Our knowledge of cancer is always expanding. Researchers and healthcare professionals take the knowledge gained from research studies and use it to develop better practices that will help prevent, detect and treat uterine cancer, as well as improve the quality of life of women with uterine cancer.
The following information is a selection of research showing promise for uterine cancer.
Risk reduction
Risk reduction strategies may reduce the chance of developing cancer.
Noteworthy research includes:
- Physical activity in adulthood may reduce the risk of developing uterine cancer, especially in women who are overweight or obese (Cancer Epidemiology Biomarkers and Prevention, PMID* 20406960). Even light to moderate exercise, including walking and housework, may have some benefit. More research is needed to understand how physical activity may reduce uterine cancer risk (Recent Results in Cancer Research, PMID 21113764).
- Celiac disease (sprue) damages the small intestine and interferes with the absorption of nutrients from food. People with celiac disease have sensitivity to gluten – a protein found in grains such as wheat, rye and barley. A study found that women with celiac disease have a lowered risk of developing female hormone-related cancers, including breast, uterine and ovarian cancers. Researchers are looking into why women with celiac disease may be less likely to develop these types of cancer (International Journal of Cancer, PMID 21953605).
- Isoflavones are a type of natural compound (phytochemical) found in some plants. Isoflavones are found in foods such as legumes, soy and tofu. A large study found that a diet rich in isoflavones may lower the risk of uterine cancer (Journal of the National Cancer Institute, PMID 22158125).
Diagnosis
A key area of research activity involves developing better ways to diagnose and stage uterine cancer.
Noteworthy research includes:
- The sentinel lymph node is the first lymph node or group of lymph nodes that receives lymph fluid from the tumour and the area around a tumour. It is the first lymph node that a cancer cell encounters and will likely spread to. Sentinel lymph nodes can be identified by an injected radioactive isotope or blue dye.
- Researchers are studying sentinel lymph node identification and removal as a possible alternative to lymphadenectomy. Lymphadenectomy is the surgical removal of one or more groups of lymph nodes (Lancet Oncology, PMID 21489874; Current Opinion in Obstetrics and Gynecology, PMID 21235023).
- A study compared sentinel lymph node detection during laparoscopy (inserting a scope through a small incision) versus laparotomy (cutting open the abdomen). The sentinel lymph node was found at a higher rate during laparoscopy. However, injecting dye into the lymph nodes during surgery did not improve the detection of cancer spread to the lymph nodes (Journal of Surgical Oncology, PMID 20119976).
- More research is needed to see if sentinel lymph node biopsy may play a role in the diagnosis of endometrial cancer.
- Researchers are studying various biomarkers to determine if they will be helpful in diagnosing uterine cancer (International Journal of Cancer, PMID 21207424). Researchers have identified several different biomarkers in uterine tissue and urine that may be helpful in diagnosing uterine cancer.
Prognostic factors
Prognostic factors that may help determine the outcome of the disease are being studied in uterine cancer. They can be used to predict the chances of recovery or of cancer coming back. Doctors may also use prognostic factors to help them make treatment recommendations.
Noteworthy research includes:
- Women with early stage uterine cancer who smoke have an increased risk of cancer recurring (coming back) and spreading to the lungs. Smokers may benefit from adjuvant therapy to help prevent the risk of cancer recurrence in the lungs (ASCO**, Abstract 5089).
- Cancer antigen 125 (CA125) is a tumour marker that may be higher than normal in women with uterine cancer. Studies are looking at the role that CA125 levels may have in predicting prognosis.
- Studies have shown that the CA125 level before surgery is helpful in predicting prognosis following surgery in women with uterine cancer. (Acta Obstetricia et Gynecologica Scandinavica, PMID 19916890).
- A study has suggested that a high CA125 level after surgery (above 35 U/mL) may be a better predictor of survival than a high level before surgery (ASCO, Abstract e15573).
- Researchers are studying other biomarkers in the blood and uterine tissue to see if they are helpful in predicting prognosis.
- Human epididymis protein 4 (HE4) is a biomarker that may be used to detect uterine cancer. HE4 levels measured before surgery may also be helpful in predicting prognosis. A study found that using both HE4 and CA125 together may even be a stronger way to predict overall survival (Gynecologic Oncology, PMID 22525819).
- Serum amyloid A(SAA) is a protein found in high concentration in the blood of women with endometrioid carcinoma, a common type of uterine cancer. SAA may be a biomarker to monitor disease recurrence and response to treatment for endometrioid carcinoma (Cancer, PMID 20041483).
- L1-CAM is a protein that helps with bonding and communication between nerve cells. A recent study found that L1-CAM positive early stage tumours were more aggressive and associated with a high risk of recurrence. Identifying L1-CAM in tumours may help make treatment decisions for women with early stage uterine cancer (ASCO, Abstract 5091).
- CXCL12 is an estrogen-regulated gene. A study found that women whose tumours test positive for CXCL12 may survive longer than women whose tumours test negative for CXCL12 (International Journal of Oncology, PMID 22025313).
- Pair box protein (PAX8) is involved in cell development and the expression of some genes. American researchers found that women with high levels of PAX8 have aggressive tumours and are more likely to have a less favourable outcome (ASCO, Abstract 5091).
Treatment
Researchers are looking for new ways to improve the treatment of uterine cancer. Advances in cancer treatment and new ways to manage the side effects related to treatment have improved the outlook and quality of life for many people with cancer.
Noteworthy research on endometrial cancer includes:
- Researchers have compared the surgical treatment of early stage uterine cancer by laparotomy (cutting open the abdomen) and laparoscopy (inserting a scope through a small incision). They found that the treatments had similar survival outcomes, but there were fewer post-operative complications with laparoscopic surgery (European Journal of Cancer, PMID 22548907, PMID 22503396, PMID 21636268; Clinical Obstetrics and Gynecology, PMID 21508692; Lancet Oncology, PMID 20638901).
- With robotic-assisted laparoscopic hysterectomy, the surgeon uses specialized robotic arms to control the tools inserted into the abdominal cavity through a small incision. Studies have shown that robotic surgery, like other laparoscopic procedures, is less invasive, with smaller amounts of blood loss than a laparotomy. However, the surgery takes longer and requires expensive equipment (Gynecologic Oncology, PMID 22391483; Journal of Clinical Oncology, PMID 22291073; Obstetrics and Gynecology, PMID 21099613; Current Opinions in Urology, PMID 20962647).
- Lymphadenectomy is the surgical removal of one or more groups of lymph nodes. Women with uterine cancer with an intermediate or high risk of recurrence who had undergone lymphadenectomy to remove lymph nodes from the pelvis and around the abdominal aorta had improved survival compared to women who did not have a lymphadenectomy (Lancet, PMID 20188410).
- Debulking (or cytoreductive) surgery removes as much of the cancer as possible. A meta-analysis (analysis of a group of other studies) found that women with advanced or recurrent uterine cancer who had all or most of the cancer removed during surgery had improved survival (Gynecologic Oncology, PMID 20434198).
- Researchers continue to study the role of chemotherapy to treat uterine cancer.
- Uterine cancer does not always respond to chemotherapy and may develop resistance to the drugs used. Researchers are attempting to identify which types of uterine cancer may respond to chemotherapy and to develop new chemotherapy drugs that may overcome resistance to therapy (Lancet, PMID 22444602; Oncologist, PMID 20930101).
- A phase III study found that the combination of paclitaxel (Taxol) and carboplatin (Paraplatin, Paraplatin AQ) was just as effective as the combination of paclitaxel and cisplatin (Platinol AQ). The paclitaxel and carboplatin regimen was less toxic than the paclitaxel and cisplatin regimen and may be a better option for women with stage IVB or recurrent uterine cancer (ASCO, Abstract 5006).
- Vaginal brachytherapy is associated with fewer gastrointestinal side effects and better quality of life following surgery for intermediate- and high-risk uterine cancer compared to external beam radiation therapy (Cochrane Database of Systematic Reviews, PMID 22513918; Lancet, PMID 20206777). The use of vaginal brachytherapy for early stage uterine cancer continues to increase in Canada.
- Researchers are studying alternative treatments to hysterectomy for women of child-bearing age with early stage uterine cancer who would like to preserve their fertility. Progestin therapy may be an option for some women with early stage uterine cancer who still want to have children. Progestin therapy is a treatment using the hormone progesterone. Progestin therapy can be given by mouth (oral progesterone) or a progestin-secreting intrauterine device (IUD). It can help shrink a uterine tumour or may even cause it to go away completely. Women who receive progestin therapy are monitored closely to look for signs that the cancer is not responding to the treatment or growing larger. The risks associated with progestin therapy are a high rate of recurrence and spread outside of the uterus. Progestin therapy is an experimental treatment (Archives of Gynecology and Obstetrics, PMID 21706284; International Journal of Gynecological Oncology, PMID 21546871, PMID 21178572).
- Researchers are studying targeted therapy in women with metastatic, recurrent or refractory uterine cancer. Both bevacizumab (Avastin) and temsirolimus (Torisel) are showing some promise, but more research is still needed (Lancet, PMID 22444602; Journal of Clinical Oncology, PMID 21788564, PMID 21537039).
- Women with diabetes have an increased risk of developing uterine cancer. Researchers have found that some women who take metformin (Glucophage) to control their diabetes have a lower risk of uterine cancer recurrence. More research is needed to find out if metformin may be used as an adjuvant or maintenance therapy in women with uterine cancer (ASCO, Abstract 5009).
Noteworthy research on uterine sarcoma includes:
- Trabectedin(Yondelis) is a promising new anti-cancer drug that researchers are studying in uterine sarcoma. This drug is derived from a sea sponge and is thought to work by causing cancer cell death. Researchers have shown that trabectedin benefits some women with leiomyosarcoma, a type of uterine sarcoma. Although there are some side effects associated with trabectedin, the side effects tend not to be as severe as those associated with other types of chemotherapy. Trabectedin is not considered toxic to the heart or nervous system and hair loss is rare (Gynecologic Oncology, PMID 21996263; International Journal of Gynecological Cancer, PMID 21540667).
Supportive care
Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects.
Noteworthy research includes:
- A study looked at the long-term side effects in women who had radiation to the pelvis for early stage uterine cancer. The study found that even 15 years after treatment, women still had problems with bladder and bowel control, which significantly affected their quality of life (Journal of Clinical Oncology, PMID 21444867).
- Vaginal brachytherapy was found to have no impact on quality of life or sexual function in women who were followed for 5 years after receiving this treatment after surgery for uterine cancer (Gynecologic Oncology, PMID 21159367).
- Five years after a diagnosis of uterine cancer, women are more likely to die of other causes unrelated to uterine cancer. A study found that heart disease was the leading cause of death in women with a history of endometrial cancer. Survivors of endometrial cancer may benefit from tests and procedures that help to identify and treat heart disease early (Gynecologic Oncology, PMID 22507532). Research has shown that obesity is linked to heart disease. Strategies to help manage weight, such as a healthy diet and exercise, may help to prevent death associated with heart disease in women with endometrial cancer.
*PMID is the National Library of Medicine PubMed abstract identity number.
**ASCO is the American Society of Clinical Oncology.
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