Every year, more than 60,000 women in the United States are diagnosed with endometrial/uterine cancer. At City of Hope, we treat you as a valued individual. Our entire uterine/endometrial cancer team works together to bring you advanced surgery, chemotherapy, radiation and supportive care options that will deliver the best outcome for you.
Listen as Thanh H. Dellinger, MD discusses the symptoms and treatments available for endometrial cancer at City of Hope.
Selected Podcast
The Latest Treatment Options for Endometrial Cancer
Featured Speaker:
Learn more about Thanh H. Dellinger, MD
Thanh H. Dellinger, MD
Thanh H. Dellinger, MD is an assistant professor in Division of Gynecologic Surgery, Department of Surgery as well as a gynecological oncologist. She also is leading a clinical trial in hyperthermic intraperitoneal chemotherapy.Learn more about Thanh H. Dellinger, MD
Transcription:
The Latest Treatment Options for Endometrial Cancer
Melanie Cole (Host): Every year, more than 60,000 women in the United states are diagnosed with endometrial and uterine cancer. My guest today is Dr. Thanh Dellinger. She’s an assistant professor in the division of gynecologic surgery in the department of surgery, as well as a gynecological oncologist at City of Hope. Welcome to the show, Dr. Dellinger. What’s going on today with endometrial uterine cancer? Are we seeing more or less?
Dr. Thanh Dellinger (Guest): Thank you, Mel, for having me on the show. I’m very pleased to talk about this. This is actually a very interesting research project of mine. Interestingly, endometrial cancer -- which is synonymous with uterine cancer, by the way – is actually rising in incidence. Compared to other cancers, actually, it’s also – the mortality’s rising. It’s very, very difficult to treat endometrial cancer once it’s recurred, or it’s advanced stage and that is probably the reason why the mortality is increasing.
Melanie: What are some of the risk factors for uterine cancer? What might somebody have that would predispose them to this type of cancer.
Dr. Dellinger: Uterine cancer, unfortunately, has predispositions in those who have more estrogen and -- for example, patients who are obese, or overweight, have an increased risk for developing uterine cancer -- those who take, for example, Tamoxifen, what we call unopposed estrogens. Other patients may have a genetic, or hereditary risk such as Lynch Syndrome, which increases your risk for colon cancer and uterine cancer and those are typically the risk factors for endometrial cancer.
Melanie: Are there any screening tests for uterine cancer? People hear about pap smears, they hear about ovarian cancer being this silent cancer. What are doing in terms of screening?
Dr. Dellinger: Unfortunately there isn’t currently any screening for uterine cancer, so unlike cervical cancer, which is screened with a pap smear – the Pap smear typically does not detect endometrial cancer. Ovarian cancer, on the other hand, like you mentioned, is a silent disease. Fortunately, uterine cancer is not a silent disease. Most women who develop uterine cancer have vaginal bleeding that is abnormal. Either you’ve already undergone menopause and now you’re having bleeding all of a sudden, or you’re premenopausal, meaning you have not undergone menopause, but have more bleeding than usual or irregular bleeding. Those are always warning signs, which would definitely result in you seeing the doctor and then getting worked up for that.
Melanie: And what would be the workup? If somebody was having an abnormal amount of bleeding and they’re in perimenopause, or—are you talking about bleeding when it’s not actually your period, or just a large amount of bleeding during perimenopause, or while you’re entering menopause?
Dr. Dellinger: Actually both. However, it is abnormal, whether it’s irregular, outside of the period, or whether it’s more than usual. That really should prompt what we call an office endometrial biopsy. The patient comes in and says they’re coming for a pap smear, you do a speculum exam, pelvic exam, and part of this, a small endometrial pipelle, or straw is placed inside the uterine cavity through the cervix during the vaginal exam. It takes about five minutes or so. There’s a little bit of cramping involved, but most patients tolerate it very well and it’s a very easy office procedure that can then tell you whether there’s evidence of pre-cancer or endometrial cancer.
Melanie: And would you see this on ultrasound as well?
Dr. Dellinger: The pelvic ultrasound is another way -- part of the workup for this. The ultrasound actually will tell you whether there’s a thickened endometrial lining. The inner lining of the uterus is thickened in women frequently when they have endometrial cancer, but bear in mind that in younger women, in premenopausal females, the lining is thickened because they undergo periods and have the usual menstrual cycle. It’s not as telling in a premenopausal lady, but in the postmenopausal female, generally a thickened lining is a warning sign.
Melanie: If a woman is diagnosed, and hopefully you’ve caught it early enough based on these symptoms, what are some of the treatment options available?
Dr. Dellinger: Fortunately most women with endometrial cancer are diagnosed with stage I disease and those women, most of the time, are cured. They can be cured with a simple hysterectomy and most frequently we are able to do what we call a robotic-assisted, or a laparoscopic surgery, a minimally invasive approach, which in surgery, small skin incisions which reduce postoperative pain and the hospitalization. During this surgery, we remove the entire uterus and cervix, and most of the time both ovaries and tubes. That is part of the staging. Sometimes we also remove some of the local lymph nodes, the lymph nodes that surround the uterus and the ovary and a little bit higher in the abdomen. Those are part of what we call the staging procedure where we want to ensure that the lymph nodes are not affected by malignancy and that would then tell whether the patient would require more therapy, such as chemotherapy or radiation.
Melanie: Does that happen very frequently where they might need chemotherapy and radiation in addition to the minimally invasive surgeries?
Dr. Dellinger: Most of the time they don’t like I said. The vast majority of patients are treated and diagnosed at stage one endometrial cancer and they’re cured with the hysterectomy and the removal of the ovaries and tubes alone. A small percentage of patients have, what we call Stage Three disease where the lymph nodes are involved, or the ovaries are involved. They do, unfortunately, require chemotherapy and radiation.
Melanie: What about hormone therapy, or does someone – you mentioned Tamoxifen earlier – is there anything that women have to do after the treatments, or continue with as an additional adjunct treatment?
Dr. Dellinger: That’s an excellent question because, like I mentioned, endometrial cancer is a frequently estrogen-responsive cancer. I mentioned that hysterectomy Is an often times a curative treatment option, but in women who are still young and desire to have their fertility spared -- or in those women who have, what we call endometrial pre-cancer – there is potentially an option to use progesterone. This is a hormone that people often times take as part of the oral contraceptive pill, but in women with a thickened endometrial lining -- or pre-cancer, or very early stage endometrial cancer – they may be candidates for progesterone treatment. That can either be given as oral tablets, or it can be given as IUD, as an intrauterine device inside the uterus that has progesterone that then gets released from this device. I do need to be very careful on saying it treats endometrial cancer because it really is only for very, very early stage endometrial cancer, women who desire fertility-sparing treatment.
Melanie: Tell us what’s going on exciting at City of Hope in the field of endometrial cancer. What are you doing there?
Dr. Dellinger: For endometrial cancer, we use robotic-assisted laparoscopic surgery, which is now the norm for uterine cancer. We also use sentinel pelvic lymph node biopsies as part of the staging procedure in early stage endometrial cancer and that avoids the full lymph node dissection for the staging procedures so as to avoid any lymphedema. Lymphedema is swelling in the leg that can occur when you remove a lot of the local lymph nodes in the pelvis. Sentinel lymph node biopsies are a nice way of avoiding lymphedema. Some other things that we’re doing at City of Hope are trying to develop a novel therapy for those patients who, unfortunately, have advanced stage disease, such as recurrent disease, or those who have failed chemotherapy. We’re trying to specifically develop personalized target therapies that are immunotherapy -- antibodies that can recognize a specific antibody that is expressed in high-risk endometrial cancers. This particular protein is called L1CAM and we’re trying to develop antibodies that recognize that, but also that are very specialized in such a way that they can also illicit T-Cells, which is part of the immune response, and then allow the body to fight cancer with your own immune cells.
Melanie: Wrap it up for us, Dr. Dellinger, with your best advice for people, for women, about taking charge of their own bodies and being their best health advocate in regards to endometrial cancer and what you want them to really be aware of.
Dr. Dellinger: There really are two things. One is being overweight, and obesity are probably the two biggest risk factors for endometrial cancer. Exercising and losing weight are great ways of preventing endometrial cancer. And the second thing is being aware of any abnormal uterine bleeding, so if your menstrual cycles are abnormal or – especially if you’re overweight -- or if you’re menopausal and you have bleeding again – that’s not something that should wait. That’s something that should be evaluated by a gynecologist.
Melanie: Thank you, so much, for being with us. It’s really great information. You’re listening to City of Hope Radio and for more information, you can go to CityofHope.Org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.
The Latest Treatment Options for Endometrial Cancer
Melanie Cole (Host): Every year, more than 60,000 women in the United states are diagnosed with endometrial and uterine cancer. My guest today is Dr. Thanh Dellinger. She’s an assistant professor in the division of gynecologic surgery in the department of surgery, as well as a gynecological oncologist at City of Hope. Welcome to the show, Dr. Dellinger. What’s going on today with endometrial uterine cancer? Are we seeing more or less?
Dr. Thanh Dellinger (Guest): Thank you, Mel, for having me on the show. I’m very pleased to talk about this. This is actually a very interesting research project of mine. Interestingly, endometrial cancer -- which is synonymous with uterine cancer, by the way – is actually rising in incidence. Compared to other cancers, actually, it’s also – the mortality’s rising. It’s very, very difficult to treat endometrial cancer once it’s recurred, or it’s advanced stage and that is probably the reason why the mortality is increasing.
Melanie: What are some of the risk factors for uterine cancer? What might somebody have that would predispose them to this type of cancer.
Dr. Dellinger: Uterine cancer, unfortunately, has predispositions in those who have more estrogen and -- for example, patients who are obese, or overweight, have an increased risk for developing uterine cancer -- those who take, for example, Tamoxifen, what we call unopposed estrogens. Other patients may have a genetic, or hereditary risk such as Lynch Syndrome, which increases your risk for colon cancer and uterine cancer and those are typically the risk factors for endometrial cancer.
Melanie: Are there any screening tests for uterine cancer? People hear about pap smears, they hear about ovarian cancer being this silent cancer. What are doing in terms of screening?
Dr. Dellinger: Unfortunately there isn’t currently any screening for uterine cancer, so unlike cervical cancer, which is screened with a pap smear – the Pap smear typically does not detect endometrial cancer. Ovarian cancer, on the other hand, like you mentioned, is a silent disease. Fortunately, uterine cancer is not a silent disease. Most women who develop uterine cancer have vaginal bleeding that is abnormal. Either you’ve already undergone menopause and now you’re having bleeding all of a sudden, or you’re premenopausal, meaning you have not undergone menopause, but have more bleeding than usual or irregular bleeding. Those are always warning signs, which would definitely result in you seeing the doctor and then getting worked up for that.
Melanie: And what would be the workup? If somebody was having an abnormal amount of bleeding and they’re in perimenopause, or—are you talking about bleeding when it’s not actually your period, or just a large amount of bleeding during perimenopause, or while you’re entering menopause?
Dr. Dellinger: Actually both. However, it is abnormal, whether it’s irregular, outside of the period, or whether it’s more than usual. That really should prompt what we call an office endometrial biopsy. The patient comes in and says they’re coming for a pap smear, you do a speculum exam, pelvic exam, and part of this, a small endometrial pipelle, or straw is placed inside the uterine cavity through the cervix during the vaginal exam. It takes about five minutes or so. There’s a little bit of cramping involved, but most patients tolerate it very well and it’s a very easy office procedure that can then tell you whether there’s evidence of pre-cancer or endometrial cancer.
Melanie: And would you see this on ultrasound as well?
Dr. Dellinger: The pelvic ultrasound is another way -- part of the workup for this. The ultrasound actually will tell you whether there’s a thickened endometrial lining. The inner lining of the uterus is thickened in women frequently when they have endometrial cancer, but bear in mind that in younger women, in premenopausal females, the lining is thickened because they undergo periods and have the usual menstrual cycle. It’s not as telling in a premenopausal lady, but in the postmenopausal female, generally a thickened lining is a warning sign.
Melanie: If a woman is diagnosed, and hopefully you’ve caught it early enough based on these symptoms, what are some of the treatment options available?
Dr. Dellinger: Fortunately most women with endometrial cancer are diagnosed with stage I disease and those women, most of the time, are cured. They can be cured with a simple hysterectomy and most frequently we are able to do what we call a robotic-assisted, or a laparoscopic surgery, a minimally invasive approach, which in surgery, small skin incisions which reduce postoperative pain and the hospitalization. During this surgery, we remove the entire uterus and cervix, and most of the time both ovaries and tubes. That is part of the staging. Sometimes we also remove some of the local lymph nodes, the lymph nodes that surround the uterus and the ovary and a little bit higher in the abdomen. Those are part of what we call the staging procedure where we want to ensure that the lymph nodes are not affected by malignancy and that would then tell whether the patient would require more therapy, such as chemotherapy or radiation.
Melanie: Does that happen very frequently where they might need chemotherapy and radiation in addition to the minimally invasive surgeries?
Dr. Dellinger: Most of the time they don’t like I said. The vast majority of patients are treated and diagnosed at stage one endometrial cancer and they’re cured with the hysterectomy and the removal of the ovaries and tubes alone. A small percentage of patients have, what we call Stage Three disease where the lymph nodes are involved, or the ovaries are involved. They do, unfortunately, require chemotherapy and radiation.
Melanie: What about hormone therapy, or does someone – you mentioned Tamoxifen earlier – is there anything that women have to do after the treatments, or continue with as an additional adjunct treatment?
Dr. Dellinger: That’s an excellent question because, like I mentioned, endometrial cancer is a frequently estrogen-responsive cancer. I mentioned that hysterectomy Is an often times a curative treatment option, but in women who are still young and desire to have their fertility spared -- or in those women who have, what we call endometrial pre-cancer – there is potentially an option to use progesterone. This is a hormone that people often times take as part of the oral contraceptive pill, but in women with a thickened endometrial lining -- or pre-cancer, or very early stage endometrial cancer – they may be candidates for progesterone treatment. That can either be given as oral tablets, or it can be given as IUD, as an intrauterine device inside the uterus that has progesterone that then gets released from this device. I do need to be very careful on saying it treats endometrial cancer because it really is only for very, very early stage endometrial cancer, women who desire fertility-sparing treatment.
Melanie: Tell us what’s going on exciting at City of Hope in the field of endometrial cancer. What are you doing there?
Dr. Dellinger: For endometrial cancer, we use robotic-assisted laparoscopic surgery, which is now the norm for uterine cancer. We also use sentinel pelvic lymph node biopsies as part of the staging procedure in early stage endometrial cancer and that avoids the full lymph node dissection for the staging procedures so as to avoid any lymphedema. Lymphedema is swelling in the leg that can occur when you remove a lot of the local lymph nodes in the pelvis. Sentinel lymph node biopsies are a nice way of avoiding lymphedema. Some other things that we’re doing at City of Hope are trying to develop a novel therapy for those patients who, unfortunately, have advanced stage disease, such as recurrent disease, or those who have failed chemotherapy. We’re trying to specifically develop personalized target therapies that are immunotherapy -- antibodies that can recognize a specific antibody that is expressed in high-risk endometrial cancers. This particular protein is called L1CAM and we’re trying to develop antibodies that recognize that, but also that are very specialized in such a way that they can also illicit T-Cells, which is part of the immune response, and then allow the body to fight cancer with your own immune cells.
Melanie: Wrap it up for us, Dr. Dellinger, with your best advice for people, for women, about taking charge of their own bodies and being their best health advocate in regards to endometrial cancer and what you want them to really be aware of.
Dr. Dellinger: There really are two things. One is being overweight, and obesity are probably the two biggest risk factors for endometrial cancer. Exercising and losing weight are great ways of preventing endometrial cancer. And the second thing is being aware of any abnormal uterine bleeding, so if your menstrual cycles are abnormal or – especially if you’re overweight -- or if you’re menopausal and you have bleeding again – that’s not something that should wait. That’s something that should be evaluated by a gynecologist.
Melanie: Thank you, so much, for being with us. It’s really great information. You’re listening to City of Hope Radio and for more information, you can go to CityofHope.Org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.