Uterine Cancer
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At the Swedish Cancer Institute, women with uterine, cervical and ovarian cancer receive care through a nationally-recognized gynecological cancer program –the seventh-highest volume uterine cancer center in the United States. This includes the expertise of a renowned team of physicians, surgeons and other specialists. All Swedish uterine-cancer patients benefit from a multidisciplinary approach to care that encompasses leading-edge imaging techniques, the latest in treatment options and a full selection of high-quality support services.
Members of our multidisciplinary care teams meet regularly to share information and discuss patient cases, in order to determine an integrated course of care for each person.
Overview
The American Cancer Society estimates that in 2021, 66,570 women will be diagnosed with uterine cancer (also known as “endometrial cancer”), and 14,480 women will die of this disease. Uterine cancer is the 4th most common cancer in women and the 6th most common cause of death in women in the United States. In 2021, 1,320 women will be diagnosed with uterine cancer in Washington state alone. Most women with this cancer present with early-stage disease when the only symptoms are usually a pink vaginal discharge or postmenopausal bleeding.
Most uterine cancers in the U.S. are “endometrioid adenocarcinomas”, and these cancers tend to be early stage and highly curable. More aggressive and rarer subtypes of uterine cancer include uterine serous carcinoma, uterine clear cell carcinoma, and uterine carcinosarcoma, and these tend to present with more advanced stage disease and are more prone to spread (“metastasize”) outside of the uterus. Rare subtypes of uterine cancer include sarcomas, which arise in the muscle wall of the uterus as opposed to the majority of cancers which arise in the lining of the organ.
Gynecologic oncologists at Swedish Cancer Institute have been at the forefront of the treatment of uterine cancer for decades. Our gynecologic oncologists began utilizing chemotherapy for patients with involved lymph nodes (now considered standard treatment for “node-positive disease” worldwide) well before most programs in the country. We developed the first gynecologic oncology robotic surgery program in the Pacific Northwest, primarily aimed at surgical treatment of uterine cancer, and published the first paper in the peer-reviewed medical literature evaluating the advantages of robotic surgery in treating this disease (now considered standard surgical treatment worldwide). In addition, we were the first group in the Pacific Northwest to study and perform sentinel lymph node dissection in endometrial cancer, now considered a standard treatment worldwide, and published one of the first studies evaluating this technique in the medical literature. Our group continues its efforts to expand treatment options for women with this disease by offering innovative clinical trials to our patients. And we have one of the highest volume uterine cancer programs in the country.
Symptoms
Most women with this disease will be found to have early-stage disease, as about 90% of women have postmenopausal bleeding which prompts a medical evaluation. Women with more advanced disease can have similar symptoms to women with advanced ovarian cancer, including abdominal pain or bloating, abdominal distention, and pelvic pain or weight loss.
Diagnosis
Fortunately, diagnosis of endometrial cancer is typically straightforward, as tissue in the lining of the uterus can usually be sampled either in the office setting (at which time the disease is found with an office procedure called an “endometrial biopsy”) or a short outpatient procedure called a “D&C” (dilation and curettage of the uterus).
Most patients have early-stage disease which is confined to the uterus or has only spread to the cervix, with the minority of patients having advanced stage disease which would include spread to the abdominal cavity, lymph nodes, or distant organs such as the liver or lungs.
Our excellent team of dedicated fellowship-trained gynecologic pathologists aid in the diagnosis of both standard cases as well as rarer subtypes of uterine cancer where expert pathologist consultation can be essential in rendering the correct diagnosis.
And our highly specialized pathologists are complimented by a skilled group of radiologists who specialize in “cross sectional imaging” (CT scans, MRIs and PET scans) in patients with cancer, and both are integral to our Swedish Cancer Institute Gynecologic Oncology Tumor Board, where patients are reviewed in a multi-disciplinary format and treatment plans are developed with a large group of uterine cancer specialists, particularly for challenging cases.
Treatment
Fortunately, most patients with early-stage endometrial cancer can be treated surgically, typically with removal of the uterus, tubes, ovaries and a “sentinel lymph node dissection”, and are usually cured with surgery alone. Minimally invasive techniques utilizing robotic surgery and sentinel lymph node dissection, which are now standard in the treatment of this disease, were first performed in the Pacific Northwest by our skilled group of gynecologic cancer surgeons.
For patients with lymph node involvement found at the time of surgery, chemotherapy is standard, with many of these patients also receiving either vaginal radiation (called vaginal brachytherapy, which can be delivered with three treatments over 4 weeks) or pelvic radiation, which usually includes a daily treatment of radiation for 5-6 weeks.
More advanced patients with involvement of the liver, lung, or abdominal organs at the time of diagnosis usually receive chemotherapy or immunotherapy initially, and if a good response is seen may be candidates for surgery.
Increasingly, immunotherapy is being used for patients with advanced uterine cancer, either alone in patients who have a specific biomarker in their tumor called “microsatellite instability” or “MSI-high,” and in combination with a new class of anti-cancer treatment called a tyrosine kinase inhibitor for patients who are “microsatellite stable” or “MS-stable.”
Essential to the success of our treatment of patients with endometrial cancer is our highly specialized radiation oncology program, the largest radiation program in the state, focused solely on gynecologic cancers, spearheaded by Dr. Daniela Buscariollo who completed a brachytherapy fellowship where she learned techniques aimed at treating endometrial cancer with internal radiation techniques, called “brachytherapy,” aimed at maximizing radiation treatment where needed while minimizing damage to surrounding structures.
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Research and Clinical Trials
If your physician believes you are a good candidate to participate in a clinical trial evaluating a new treatment or more effective combinations of treatments — and you agree — you will have access to the very latest in research treatments.
At any given time, the Swedish Cancer Institute offers patients more than 140 clinical-research studies involving most types of cancers. Additionally, our physician specialists collaborate with other regional and national research groups, including Southwest Oncology Group, National Cancer Institute, Puget Sound Oncology Consortium and Fred Hutchinson Cancer Research Center.
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Beyond physical health, the Swedish Cancer Institute is committed to the emotional well-being of our patients and their families. We offer:
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See Patient Support and Resources and Services for the Body, Mind and Spirit at Swedish.
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