure. There is currently no screening test for this disease; however, an early symptom of postmenopausal bleeding often allows for this cancer to be detected in the early stages. In 2008 there are expected to be 40,100 new cases of cancer of the uterus¹, with the vast majority of these being endometrial cancers. It is estimated that 7,470 women will die of uterine cancer this year.[1]

Because endometrial cancer is detected early in most cases, patients are often treated surgically with a total hysterectomy and removal of the fallopian tubes, ovaries, and lymph nodes. In some patients, radiation treatments or chemotherapy may be recommended based on findings made at surgery. However, when the cancer is found to have spread during surgery-with visible evidence of tumor deposits in different parts of the abdomen and pelvis-the correct treatment is not very well defined.

Clinical Trial of the Gynecologic Oncology Group

A randomized Phase III clinical trial of surgery, radiation therapy, and chemotherapy in women with advanced endometrial cancer was recently conducted to determine if the addition of paclitaxel to a standard two-drug chemotherapy regimen (cisplatin plus doxorubicin) after surgery and radiation treatment improved survival in women with advanced endometrial cancer. Results were presented at the SGO meeting.[2]

All patients underwent an aggressive surgical debulking procedure in which cancer metastases throughout the abdomen and pelvis, along with the uterus, ovaries, and fallopian tubes plus/minus lymph nodes, were removed, followed by radiation therapy. Of the 659 patients enrolled onto this trial from July 2000 to September 2004, 552 women were then eligible to receive either six cycles of the two-drug regimen (cisplatin plus doxorubicin) or six cycles of the three-drug regimen (cisplatin plus doxorubicin and paclitaxel).

As expected, patients treated with three drugs experienced more frequent and more severe side effects, including bone marrow suppression and numbness, related to paclitaxel. The proportion of patients alive and free of relapsing cancer at three years of follow-up was 62 percent for the two-drug regimen, and 64 percent for the three-drug regimen. The investigators concluded that the addition of paclitaxel to cisplatin plus doxorubicin in women who had undergone maximal surgical debulking and radiation therapy for advanced endometrial cancer was not associated with a significant improvement in survival.

To improve survival in advanced endometrial cancer, further studies involving newer chemotherapy agents and possibly novel biologic drugs need to be conducted.

Gestational Trophoblastic Disease

Molar pregnancies result in an abnormally developed placenta without a normal fetus. As a result, molar pregnancies are suctioned from the uterus through the vagina and in 20 percent of cases, will also require chemotherapy after surgery. In the “low risk” version of this situation-referred to as gestational trophoblastic neoplasia (GTN)-cure rates approach 100 percent when drugs such as methotrexate or dactinomycin are administered.

Methotrexate and dactinomycin have different side effects and different dosing schedules. Often when one of these drugs fails to cure a case of gestational trophoblastic neoplasia, the disease is then cured with the other drug. It is not known, however, which is the best drug to start treatment with or if it makes a difference.

Clinical Trial of the Gynecologic Oncology Group

A recent randomized Phase III trial of weekly intramuscular injections of methotrexate versus intravenous injections of dactinomycin every two weeks compared the two drugs as first-line therapies.[3]

Of the 240 patients who were enrolled on this study from June 1999 to February 2007, 215 were eligible for analysis. Mild nausea, vomiting, and hair loss were reported by more patients treated with dactinomycin when compared with those receiving methotrexate. In addition, severe side effects related to bone marrow suppression occurred in two patients receiving dactinomycin. Sixty-nine percent of patients treated with dactinomycin were successfully placed into remission as compared with 53 percent who received methotrexate.

Although side effects were more common in patients treated with dactinomycin, this study demonstrated that biweekly administration of dactinomycin was statistically superior to weekly administration of methotrexate as initial management of low-risk GTN. Future studies will likely be needed to address whether alternating dactinomycin with methotrexate will place patients into remission sooner than dactinomycin alone.

Advanced Ovarian Cancer

Because there is no screening test for ovarian cancer and because early symptoms are often missed, the vast majority of patients are diagnosed with advanced disease, placing overall five-year survival rates at 20 to 30 percent. In 2008 it is estimated that there will be 21,650 new cases in the United States and 15,520 deaths from this disease.¹ Standard therapy involves aggressive surgical debulking of the tumor (removing as much as possible) followed by intravenous (IV) chemotherapy.

Intrapeitoneal (IP) chemotherapy involves administering the chemotherapy drugs directly into the patient’s abdominal cavity, and this method has been shown to prolong survival in patients with optimally debulked ovarian cancer (where the amount of residual visible cancer left behind at the end of surgery is less than 1 cm). Unfortunately, many patients cannot enjoy the survival benefit associated with IP chemotherapy because they are not able to be optimally debulked at the time of surgery. In many centers, patients who are felt to be inoperable or for whom the likelihood of optimal debulking is felt to be very low, are given chemotherapy first in a strategy known as neoadjuvant chemotherapy, which is then followed by interval debulking.

Clinical Trial of the Southwest Oncology Group

A recent clinical trial that evaluated whether intraperitoneal (IP) chemotherapy could be incorporated into the treatment of women with advanced ovarian cancer who were rendered optimally debulked after first having been treated with neoadjvuant chemotherapy.[4] Among the 62 patients registered between March 2001 and February 2006, 26 were rendered optimally debulked following neoadjuvant chemotherapy and were then eligible to receive a combination of IV and IP chemotherapy. Four of these patients experienced severe bone marrow suppression. The overall survival of these 26 patients was reported as being 34 months.

Because the survival results in this study are superior to those reported for patients who cannot be optimally debulked, it suggests that another viable indication for IP therapy would include patients who are able to be optimally debulked following neoadjvuant chemotherapy. To validate these results, a larger Phase III trial comparing the outcome of patients who are rendered optimally debulked following neoadjuvant chemotherapy is needed wherein patients are then randomized to either standard postoperative IV therapy or postoperative IV and IP therapy.

Early Ovarian Cancer

With the exception of very specialized tumors of the ovary (for example, borderline tumors and malignant germ cell tumors), ovarian cancer typically presents in the advanced stages. For those patients fortunate enough to be diagnosed with a Stage I ovarian cancer, cure rates following chemotherapy can be as high as 90 percent.

Among those patients with Stage I ovarian cancer for whom chemotherapy is recommended, it is not clear whether a limited number of cycles of chemotherapy (for example, three) is as effective as the six cycles used in the setting for patients who are diagnosed with advanced disease.

Exploratory Analysis of a Gynecologic Oncology Group Clinical Trial

A randomized Phase III clinical trial conducted by the Gynecologic Oncology Group (GOG) and published in 2006 compared three versus six cycles of chemotherapy in 427 patients with early Stage I-II ovarian cancer.[5] This study revealed a trend toward an improved survival in those patients who received six cycles of chemotherapy. At the recent SGO meeting, another trial sought to build on the findings of that GOG study by identifying subsets of patients with early-stage ovarian cancer who may benefit from six cycles of chemotherapy.[6]

Some of the factors that the investigators looked at included: age of the patients and their functional status (for example, whether they were active and healthy or less so), ethnicity, stage of disease (I versus II), the grade of the cancers (1, 2 or 3), presence of ascites fluid (abnormal buildup of fluid in the abdomen), and whether the ovarian tumor had ruptured.

The risk of relapse in those who received six versus three cycles of chemotherapy was not different based on age, race, functional status, stage, grade, or for presence of ascites or rupture. However, for women with serous ovarian cancers, the risk of relapse was significantly decreased after six compared with three cycles of chemotherapy; Five-year relapse-free survival rates were 83 percent versus 60 percent, respectively.

This analysis identified a subgroup of early-stage ovarian cancer patients who are likely to benefit from six cycles of chemotherapy-specifically, those with serous ovarian cancers. This important observation supports and validates the trend that was seen in the original publication of this GOG trial. Because early-stage ovarian cancer is relatively uncommon, it is unlikely that any trial group will be able to run another large study on early-stage ovarian cancer, thus making this exploratory analysis of existing GOG data an invaluable contribution to the body of literature on this disease.

Vulvar Cancer

Cancer of the vulva accounts for 8 percent of gynecologic malignancies, and women are usually diagnosed later in life-many in their 70s and 80s. It is estimated that there will be 3,460 new cases and 870 deaths in the Unites States in 2008.¹ The cancer usually spreads by local extension of the tumor or through the lymphatic pathways, first to the lymph nodes in the groin, followed by spread to the lymph nodes in the pelvis.

Treatment of vulvar cancer typically consists of radical vulvectomy (partial or complete removal of the vuvla), with dissection of one or both sides of the lymph nodes in the groin. Patients found to have disease in the groin lymph nodes are candidates for additional therapy. In a previous randomized study by the Gynecologic Oncology Group, investigators reported that the addition of pelvic and groin radiation therapy to women found to have cancerous groin lymph nodes was superior to surgical removal of the lymph nodes in the pelvis.[7]

Updated Analysis of a Gynecologic Oncology Group Study

Long-term follow-up data on the original GOG trial recently revealed that among the 111 patients who had been enrolled onto this protocol from 1977 to 1984, the six-year cancer-related survival significantly favored the group of patients who had received postoperative pelvic and groin radiation therapy as compared with those patients who had been randomly assigned to undergo pelvic lymph node dissection on the side of the body where lymph node metastases to the groin had been found.[8] This benefit was especially important in those patients with enlarged or fixed groin nodes and for those with two or more positive groin lymph nodes. When more than 20 percent of the groin nodes on the same side of the vulvar cancer were positive for metastases, cancer-related death and overall survival were significantly influenced. Interestingly, late toxic effects were similar among the two different treatments.

With prolonged follow-up, this study verified that the results obtained in the original GOG study published in the early 1990s were sustained: postoperative radiation to the groin and pelvis is superior to pelvic lymph node dissection when vulvar cancer metastases are found in the groin. Furthermore, this study identified important subsets of patients whose groin lymph nodes were involved with metastases (for example, those with 20 percent groin nodes positive, two or more positive nodes) who are at especially high risk of relapse and death for whom innovative new therapies (for example, chemotherapy) are needed.

Vaccination Against Cervical Cancer

Pap smears have decreased the incidence and death rate of cervical cancer among women in developed countries such as the United States. Cervical cancer is caused by the specific high-risk strains of the human papillomavirus (HPV), which can be detected by a special test called Hybrid Capture II (made by Digene).

Now that an HPV vaccine (Gardasil®, manufactured by Merck) has been approved by the U.S. FDA, further reductions in cervical cancer incidence and death may be anticipated. Gardasil is a quadrivalent vaccine because it confers protection against four subtypes of HPV (HPV 6 and HPV 11, which cause 90 percent of genital warts, and HPV 16 and HPV 18, which cause 70 percent of cervical cancers).

Despite the success of Pap smear programs and the ability to detect HPV, over 2 billion dollars in healthcare expenditure occurs annually as a result of abnormal Pap tests and their subsequent evaluation, which often requires cervical biopsies and other surgical procedures on the cervix. This is because, although Pap smears and HPV detection allow a pre-cancerous or dysplastic state of the cervix to be detected and treated before it can turn into cancer, neither of these two methods eliminate the original problem, which is infection with HPV.

Clinical Trial of the Quadrivalent HPV Vaccine Merck Study Group

Recently, the end-of-study data from three pivotal Phase II/III clinical trials of the quadrivalent HPV vaccine were reported at the SGO meeting.[9]A total of 18,15016 to 26-year-old women were enrolled in one of three randomized, placebo-controlled trials. Vaccine or placebo was given at Day 1, Month 2, and Month 6. Subjects underwent Pap testing on Day 1 and every six to 12 months for up to 48 months. Patients with specific abnormalities on the Pap smear were referred for colposcopy and, depending on the findings, definitive treatment was carried out.

After an average follow-up period of four years, the investigators noted a reduction in Pap tests, colposcopy, cervical biopsy, and definitive treatment among patients who were uninfected with HPV at the time of vaccination. Interestingly, these reductions were seen irrespective of the specific type of HPV involved.

Vaccination with the quadrivalent vaccine appears to be able to decrease the number of Pap tests, colposcopies, cervical biopsies, and treatment women require. This occurs presumably because the vaccine protects against infection with HPV, which is the inciting event in the development of pre-cancerous cervical disease (which is not possible with Pap smears and HPV testing along). Long-term studies are required to determine the duration of protection that is achieved by the three-dose vaccination series.

Advanced and Recurrent Cervical Cancer

It is estimated that in 2008 there will be 11,070 new cases of cervical cancer in the United States and 3,870 deaths.¹ This relatively low incidence of cervical cancer has been primarily brought about through the inclusion of Pap smears in screening programs. However, for women who do not have access to healthcare, important clinical tools, such as Pap smears, HPV testing, and the HPV vaccine, will remain unavailable.

Fortunately, many cervical cancers are diagnosed at an early stage when they may be cured through radical surgery. For those cancers that are locally advanced but have not metastasized, a combination of pelvic radiation plus chemotherapy has resulted in respectable cure rates, which approach nearly 80 percent in some groups.[10] For metastatic cervical cancer and most cases in which relapse occurs, treatment is often futile, with most patients surviving less than one year despite chemotherapy. The armamentarium of chemotherapy drugs, either alone or in combination with one another, has been exhausted in a number of previous trials for this disease with mixed results.[11]

Clinical Trial of the Gynecologic Oncology Group

A recent Phase II trial investigated the novel biologic agent bevacizumab in women with relapsing cervical cancer.[12] Bevacizumab is considered an anti-vascular drug, which prevents the tumor from growing blood vessels to the patient, thus preventing ongoing nutrition of the cancer. The investigators reported on 46 patients who were treated with this unique drug after having received unsuccessful treatment with chemotherapy drugs for relapsing disease. For 38 patients, their cervical cancer had originally been treated with radiation therapy. Although several severe side effects associated with bevacizumab were observed, there were no treatment-related deaths. Importantly, five patients (11 percent of the study group) experienced cancer shrinkage and 11 patients (24 percent of the study group) had tumors that did not grow for at least six months.

Because the results of this study involving a biological agent compared favorably with those studies that have tested chemotherapy drugs for metastatic cervical cancer, serious consideration will be given by the GOG to conduct a randomized clinical trial comparing chemotherapy drugs with and without bevacizumab for this disease.

Coverage of the 39^th Annual Meeting of the Society of Gynecologic Oncologists Provided by:

References

Differences between the prescribed dose of radiation in intensity modulated radiation therapy (IMRT) and the dose that’s actually delivered may make comparison studies in gynecological cancers difficult to interpret. These findings were reported in the Journal of the National Cancer Institute.

Radiation therapy is often used in the treatment of various forms of cancer. Radiation therapy uses beams of radiation to slow or stop cancer cell growth, which shrinks or eliminates the tumor.

Intensity modulated radiation therapy is an advanced radiation technique that uses computers to control the devices that deliver precise radiation doses to malignant tumors or specific areas of the tumor. Because the surrounding tissues are minimally affected with IMRT, higher, more-effective radiation doses may be delivered to the tumor, with fewer side effects.

Currently, IMRT is approved for the treatment of cancers of the prostate, head and neck, breast, thyroid, and lung, as well as for gynecological cancers, brain and liver tumors, lymphomas, and sarcomas.

Although widely accepted as an effective method for delivering radiation, IMRT depends on the software that controls the devices and the treatment machines. Researchers have been concerned that the system may allow for some inconsistencies in IMRT dose prescriptions, treatment planning, dose recording, and dose delivery among cancer patients treated at different medical facilities.

In order to look for inconsistencies in patient care among different medical facilities, researchers evaluated the records of 803 patients who were treated with IMRT between October 2004 and July 2006 at five different medical facilities within the United States. Each facility had a different treatment planning system. Patients were treated for cancers of the brain, head or neck, or prostate. In each case, researchers identified the prescribed dose and the actual dose of radiation received.

• Doses were inconsistent among the five institutions.
• A total of 46% of the patients received a maximum dose that was 10% higher than the prescribed dose, while 63% of the patients received a dose that was more than 10% lower than the prescribed dose.
• Prostate cancer treatment had the least variability in dose, while cancers of the head and neck had the greatest variation.
• Overall, the average dose varied from the prescribed dose by 2% in 68% of the patients, 5% in 88% of the patients, and by 10% in 96% of patients.

These variations raise concern about the validity of comparing clinical outcomes among patients who have received IMRT as part of their cancer treatment. The study suggests that broader national or international guidelines for dose prescriptions, planning, and reporting may be necessary to effectively compare clinical trial results for IMRT.

Reference: Das, I., Cheng, C., Chopra, K., et al. Intensity modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. Journal of the National Cancer Institute. 2008. doi: 10.1093/jnci/djn020.

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Survival for patients diagnosed with uterine leiomyosarcomas may be influenced by several factors. These findings were recently published in the journal Cancer.

The uterus is located in the abdomen and is part of the female reproductive system. During childbearing the embryo is implanted in the uterus and the baby develops there. It is a hollow, pear-shaped organ that is composed of two layers of tissue: the lining of the uterus, or endometrium, and the outer layer of muscular tissue called the myometrium.

Uterine leiomyosarcomas (LMS) are a rare form of uterine cancer, where muscular tumors develop in the lining of the uterus. Benign muscular tumors, called fibroids, are more commonly seen in the uterus.

Uterine cancer is often diagnosed by a biopsy of the tumor. Following diagnosis the stage of the cancer, or extent its spread, is determined. Stage indicates factors such as whether or not the cancer has spread beyond the uterus and if the surrounding lymph nodes have been affected.

The cause of uterine cancer is unknown, but several risk factors have been identified. These include age of more than 50 years, a history of benign uterine lining abnormalities, hormone replacement therapy, obesity, race, history of colorectal cancer, and use of the drug tamoxifen (Nolvadex®).

This recent study evaluated results of the Surveillance, Epidemiology, and End Results data base between the years 1988–2003 to identify factors that may impact survival of women diagnosed with LMS. The average age of the 1,396 patients in the study was 52 years. Various stages of uterine cancer were included as follows: 951 patients had Stage I disease, 43 patients had Stage II disease, 99 patients had Stage III disease, and 303 patients had Stage IV disease.

• The five-year survival rates for each stage were identified as follows: Stage I, 75%; Stage II, 60%; Stage III, 44%; Stage IV, 28%.
• Of the 348 patients who underwent surgery to examine surrounding lymph nodes for signs of cancer, 23 were found to have evidence of cancer. These patients had a five-year survival rate of 26% compared with 64% for patients with no cancer spread to their lymph nodes.
• Some of the patients who were under age 50 and who had Stage I or II disease chose have their ovaries surgically removed (oophorectomy) in an attempt to prevent further spread of the cancer (240 women). Oophorectomy, however, did not change five-year survival.

When all factors were evaluated together, those associated with poorer survival included older age at time of diagnosis, more-advanced stage of cancer, African- American race, larger or aggressive tumors, more-recent year of diagnosis, and lack of surgical intervention prior to treatment.

Reference: Kapp, D., Shin, J., Chan, J. et al. Prognostic factors and survival of 1396 patients with uterine leiomyosarcomas. Cancer. 2008: 112(4) 820-830.

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Among women who received post-surgery radiation therapy for endometrial cancer, vaginal brachytherapy (a type of internal radiation therapy) resulted in better quality of life than external beam radiation therapy. These results were presented at the European Cancer Conference (ECCO 14).

Some patients with endometrial cancer receive adjuvant (post-surgery) treatment with radiation therapy. Two different approaches to delivering radiation therapy for endometrial cancer are external beam radiation therapy and vaginal brachytherapy. Vaginal brachytherapy is a type of internal radiation therapy in which radioactive material is placed within the vagina.

To compare vaginal brachytherapy to external beam radiation therapy, researchers in The Netherlands conducted a clinical trial among 427 women with endometrial cancer. The trial was restricted to selected patients with Stage IB, IC, or IIA cancer. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (surgical removal of the uterus, the ovaries, and the fallopian tubes).

The study was designed to address both treatment effectiveness and impact on quality of life. The presentation at the European Cancer Conference focused on the quality of life results; effectiveness results are not yet available.

• In both groups of patients, quality of life was lowest after surgery and then gradually improved.
• From six months onwards, patients who had received vaginal brachytherapy reported better overall quality of life than patients who received external beam radiation therapy.
• Patients who had received vaginal brachytherapy reported fewer bowel symptoms (such as diarrhea) and less fatigue than patients who received external beam radiation therapy.
• There was no significant difference between the groups in sexual symptoms (such as vaginal dryness) or sexual interest.

While these results suggest that vaginal brachytherapy results in better quality of life than external beam radiation therapy, effectiveness information is not yet available from this study. This information will be available in the future, and will help guide treatment decisions for women with intermediate-risk endometrial cancer.

Reference: Putter H, Schultz IM, Jobsen JJ et al. Quality of life after radiotherapy for endometrial cancer: first results from the randomized PORTEC2 trial. Presented at ECCO-14 – The European Cancer Conference. Barcelona, Spain, September 23-27, 2007. Abstract O#5000.

Related News: Brachytherapy Effective for Stage I Endometrial (Uterine) Cancer (8/12/2005)

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According to an article recently published in Gynecologic Oncology, nearly one-third of survivors of a gynecologic cancer suffer from anxiety or post-traumatic stress disorder symptoms.

Patients who are survivors of cancer often struggle with psychological or emotional distress. In order to improve a patient’s quality of life, these issues must be addressed. Research has recently focused on long-term survivorship issues. With greater understanding of these issues, intervention, when necessary, may be appropriately implemented for these individuals.

Researchers from Australia recently conducted a clinical study to evaluate the long-term psychosocial outcomes of women who were survivors of gynecologic cancers. This study included 199 women who were cancer-free and had received treatment for a gynecologic cancer between one and eight years earlier.

• Nearly one-third of patients reported levels of anxiety that were clinically relevant, with the most frequent concern being fear of a recurrence of their cancer.
• Nearly 20% of patients reported symptoms that were indicative of posttraumatic stress disorder (PTSD); these symptoms occurred in nearly one-third of patients who had been diagnosed with advanced-stages of cancer.
• The duration of time since the diagnosis of their cancer was not related to distress levels.
• Nearly 90% of patients reported a need for supportive care.

The researchers concluded that long-term survivors of gynecologic cancers often suffer from anxiety or PTSD symptoms and require supportive care in order to improve their quality of life.

The authors state, “All members of the care team need to be aware that significant psychosocial morbidity may occur many years after the successful treatment of a gynecologic malignancy and may be associated with elevated supportive care needs. Comprehensive and extended supportive care services are required to address anxiety and trauma responses and investigate strategies to meet ongoing needs in order to improve long-term psychosocial outcomes.”

Long-term survivors of cancer who are feeling anxiety or emotional distress should speak with their healthcare provider regarding supportive care measures to improve psychosocial function and quality of life.

Reference: Hodgkinson K, Butow P, Fuchs A, et al. Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes. Gynecologic Oncology. 2007; 104: 381-389.

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According to an article recently published in Gynecologic Oncology, short term outcomes of surgery for uterine cancer are better if the surgery is performed by surgeons who perform a high volume of these surgeries.

Complicated surgery for cancer is increasingly being performed in specialized centers. This is the result of a large and growing body of evidence that has demonstrated improved outcomes for patients treated by surgeons who perform a high volume of specialized surgeries and for patients who are treated in a hospital with a high volume of patients undergoing a specific procedure.

Researchers from Johns Hopkins Oncology Center recently conducted a study that evaluated the outcomes of women undergoing surgery for uterine cancer between 1994 and 2005 in the state of Maryland. In this study, surgeon and hospital case volume were divided into two categories-low and high-based on the number of cases over a 12-year period.

• Low-volume surgeon: less than 99 cases in 12 years
• High-volume surgeon: more than 100 case in 12 years
• Low-volume hospital: less than 199 cases in 12 years
• High-volume hospital: more than 200 cases in 12 years

These researchers evaluated 6,181 cases of uterine cancer. The study involved 894 surgeons and 49 hospitals.

• 60% of surgeries for uterine cancer were performed by low-volume surgeons.
• 90% of the surgeries were performed in high-volume hospitals.
• Patients treated by high-volume surgeons had nearly half (48%) the rate of in-hospital death as those not treated by high-volume surgeons. They reported that management by high-volume surgeons was associated with a 48% reduction in the risk of in-hospital death.

The researchers concluded that these results add to existing evidence clearly indicating that patients treated by surgeons performing high volumes of specific types of surgery experience better outcomes. Results from this study indicate that women with uterine cancer have a reduced risk of death when treated by high-volume surgeons.

Patients diagnosed with uterine cancer may wish to speak with their physician regarding the volume of procedures they have performed.

Reference: Diaz-Montes TP, Zahurak ML, Giuntoli RL, et al. Uterine cancer in Maryland: Impact of surgeon case volume and other prognostic factors. Gynecologic Oncology. 2006;103:1043-1047.

According to an article recently published in the British Journal of Cancer, treatment including either chemotherapy or radiation therapy following surgery provides similar outcomes among patients with early, high-risk uterine cancer.

The uterus, or womb, is located in a woman’s pelvis. Endometrial cancer is the most common type of uterine cancer and refers to the type of cell within the uterus where the cancer originated. Early endometrial cancer refers to cancer that has not spread from the uterus. However, some patients with early endometrial cancer are at a high risk for developing a recurrence. These high-risk patients often have cancer that has spread into the muscular layer of the uterus.

It has not yet been established whether chemotherapy or radiation therapy following surgery provide an improved outcome for women with early, high-risk endometrial cancer. Researchers from Italy recently conducted a trial to directly compare chemotherapy and radiation therapy following surgery among 345 women with high-risk endometrial cancer.

• There was no improvement in progression-free survival or overall survival between the two groups of patients.
• At three, five, and seven years, the overall survival rates were 78%, 69%, and 62% for patients treated with radiation therapy, and 76%, 66%, and 62% for those treated with chemotherapy.
• At three, five, and seven years, the progression-free survival rates were 69%, 63%, and 56% for those treated with radiation therapy, and 68%, 63%, and 60% for those treated with chemotherapy.

The researchers concluded that there is no difference in outcomes between radiation therapy and chemotherapy following surgery for the treatment of early, high-risk endometrial cancer. The researchers stated that trials comparing radiation plus chemotherapy to radiation therapy alone are ongoing and results are eagerly awaited.

Patients with early, high-risk endometrial cancer may wish to speak with their physician regarding their individual risks and benefits of either radiation or chemotherapy.

Reference: Maggi R, Lissoni A, Spina F, et al. Adjuvant Chemotherapy Vs Radiotherapy in High-Risk Endometrial Carcinoma: Results of a Randomised Trial. British Journal of Cancer. 2006;95:266-271.

Chemotherapy has been shown to improve survival compared to whole abdominal radiation in the treatment of women with a rare form of uterine cancer-carcinosarcoma of the uterus-who have undergone surgery to remove most of their disease. These results were presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO) held in Atlanta, Georgia, June 2-6, 2006.

Optimal adjuvant treatment following initial surgery has not yet been established for the treatment of patients with carcinosarcoma of the uterus who have already undergone surgery to remove as much of the cancer as possible. Approaches including chemotherapy and/or radiation therapy are utilized; however, side effects need to be carefully weighed against the benefits of either approach.

Researchers affiliated with the Gynecologic Oncology Group conducted a randomized clinical trial directly comparing chemotherapy consisting of cisplatin, ifosfamide, and mesna (CIM) to abdominal radiation in the treatment of women with stages I-IV uterine carcinosarcoma. This trial was initiated in 1993, and the 206 patients were followed for 12 years.

After surgery, the patients had no residual disease greater than 1 cm. Patients received their treatment within eight weeks of surgery. The median age was 65 years. The researchers reported the following results:

• Chemotherapy reduced the risk of recurrences by approximately 30%, after adjusting for stage of disease.
• At five years, survival rates were 44% for those treated with chemotherapy, compared with 34% for those treated with whole abdominal radiation.
• At five years, survival rates for patients with stages I-II were 60% for those treated with chemotherapy, compared with only 30% for those treated with whole abdominal radiation.
• Cancer recurrences in the abdominal area were more common among women treated with whole abdominal radiation.
• Cancer recurrences in the vaginal area were more common among women treated with chemotherapy.

The researchers concluded that chemotherapy appears superior to whole abdominal radiation in the treatment of patients with carcinoscarcoma of the uterus who had most of their cancer removed through surgery. Patients with stages I-II appeared to derive the most benefit. Further studies including those using newer chemotherapy drugs, as well as the addition to chemotherapy of radioactive seeds that are implanted in the vagina are ongoing.

Reference: Wolfson A, Brady M, Mannel R, et al. A Gynecologic Oncology Group Randomized Trial of Whole Abdominal Irradiation (WAI) vs Cisplatin-Ifosfamide+Mesna (CIM) in Optimally Debulked Stage I-IV Carcinosarcoma (CS) of the Uterus. Proceedings from the 42nd Annual Meeting of the American Society of Clinical Oncology (ASCO). June 2006. Atlanta, GA. Abstract #5001.

The removal of lymph nodes during surgery appears to improve cancer-free survival among some patients with endometrial uterine cancer. These findings were presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO) held in Atlanta, Georgia, June 2-6, 2006.

Endometrial cancer is a cancer of the uterus and is the most frequently diagnosed gynecologic cancer in the U.S. Fortunately, long-term survival rates are high for cancers detected and treated early.

Standard treatment for endometrial cancer includes a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries). The surgical procedure in which the lymph nodes are removed and examined to see if they contain cancer is called a lymphadenectomy.

Researchers from Stanford University and China recently analyzed data collected between 1988 and 2001 from 39,396 patients to determine if patients who underwent lymphadenectomy in addition to standard surgical treatment experienced a survival advantage. Approximately one-third of the patients had undergone lymphadenectomy during their surgical procedure.

The researchers reported that, at five years, patients with stage I, grade 3, or stages II-IV uterine cancers who had undergone lymphadenectomy survived longer and were cancer-free for longer than patients who were not treated with lymphadenectomy.

Five-year survival rates are as follows:

• Stage I: 97% without lymphadenectomy and 97% with lymphadenectomy
• Stage II: 82% without lymphadenectomy and 90% with lymphadenectomy
• Stage III: 61% without lymphadenectomy and 73% with lymphadenectomy
• Stage IV: 28% without lymphadenectomy and 53% with lymphadenectomy

Research is ongoing to determine the optimal number of nodes that should be removed during lymphadenectomy. Women diagnosed with endometrial cancer may wish to speak with their physicians regarding the potential risks and benefits of lymphadenectomy.

Reference: Karnik Lee N, Wu H, Cheung M, et al. The Impact of Lymphadenectomy in Women with Endometrioid Uterine Cancer: A Study of 39,396 Women. Proceedings from the 42nd Annual Meeting of the American Society of Clinical Oncology. 2006. Atlanta, GA. Abstract #5000.

According to an early online publication in the Journal of Clinical Oncology, amplified expression of the human epidermal growth factor receptor-2 (HER2) is associated with more aggressive cancer and worse survival among patients with endometrial cancer.

Endometrial cancer refers to cancer of the uterus, or womb. Endometrial cancer is the most frequently diagnosed gynecologic cancer in the U.S. Fortunately, long-term survival rates are high for endometrial cancers that are detected and treated early.

Unfortunately, certain women diagnosed with endometrial cancer tend to have worse outcomes than others. In order to individualize treatment, researchers continue to evaluate possible variables associated with differences in outcomes.

The HER2 receptor is involved in cellular growth and replication. Some cancers over-express HER2 on the surface of their cells, which is thought to play a role in the growth and/or spread of the cancer.

Herceptin® (trastuzumab) is a monoclonal antibody that is approved for advanced breast cancer with over-expression of HER2; it is designed to target the HER2 receptor. Herceptin reduces or prevents the activity of HER2, ultimately slowing the growth of breast cancer. Herceptin, as well as other agents targeting HER2, are being evaluated in clinical trials for the treatment of various cancers.

Researchers from several medical institutions in the U.S. recently conducted a study to evaluate the possible relationship between HER2 expression and endometrial cancer outcomes. This study included 483 women diagnosed with different stages and types of endometrial cancer; they were tested for HER2 expression. Researchers determined the following:

• Patients with cancer that over-expressed HER2 had a significantly worse prognosis than those whose cancers did not express HER2.
• Median overall survival was 5.2 years for patients with over-expression of HER2, 3.5 years for patients with expression of HER2, and 13 years for patients who did not express HER2 on their cancers.
• Over-expression of HER2 was more common among more aggressive cancers.

The researchers concluded that over-expression of HER2 appears to play a significant role in the nature of endometrial cancer and patient outcomes. Future trials are needed to determine if treatment including Herceptin or other agents that target HER2 may improve outcomes for patients with endometrial cancer that over-expresses HER2.

Reference: Morrison C, Zanagnolo V, Ramirez N, et al. HER2 Is an Independent Prognostic Factor in Endometrial Cancer: Association With Outcome in a Large Cohort of Surgically Staged Patients. Journal of Clinical Oncology. 2006; 24: 2376-2385.

According to a recent article published in the Journal of the American Medical Association (JAMA), radiation following surgery improves survival in patients with stage I endometrial cancer.

Endometrial cancer refers to cancer of the uterus, or womb. Endometrial cancer is the most frequently diagnosed gynecologic cancer in the U.S. Fortunately, long-term survival rates are high for cancers detected and treated early.

Stage I endometrial cancer refers to cancer that has not spread outside the uterus. Stage IC is cancer that invades more than one half of the muscle wall of the uterus.

Standard treatment for stage I endometrial cancer includes a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries) with or without removal of the pelvic and para-aortic lymph nodes. Despite complete surgical removal of all visible cancer, 5%-20% of patients will experience recurrence. These recurrences are caused by undetectable cancer cells that remain in the body following surgery.

Adjuvant radiation therapy refers to radiation that is administered following surgery. The radiation is aimed near the site of the original cancer and is used to kill any possible remaining cancer cells. Although clinical trials have demonstrated improved outcomes with the use of adjuvant radiation therapy for stage I endometrial cancer, this treatment has remained controversial.

Researchers from the University of Utah medical center and the Huntsman Cancer Institute recently evaluated data from clinical trials evaluating adjuvant radiation therapy in the treatment of stage I endometrial cancer. The trials included 21,249 women with stages IA-IC endometrial cancer. All of women had undergone initial surgery to remove their cancer. Nearly 20% went on to receive adjuvant radiation therapy. Outcomes between patients who received surgery only were compared to those who received surgery plus radiation therapy.

Overall, patients with stage IC endometrial cancer had improved survival with adjuvant radiation therapy:

• Survival at 10 years for women with stage IC grade I (least aggressive) cancer who were treated with radiation therapy was 92% for those under 56 years, 76% for those between 56 and 75 years of age, and 59% for those older than 75 years.
• Survival at 10 years for women with stage IC grade I cancer who did not receive radiation therapy was 69% for those younger than 56 years, 72% for those between 56 and 75 years of age, and 42% for those older than 75 years.
• Survival at 10 years for women with stage IC grade 3-4 (more aggressive) cancer who were treated with radiation therapy was 86% for those under 56 years, 51% for those between 56 and 75 years of age, and 27% for those 75 years or older.
• Survival at 10 years for women with stage IC grade 3-4 cancer who did not receive radiation therapy was 77% for those under 56 years, 42% for those between 56 and 75 years, and 11% for those over the age of 75 years.
• Survival at 5 years was also significantly improved across all age groups of women with stages IC grade I or grades 3-4 cancer who were treated with radiation therapy.

The researchers concluded that adjuvant radiation therapy provides a survival benefit at 5 and 10 years across all age groups of women diagnosed with stages IC grade I or grades 3-4 endometrial cancer. Women diagnosed with stage IC endometrial cancer should speak with their physicians regarding their individual risks and benefits of adjuvant radiation therapy.

Reference: Lee C, Szabo A, Shrieve D, Macdonald K, Gaffney D. Frequency and Effect of Adjuvant Radiation Therapy Among Women with Stage I Endometrial Adenocarcinoma. Journal of the American Medical Association. 2006;295:389-397.

According to a recent article published in Gynecologic Oncology, the use of ultrasound, or sonography, appears highly accurate in detecting cancer recurrences in women diagnosed with gynecologic cancers who display no other symptoms of a recurrence.

Gynecologic cancers may include cancers of the cervix, ovaries, uterus, fallopian tubes, or vulva. Although initial treatment for these cancers may produce a remission, or a disappearance of the cancer, many women may develop a recurrence of their cancer. Detection and treatment of recurrences as early as possible are essential in providing optimal outcomes for these women.

Because many gynecologic cancers are located in the pelvis, early detection of recurrences may be difficult; the specific types of procedures and scheduling of procedures to detect recurrences are not clearly defined for women with gynecologic cancers.

Patients may undergo routine scans, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans to monitor their disease for recurrences, and they also may undergo blood sampling to test for levels of specific “markers” that indicate recurrence.

Often, patients may display symptoms of a cancer recurrence, at which time they may undergo scans or blood tests; however, cancer tends to be more advanced in patients who display symptoms compared to those who do not display symptoms. Therefore, researchers have been evaluating ways in which to accurately detect recurrences prior to symptoms so that they are detected at their earliest progression.

Researchers from Italy recently conducted a clinical study to evaluate the possible role of ultrasound as a follow-up tool to monitor for recurrence in women diagnosed with gynecologic cancers. This study included 385 women who had undergone surgery for their cancer. Follow-up examinations included a clinical examination, blood tests, CT/MRI scans, and vaginal and abdominal sonography.

• Ultrasound detected areas of concern in 21.5% of women.
• Among women who displayed no symptoms of a recurrence, sonography accurately detected nearly 100% of recurrences.
• Among women who displayed symptoms of a recurrence or had signs of a recurrence from a blood test, sonography was not as accurate.
• 37% of women with a single site of a recurrence had it centrally located within the pelvis.

The researchers concluded that ultrasound examinations provide high accuracy in detecting recurrences in asympotomatic women diagnosed with gynecologic cancers and may be an effective follow-up tool for women with these cancers. Future trials comparing ultrasound to other measures for the detection of recurrences are warranted.

Women diagnosed with gynecologic cancers may wish to speak with their physician regarding their individual risks and benefits of participating in a clinical trial further evaluating screening measures for recurrences. Two sources of information regarding ongoing clinical trials are the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Testa A, Fruscella E, Ludovisi M, et al. The role of sonographic examination in the follow-up of gynecological neoplasms. Gynecologic Oncology. 2005; 99: 696-703.

According to a study published in the journal Obstetrics and Gynecology, roughly 25% of young women with endometrial cancer may also have ovarian cancer.

Endometrial cancer refers to cancer that begins in the lining of the uterus. With approximately 36,100 new cases each year, endometrial cancer is one of the most common gynecologic cancers.

Ovarian cancer is the fourth leading cause of cancer death among US women. According to the American Cancer Society, an estimated 22,220 new cases will be diagnosed in the US in 2005.

Women who are diagnosed with these or other cancers during their reproductive years are often concerned about the effect of cancer treatment on their fertility. Treatment of endometrial cancer often involves surgical removal of the uterus, ovaries, and fallopian tubes; this eliminates hopes for later pregnancy and induces an abrupt menopause.

In response, alternative, less extensive treatment approaches have been proposed for women with early-stage, low-grade endometrial cancer. These alternative treatment approaches may involve preservation of the ovaries, which allows for continued ovarian hormone production and egg production. Because endometrial cancer may coexist with ovarian cancer, however, endometrial cancer patients who are considering ovarian preservation will need to weigh the risks of coexisting ovarian cancer.

In order to describe the frequency of coexisting endometrial and ovarian cancers in young women undergoing hysterectomy for endometrial cancer, researchers evaluated 102 patients between the ages of 24 and 45 years. The patients were treated at four institutions in California between 1996 and 2004:

• Twenty-six of the women (25%) were found to have ovarian cancer as well as endometrial cancer.
• Twenty-three of the ovarian cancers appeared to be primary ovarian cancer (cancer that started in the ovary) and three appeared to be endometrial cancer that had spread to the ovaries.

Given the frequency of ovarian cancer in young women with endometrial cancer, the researchers conclude, “Careful preoperative and intraoperative assessment of the [ovaries] is mandatory in young women with endometrial cancer.” They caution, “Those who desire ovarian preservation should be counseled regarding the high rate of coexisting ovarian malignancy.”

Reference: Walsh C, Holschneider C, Hoang Y et al. Coexisting ovarian malignancy in young women with endometrial cancer. Obstetrics and Gynecology. 2005;106:693-9.

Patients with stage I uterine papillary serous carcinoma have fewer cancer recurrences and longer survival when treated with platinum-based chemotherapy in addition to surgery, according to a study published in the journal Gynecologic Oncology.

Uterine papillary serous carcinoma (UPSC) is a relatively uncommon but aggressive type of uterine cancer. Patients diagnosed with stage I UPSC have cancer that has not spread outside the uterus. Stage IA is cancer confined to the inner layer of cells of the uterus (endometrium). Stage IB is cancer that invades less than one-half of the muscle wall of the uterus. Stage IC is cancer that invades more than one-half of the muscle wall of the uterus. The standard treatment for stage I uterine cancer is surgical removal of the uterus, the ovaries, and the fallopian tubes.

Due UPSC’s high rate of recurrence, researchers are interested in identifying adjuvant therapies that will reduce the rate of recurrence and improve survival. Adjuvant therapies are treatments given after the primary treatment (in this case, after surgery) to improve the effects of treatment. In order to determine whether adjuvant treatment with platinum-based chemotherapy drugs improves survival, researchers at Yale reviewed the treatment and outcomes of 74 stage I UPSC patients who were treated between 1987 and 2004.

Among women with the most minimal stage IA cancer (no residual cancer in the hysterectomy specimen), there were no recurrences, regardless of whether or not the woman received chemotherapy. Among all other patients, women who received adjuvant chemotherapy were less likely to have a recurrence than women who did not receive adjuvant chemotherapy. Survival was also significantly better among women treated with chemotherapy.

In addition to evaluating the effect of adjuvant chemotherapy, the researchers also collected information about radiation treatment to the vaginal cuff. The vaginal cuff is the upper part of the vagina and a common site of cancer recurrence. The forty-three patients who received vaginal cuff radiation had no recurrence at the cuff. In contrast, six of 31 (19%) of patients who did not receive radiation had a recurrence at the cuff.

The researchers conclude that adjuvant platinum-based chemotherapy improves survival and reduces cancer recurrences among women with stage I uterine papillary serous carcinoma. Furthermore, radiation therapy appears to reduce recurrences at the vaginal cuff. The researchers recommend that all women with stage I UPSC (with the possible exception of some women with stage IA UPSC, who may require less treatment) be offered adjuvant platinum-based chemotherapy and radiation to the vaginal cuff.

Reference: Kelly MG, O’malley DM, Hui P et al. Improved survival in surgical stage I patients with uterine papillary serous carcinoma (UPSC) treated with adjuvant platinum-based chemotherapy. Gynecologic Oncology. 2005;98:353-9.

Brachytherapy after surgery for stage I endometrial cancer appears to be an effective alternative to external beam radiation therapy, according to a study published in the International Journal of Radiation, Oncology, Biology, Physics.

Endometrial cancer refers to cancer that begins in the lining of the uterus (endometrium), or womb. With approximately 36,100 new cases each year, endometrial cancer is one of the most common gynecologic cancers in women. Patients diagnosed with Stage I uterine cancer have cancer that has not spread outside the uterus. Stage IA is cancer confined to the inner layer of cells of the uterus (endometrium). Stage IB is cancer that invades less than one half of the muscle wall of the uterus. Stage IC is cancer that invades more than one half of the muscle wall of the uterus.

The standard treatment for stage I uterine cancer is a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries). In some cases, lymph nodes are also removed. Despite complete surgical removal of all detectable cancer, 5 to 20% of patients will experience recurrence of their cancer. This is because some patients with stage I cancer have microscopic cancer cells, called 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. Micrometastases can cause relapses that follow treatment with surgery alone. Following surgery, some patients may benefit from additional treatment (adjuvant therapy) to decrease the risk of cancer recurrence. Many women are treated with adjuvant radiation therapy.

There are currently two types of radiation therapy in common use; external beam radiation therapy (EBRT) and brachytherapy. External beam radiation therapy is given via machines called linear accelerators, which produce high-energy radiation beams outside of the body that penetrate the tissues and deliver the radiation dose deep into the areas where the cancer resides. With brachytherapy, radiation is given through radioactive pellets or “seeds” that are placed near the site of the cancer. Brachytherapy is commonly used to treat prostate cancer in men. In the case of endometrial cancer, the radioactive pellets are placed in the vagina, after hysterectomy, to prevent cancer recurrence in the vaginal cuff. The vaginal cuff is the upper part of the vagina, and a common site of cancer recurrence. A benefit of brachytherapy is that it doesn’t require frequent visits to the doctor in order to deliver the radiation. It may also be associated with fewer side effects than EBRT.

To evaluate the frequency of cancer recurrence after surgery and brachytherapy, researchers at the Mayo Clinic evaluated 100 women with stage I endometrial cancer. All had received adjuvant vaginal brachytherapy. With over half of the women now followed for more than 23 months since treatment, there has not been a single case of cancer recurrence in the pelvis or vagina. Side effects of brachytherapy were generally mild and include changes to the lining of the vagina, temporary urinary irritation, and temporary diarrhea.

Because this study did not directly compare brachytherapy to EBRT, and patients have not been followed for several years, it is not possible to unequivocally conclude that brachytherapy is equal or superior to EBRT. Nevertheless, vaginal brachytherapy appears to be a safe and effective alternative to EBRT for women with stage I endometrial cancer. Patients may wish to inquire about the results of ongoing studies and the role vaginal bracytherapy may play in the management early-stage endometrial cancer.

Reference: Solhjem MC, Petersen IA, Haddock MG. Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer. International Journal of Radiation, Oncology, Biology, Physics. 2005;62:1379-1384.

More Endometrial Cancer News: Estrogen plus Progestin May Increase the Risk of Endometrial Cancer

According to the results of a study recently published in Gynecologic Oncology , women with gynecologic cancer often experience emotional stress and depression after losing their fertility from cancer treatment.

Gynecologic cancers are malignancies that involve any part of the female reproductive organs. Unfortunately many of the areas affected, such as the ovaries and cervix, may not produce symptoms until the disease is at an advanced stage or has spread to other sites within the abdomen or other organs.

When cancer is advanced, it requires aggressive treatment to contain the disease. Current treatments for gynecologic cancers include surgery, radiation and chemotherapy. In some cases, women may lose their fertility after undergoing treatment for these types of cancer.

In this recent study, 20 women with a history of gynecologic cancers were surveyed. The average age of the women was 40, although ages ranged from 27-49 years. Of these women, 40% had undergone treatment for cervical cancer, 20% had been treated for ovarian cancer and 40%had been treated for uterine cancer. The surveys used were designed to measure depression, stress, grief, sexual function, and menopausal symptoms.

Results of the study found that 40% of the women experienced depressive symptoms, with 35% of the women describing their symptoms as moderate to severe. Dissatisfaction with their sex lives was also reported by 67% of the women, with pain during intercourse and low levels of sexual desire being the more frequently reported symptoms.

Researchers concluded that the findings of this study indicate that women who are treated for gynecologic cancers are experiencing grief, stress, and sexual dysfunction. Patients are encouraged to speak to their physician regarding the impact of treatment for gynecologic cancer.

Reference: Carter J, Rowland K, Chi D, et al. Gynecolgic Cancer Treatment and the Impact of Cancer-Related Infertility. Gynecologic Oncology. 2005 published online.