The lining of the uterus is called the endometrium. When cancer cells develop in this region, it can spread to other organs such as the ovaries and fallopian tubes. Initial cancer treatment for endometrial cancer, also known as uterine cancer, is a complete hysterectomy which is the removal of the uterus and cervix.
If cancer recurs, it is usually in lymph nodes and surrounding tissue of the pelvis and abdomen. The use of laparoscopic treatment for recurrance of endometrial cancer is an effective way to examine the pelvis and abdomen and stage the progression of the disease
Minimally invasive surgery like laparoscopy can eliminate the scarring and pain of traditional surgery and enhance recovery time.
During the procedure, a small instrument is placed through the belly button that delivers air into the pelvis and abdomen. The air in the belly allows the instruments to move freely. A device called a trocar is used to puncture a small hole where the scope will be inserted. Two additional small punctures are made in the abdomen that allow instruments to move tissue, cut and cauterize.
The scars are very small, usually less than an inch and are dressed with a band aid. Less bleeding is noted and the patient is under anesthesia less than with traditional abdominal surgery (laparotomy).
Laparoscopic debulking is the removal of cancerous tumors. Examining each tumor can determine the extent that the cancer has invaded the tissue. The tumors usually vary in size and location which also shows the extent of the disease. Determining the stage of cancer will set the course of treatment.
Laparoscopic surgery has proven to be as accurate as open laparotomy for staging endometrial cancer. In a study conducted by the Gynecologic Oncology Group laparoscopic treatment for stages I and II for uterine cancer did not result in any recurrence.
In the case of recurrent endometrial cancer, staging may be redundant but it can reveal the extent of the spread of the disease.
Recurring Endometrial Cancer
Recurring endometrial cancer can affect the pelvis area or move beyond the area into another body system and affect the intestines, bladder, liver and pancreas. The use of laparoscopic surgery for recurring endometrial cancer can identify any areas within the abdomen that may be affected and what course of treatment to take.
Internal radiation is a treatment used on confined areas of recurrence in the pelvis. It involves the placement of a device that holds radon pellets into the vagina where it can release radiation to the affected area.
External radiation, chemotherapy and hormone treatments are also used to fight recurring endometrial cancer.
Laparoscopic surgery has been abandoned when vision was obscured, excessive bleeding was evident or the patient’s weight interfered with the process. Traditional laparotomy is then initiated in order to continue with the procedure.
For some patients that have not had success with traditional cancer treatment, the National Cancer Institute recommends talking to your physician about clinical trials. Information about the latest trials can be found on their website at https://www.cancer.gov/clinicaltrials.
Studies have shown that laparoscopic treatment for recurrance of endometrial cancer is more cost effective than laparotomy. In a study conducted by The American Society of Clinical Oncology, the 2006 the cost for traditional laparotomy was $16,184. The cost for laparoscopic staging was $14,616, a $1,568 difference. Recovery time is less for those receiving laparoscopic treatment requiring less hospital time and costs.
The benefits from laparoscopic treatment are a faster recovery time, less invasive surgery, less time under general anesthesia and less expense than laparotomy. Debulking and staging can be done as well as traditional surgery.
Clinical studies may be an option for some patients. The National Cancer Institute encourages participation and reminds the public that many treatments are used today that were part of clinical trials.
National Cancer Institute: Endometrial Cancer Treatment
PubMed.gov: Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs).
American Society of Clinical Oncology: Laparoscopic treatment of endometrial cancer: A cost-effectiveness analysis
Alere Cancer Page: Laparoscopic Surgery for Endometrial Cancer Offers Better Quality of Life Ruetter
Medpage Today: SGO Laparoscopy Passes Staging Test for Uterine Cancer
Women’s Center: Minimally Invasive/Laparoscopic Cancer Surgery