Treatment of uterine endometrial cancer: chemotherapy, recommendations after surgery

The methods of treating endometrial cancer, as well as the results of therapy, depend on the stage at which the disease was detected. Even during diagnostics, doctors study all the information about the problem: they determine the location of the pathological focus, its type, prevalence and degree of aggression. After this, several doctors at once (consultation) draw up an individual treatment plan.

If endometrial cancer is detected at an early stage of development, then most often they resort to surgical arrest of the disease process, with subsequent appointment of radiation therapy (sometimes in combination with brachytherapy). Radiotherapy helps to reduce the risk of recurrent oncology. The term "brachytherapy" refers to a type of radiotherapy in which radiation is delivered directly to the affected tissues of the organ - to the tumor site.

If at the time of diagnosis the cancerous process has already spread to nearby tissues and organs, then it is necessary to resort to resection of the uterus and appendages, with subsequent administration of chemotherapy drugs and radiation therapy.

In case of intensive spread of cancerous tumor (for example, to vital organs, bones), when the operation is extremely difficult or impossible, supportive treatment is prescribed, the purpose of which is to stop the development of the disease process and prolong the life of the woman. Most often, in such situations, chemotherapy drugs, hormones, and immunotherapy are prescribed. Conservative treatment can be supplemented with radiation exposure.

Clinical guidelines

There are a number of clinical guidelines that apply to the treatment of endometrial cancer, as follows.

Chemotherapy.

Due to the relatively weak overall effect of chemotherapy drugs in endometrial cancer, it is impossible to determine the optimal regimen for this type of treatment. Most often, such drugs are used as mono or polytherapy.

Monotherapy includes the following prescriptions:

• intravenous drip administration of gemcitabine in the amount of 1250 mg/m² over half an hour (first, eighth and fifteenth days, repeat administration after a week);
• intravenous drip administration of doxorubicin in an amount of 60 mg/m² once every 21 days (four to six courses);
• intravenous drip administration of cisplatin in an amount of 100 mg/m² once every 21 days (four to six courses);
• intravenous drip administration of epirubicin in an amount of 75-100 mg/m² once every 21 days (four to six courses).
• The number of courses of polytherapy is prescribed on an individual basis:
• intravenous drip administration of doxorubicin at 50 mg/m² once every 28 days;
• intravenous drip infusion of cyclophosphamide at 500 mg/m² once every 28 days, infusion of fluorouracil at 500 mg/m² once every 28 days, or cisplatin at 50 mg/m², doxorubicin at 30 mg/m² (first and eighth days), fluorouracil at 400 mg/m² (first and eighth days), cyclophosphamide at 400 mg/m² (first and eighth days - the course is repeated every 28 days), or doxorubicin at 50 mg/m² once every 21 days;
• intravenous infusion of cisplatin at 100 mg/m² once every 21 days.

Hormonal therapy for endometrial cancer

Prescribing hormonal drugs to prevent relapse and metastasis is not practiced in all cases of endometrial cancer. A generalized process may require the following prescriptions:

• intramuscular injections of gestonorone caproate 200 mg weekly, long-term, or oral megestrol 160 to 320 mg daily for at least two months, or oral medroxyprogesterone 200 to 800 mg daily for ten weeks (then switched to oral 200 to 800 mg twice weekly long-term).

The dynamics of the effect of chemotherapy drugs are determined by the following criteria:

• the degree of reduction in the diameter of the primary or recurrent lesion;
• disappearance or reduction in the diameter of metastatic foci.

The basic criterion is also considered to be an improvement in the general well-being of patients, the disappearance of symptoms, an improvement in the quality of life and an increase in its duration.

Modern anticancer drugs are capable of acting in several directions at once, so they are usually used in combination. A standard treatment regimen may combine drugs that destroy cancer cells, as well as agents that inhibit tumor growth and prevent the formation of new malignant structures.

In the later stages of the disease, it is almost always necessary to use analgesics, as well as various symptomatic drugs.

The following groups of medications are considered basic chemotherapeutic drugs:

• Alkylating agents that destroy proteins involved in the formation of DNA of malignant structures (a typical representative is cyclophosphamide).
• Platinum drugs are toxic cytostatic agents that also destroy the DNA of malignant cells.
• Antimetabolite drugs – alter the cellular genetic mechanism, making cell division impossible (a typical representative is gemcitabine).
• Anthracycline drugs form substances capable of damaging the DNA of affected structures (a typical representative is daunorubicin).
• Taxane drugs – alter the mechanisms of division of malignant cells (for example, paclitaxel).
• Vinca alkaloid drugs cause the destruction of the cancer cytoskeleton (for example, the well-known vincristine and vinblastine).

Hormonal treatment is appropriate for many types of hormone-dependent tumor processes. Estrogen-containing medications are used to suppress androgen activity, and androgen-containing medications are used to suppress estrogen production.

Why is the use of such drugs controversial among medical professionals? First of all, hormonal drugs can suppress the action of chemotherapy drugs. Secondly, prolonged hormonal treatment can cause the body to develop resistance.

Can Norcolut be prescribed for endometrial cancer? This medication is used in the following cases:

• if we are talking about a small fibroid;
• if there is endometriosis, endometrial hyperplasia.

Cancerous processes of the reproductive organs are considered a contraindication to the use of Norcolut, so it is not prescribed in this situation.

Tamoxifen, a well-known drug that is actively used in breast cancer, is also not prescribed for the treatment of endometrial cancer. Moreover, tamoxifen and endometrial cancer were linked for a long time: it was believed that long-term use of the drug could cause malignant degeneration of the mucous tissues in the uterus. Despite the fact that scientists were subsequently unable to provide all the necessary evidence for such information, the use of tamoxifen in endometrial cancer is considered inappropriate.

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Folk remedies

Is it worth trying to cure endometrial cancer using folk remedies? There is no clear answer to this question. Some women claim that folk medicine helped them get rid of the terrible disease, while for others, such treatment was just a waste of precious time, which only led to the aggravation of the problem.

One thing can be said with certainty: starting such treatment is allowed only after a frank conversation with the attending physician. Perhaps appropriate recommendations will be given, and folk methods can successfully enhance the effect of traditional therapy.

• Grind 150 g of aloe leaves, mix in 250 g of honey and 200 ml of quality red wine. Place the resulting mixture in the refrigerator for five days. Take 1 teaspoon three times a day before meals.
• Brew 1 tbsp. milk thistle in 1 liter of boiling water, leave for five hours, filter. Drink 100 ml three times a day, before meals. Store the remedy in the refrigerator for no more than three days.
• Pour water over fresh or dried birch buds, based on the proportion of 5:1. Put on the fire, bring to a boil, turn off, cover with a lid and keep for two hours. Then filter the product and use for douching (daily, morning and evening).
• Cotton or gauze tampons are soaked in sea buckthorn or celandine oil. Such tampons are placed overnight every day.

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Herbal treatment

• Do daily douching with infusions of plants such as celandine, kalanchoe, and knotweed.
• Regularly drink tea with the addition of ginseng, pink radiola, and common barberry.
• Drink lemon balm tea 4-5 times a day between meals.
• Infuse the rhizome of white lily in a thermos (1 tbsp. per 1 liter of boiling water), drink 200 ml twice a day.
• Take warm teas with the addition of chamomile, milk thistle, and calendula decoctions several times a day.
• Take wormwood infusion daily, 30 drops with a small amount of water.

Homeopathy

Of course, oncology is not a reason for experiments. But if we consider that endometrial cancer is a complex disease, in which several painful processes occur at once, then it is necessary to act on the problem in a complex manner. Otherwise, the signs of pathology can return again in the form of a relapse.

Many specialists are confident that the use of homeopathic treatment against the background of traditional therapy leads to a more stable and pronounced result. Homeopathic preparations are prescribed in stages:

• taking medications to inhibit tumor growth;
• blocking tumor growth;
• targeted action on the tumor with the aim of destruction;
• restoration of the body, prevention of recurrence of the disease.

The selection of drugs is carried out by a homeopath during an individual consultation with a patient suffering from endometrial cancer. Preference is given to the following remedies:

• Argentum metallicum;
• Asafoetida;
• Argentum iodatum.

Dosages are determined individually: not only the stage and symptoms of the disease are taken into account, but also the age, as well as the mental and constitutional characteristics of the patient.

Surgical treatment

For most patients, the basic method of getting rid of endometrial cancer is surgical intervention. Most often, the uterus is completely removed: such an operation is called total hysterectomy. Removal of the uterus and appendages is indicated in the menopausal period.

When choosing a treatment strategy, the prevalence of the tumor process is necessarily taken into account. There are two types of surgical removal of the uterus:

• amputation, when the uterus is separated from the cervix;
• extirpation, when the organ is removed along with the neck.

According to clinical observations, the first option of removal is perceived by patients as less painful, and the probability of complications during amputation is lower than during extirpation. Therefore, the second option is used only when there is a suspicion of the spread of pathology to the cervical area.

Most often, during the intervention, the appendages are removed. Of course, as a result of this, the hormonal balance in the woman's body is reduced to some extent, but not critically: other glands take over the production of hormones - for example, the adrenal glands.

Hysterectomy surgery can be performed using the following methods:

• abdominal, with access through an incision in the abdomen;
• vaginal, with access through an incision on the posterior vaginal wall.

Only in some cases can organ removal be avoided: if the neoplasm does not exceed 3 mm in size. In such a situation, endometrial layer ablation is performed. As a result, the uterus is preserved, but the woman still becomes infertile.

Radiation therapy for endometrial cancer

Radiation therapy involves the use of high-energy rays to destroy cancer cells. Radiation can be external or internal (called brachytherapy).

Radiation therapy is performed after surgery to reduce the likelihood of relapse. In addition, such therapy is appropriate if surgery is contraindicated for any reason.

If the tumor recurs, radiation can be used as the main treatment procedure.

In the overwhelming majority of patients with stage II or III endometrial cancer, radiation therapy is used as a preventive anti-relapse method.

This type of treatment may be accompanied by a number of side effects, which usually subside on their own several months after the end of the effect. Thus, increased dryness of the skin, hair loss, vaginal discharge, diarrhea, nausea, discomfort when urinating, and a constant feeling of fatigue may be noted. In addition, long-term consequences in the form of lymphatic edema of the lower extremities are also possible.

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Endometrial cancer treatment in Israel

Israeli oncology and surgery specialists treat endometrial cancer using gentle and effective methods. Resection of the tumor and damaged tissue is performed through small punctures in the abdominal wall or through an intravaginal incision. This approach eliminates damage to healthy tissue, accelerates the regeneration period and prevents the formation of gross cicatricial changes.

During the surgical intervention, a biopsy is performed according to the new Frozen Section method. This is the taking of material from all lymph nodes located near the uterus, with subsequent analysis. This method allows you to determine which nodes should be removed in order to avoid relapse of the disease in the future.

For comparison: in most domestic clinics, basic cancer treatment is carried out by open surgery, and hysterectomy is never accompanied by an examination of the lymph nodes. As a result, according to statistics, 60% of patients develop recurrent pathology within two years.

In order to choose the best Israeli clinic for treatment, you need to take into account the following points:

• qualifications of specialized specialists;
• the presence of modern equipment in the clinic, allowing tumors to be removed with extreme precision, in order to avoid relapse of the disease;
• the level of service and pricing policy of the treatment center.

As a rule, choosing a good clinic in Israel for the treatment of endometrial cancer does not present any particular problems. The main thing is to contact the institution in advance and discuss all possible nuances.

Nutrition for endometrial cancer

A cancerous tumor in the active growth stage absorbs most of the energy, which leads to weakening of the body. Therefore, the diet for endometrial cancer should be composed so that the patient replenishes vitamin reserves daily and can maintain and support the necessary energy potential. Strengthening the body's capabilities will lead to strengthening the immune system and strengthening the response to the aggression of the malignant process.

In the later stages of the disease, a woman, as a rule, rapidly loses weight and becomes exhausted. This point must also be taken into account when making a menu for the patient: food must retain the maximum possible percentage of useful components.

Some foods are believed to have a unique antitumor effect. These include:

• all types of cabbage;
• onions, garlic;
• asparagus, peas, soybeans, beans;
• carrots, beets;
• cereals;
• vegetables and fruits that have not been heat treated;
• greens, berries.

Nutritionists advise giving up meat altogether, replacing it with sea fish.

What should be strictly avoided:

• from alcoholic drinks, strong black tea, cocoa, chocolate;
• from sweets, sugar;
• from white bread, baked goods;
• from spicy and salty dishes, smoked products;
• from semi-finished products, fast food.

Drinking tea or decoctions based on medicinal plants, as well as regular still water, is encouraged.