Uterine Cancer: Is Hysterectomy the Only Option?

Uterine cancer is the most common gynecologic malignancy in the United States. There are approximately 43,000 women diagnosed with this disease each year in our country and about 8,000 women die from it annually.

So, why is this disease so common in our country?

The biggest risk factor for uterine cancer is obesity. This isn't difficult to understand, particularly when considering that 65% of adults in the United States are overweight. In Texas, it's estimated that the number of overweight or obese adults will grow to 20 million by 2040.

Why is this important to our patients and why is this becoming a major issue, particularly for young women?

It's estimated that up to 15% of women diagnosed with uterine cancer will be in childbearing years. In other words, many young women who have never had children are being diagnosed with uterine cancer. This is a major problem, since the standard treatment for this disease is a hysterectomy. Options to preserve fertility are limited to hormonal therapy.
The response rates to hormonal therapy aren't ideal, ranging from 26% to 75%. In addition, the relapse rate in these patients is about 30%.

Not every patient is a candidate for this type of treatment. Hormonal treatment is limited to patients with a grade 1 tumor and with no evidence of invasion of their disease to the muscle of the uterus.

One patient can change everything
Recently, a patient in her 20s who didn't have children came to me with uterine cancer and said, "Well, doctor, if a patient develops lung cancer, the entire lung is not removed and when a patient develops brain cancer, the entire brain is not removed. So, why when a patient develops uterine cancer, do you recommend removing the entire uterus?"

Although the answer might seem obvious to most surgeons --"because that's the way we've always done it" -- it's absolutely an excellent question. Therefore, what are we doing to be innovative and potentially have an option of uterine-sparing surgery for future patients?

In the Department of Gynecologic Oncology at MD Anderson, we have a prospective study where we're exploring ways to determine if we can identify the tumor margins through very novel technologies using a tool called confocal microscopy. These are very small probes that can be introduced in the uterus through a camera.

In image on the right you can see the difference between normal and tumor tissue. This concept would allow surgeons to determine the tumor margins in the uterus and remove just the tumor while preserving the uterus. This would allow young patients to be treated for their cancer and have babies in the future.

While this surgical approach is in its infancy, we anticipate that young women soon will have more than one option to keep their uterus if diagnosed with uterine cancer.

It's also important to highlight that this innovative surgery isn't only applicable to young women seeking fertility preservation. It also applies to patients who may be at high risk of complications from a major surgery, such as the very obese patient or elderly patient with multiple medical problems.

As a patient, it's important to be well informed and ask your doctor about these options.

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Pedro Ramirez M.D.