Uterine Cancer Services at Hoag Gynecologic Oncology

Uterine cancer is the most common gynecologic cancer. The uterus is a muscular, pear-shaped reproductive organ in women in which a fetus might grow. Uterine cancer develops when cells in the uterus develop mutations that cause the cells to multiply out of control without eventually dying as healthy cells do. These abnormal cells can accumulate into tumors that can potentially spread to other areas of the body.

There are two main types of uterine cancer:

• Endometrial cancer: The most common type of uterine cancer, endometrial cancer occurs in the cells lining the uterus.

• Uterine sarcoma: Cancer that occurs in the muscle of the uterus, or myometrium. While accounting for only around five percent of uterine cancers, uterine sarcoma is generally much more aggressive and difficult to cure.

One of the strongest risk factors for uterine cancer is being overweight. This is due to the higher level of estrogen in the blood of heavier people, which increases the risk of developing endometrial cancer. Hoag offers help with weight management in order to minimize the health risks that come with it. Other risk factors for uterine cancer include:

• Diabetes

• The use of estrogen without progesterone

• Use of the estrogen receptor modulating drug Tamoxifen, which is also known by the brand names Nolvadex or Soltamox

• Starting menopause after age 52

• Genetics and family history

  • Hoag Family Cancer Institute offers a Hereditary Cancer Program to assess a person’s family history and any associated risk for cancer. Learn more by calling (949) 764-5764.

Currently, the only way for women to definitely avoid developing uterine cancer is to have the uterus removed through radical hysterectomy. But, there are steps doctors at Hoag can help you with that may reduce the risk of developing uterine cancer including:

• Losing weight and getting regular exercise

• Taking birth control pills.

• Taking estrogen only when combined with progesterone

Currently, there is no definitive, non-invasive test to screen for uterine cancer. If you have symptoms that suggest uterine cancer, your doctor will talk to you about the issues you are having, followed by a pelvic exam.

Other tests or procedures to help diagnose or rule out uterine cancer may include:

• Transvaginal ultrasound: In this test, an ultrasound wand is inserted into the vagina so the doctor can use sound waves to create images of the reproductive organs in order to look for evidence of cancer.

• Endometrial biopsy: This involves surgically removing a piece of tissue from the lining of the uterus so it can be tested for the presence of cancer.

Endometrial cancer may be treated with surgery, radiation therapy, chemotherapy or hormonal therapy, though treatment for uterine sarcoma may also involve removal of the uterus, fallopian tubes or ovaries. Your multidisciplinary Hoag treatment team will work with you to develop a personalized plan depending on your individual situation. Your treatment will depend on a number of factors, including:

• Stage, grade and subtype of tumor

• Size and location

• Your age and general health condition

As a leading provider of advanced gynecologic care, Hoag treats more women than any other hospital in Orange County. You can trust Hoag for your uterine cancer treatment.

Our dedicated ovarian cancer nurse navigators will be there for you following your diagnosis to help you find resources, review your options and support you in making informed decisions at every step of your cancer treatment and recovery.

Your treatment options for uterine cancer can depend on several factors, including your age, other conditions you may have and how advanced the cancer is at the time of diagnosis. Hoag can help with several treatment options for uterine cancer including:

• Surgical removal of the uterus and cervix, also known as a hysterectomy. Most women with uterine cancer will also require removal of the ovaries, fallopian tubes, and lymph nodes in the pelvic region

  • In some cases, a minimally invasive hysterectomy is the best option. Hoag is a Center of Excellence in Minimally Invasive Gynecology (COEMIG) and our gynecologic oncologists are also accredited as such. As a COEMIG site, Hoag offers different types of minimally invasive surgery including laparoscopic and robotic-assisted approaches. In other cases, a total abdominal hysterectomy is necessary.

• Radiation therapy/radiotherapy

  • Brachytherapy, also known as “internal radiation therapy,” is a radiation treatment in which a small radioactive source is temporarily placed inside the body. Because of the high dose rate, brachytherapy treatments are usually delivered on an outpatient basis or with a minimal hospital stay. Explore advanced treatment options at Hoag.

  • Learn more about Hoag Radiation Oncology.

• Chemotherapy

• Hormonal therapy

• Robotic-assisted surgery from Hoag, the unmatched leader on the West Coast in the field of robotic-assisted, minimally-invasive surgery to help treat gynecologic cancers. Hoag’s Gynecologic Robotic Surgery Program offers a team of experienced physicians who are specialty-trained in using the da Vinci robot – the most advanced, minimally invasive approach to surgery available today. Benefits to robotic and minimally invasive surgeries include:

  • Less postoperative pain and scarring

  • Decreased blood loss and lower risk of blood transfusion

  • Lower risk of infection

  • Shorter hospital stay

  • Faster return to normal activities.

Explore robotic surgery at Hoag.

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many gynecologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained gynecologic oncologists who utilize the latest techniques and technology in the surgical management of many different cancers found in women, including uterine cancer.

Radical cancer surgery is a surgical procedure in which physicians remove the entire tumor, a margin of normal tissues, and in some cases, nearby lymph nodes. At Hoag, our surgeons have undergone extensive training in radical gynecologic cancer surgery and procedures, including in the areas of:

• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.

• Radical hysterectomy

• Excision of vulvar and vaginal cancers

At Hoag, our team applies a multidisciplinary approach to cancer surgery. Our physicians work together on your care, consulting with colleagues in plastic surgery, anesthesia and other specialties to help patients achieve better outcomes, maintain sexual and urinary function and preserve overall quality of life. Hoag surgeons utilize the Enhanced Recovery After Surgery (ERAS) pathway, an approach focused on understanding a patient’s specific biology to improve recovery time and pain management. With ERAS, patients become an active participant in their recovery in four key areas:

• Planning and preparing before surgery

• Reducing the physical stress of surgery

• Post-surgery pain relief planning

• Early feeding and movement after surgery

With ERAS, post-surgical patients require fewer narcotics, suffer from less constipation, are able to return to eating normally sooner and have a recovery period that is, on average, two days faster.

Hoag’s non surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag Newport Beach was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.

Explore advanced treatment technologies for cervical cancer available at Hoag.

The stages of uterine cancer treatment, including radiation therapy and surgery, can sometimes impact a person’s ability to conceive and bear a child. If you are considering having children in the future, you can discuss fertility options with your doctor. These may include:

• Egg freezing

• Embryo freezing

• Fertility-preserving surgery

• Gestational surrogacy

Fertility preservation works best if initiated prior to your cancer treatment. These options, such as egg or embryo freezing, can be completed within approximately two weeks of diagnosis so as not to compromise initiation of your cancer treatment. To help patients understand the impact of gynecological cancer treatment on their fertility, Hoag has developed a series of questions you can ask your oncologist or fertility specialist.