Non-surgical treatment of endometrial cancer

Endometrial cancer is a common gynecological malignancy. The treatment of this disease should be determined according to the size of the uterus, whether the myometrium is infiltrated by cancer, whether the cervical canal is involved, the degree of differentiation of cancer cells and the patient's general condition. The main treatments are surgery, radiotherapy and drug therapy, which can be used alone or in combination. Let's learn about the non-surgical treatment methods below.

Although adenocarcinoma is not sensitive to radiation, radiotherapy can be considered for the elderly or those with severe complications who cannot tolerate surgery and those who are not suitable for surgery in stage III and IV. It still has a certain effect. Radiotherapy should include intracavitary irradiation and external irradiation. Intracavitary irradiation often uses 137Cs, 60Co, etc., and external irradiation often uses 60Co and linear accelerators. Ra has been abandoned.

Progestin therapy

Progestin therapy can be considered for patients with advanced or recurrent cancer, those who cannot undergo surgical resection or those who are young, early-stage, and those who require the preservation of fertility. Various synthetic progestin preparations such as medroxyprogesterone and progesterone caproate can be used. The dosage should be large, medroxyprogesterone 200-400mg/d; progesterone caproate 500mg, twice a week, and it should be used for at least 10-12 weeks to evaluate whether there is any effect. Its mechanism of action may be to act directly on cancer cells, delay the replication of DNA and RNA, and thus inhibit the growth of cancer cells. Progesterone therapy is more effective for endometrial cancer with good differentiation, slow growth, and high estrogen and progesterone receptor content. The side effects are relatively mild, which can cause water and sodium retention, edema, drug-induced hepatitis, etc., and gradually improve after stopping the drug.

Anti-estrogen therapy

Tamoxifen is a nonsteroidal anti-estrogen drug with a weak estrogenic effect. It can also be used to treat endometrial cancer. Its indications are the same as those for progestin therapy. The general dose is 10-20 mg, taken orally twice a day, for long-term or divided courses. Tamoxifen has the effect of increasing the level of progesterone receptors. Patients with low receptor levels can first take tamoxifen to increase the level of progesterone receptors, and then use progesterone therapy or both at the same time to improve the efficacy. Side effects include hot flashes, chills, irritability and other manifestations similar to perimenopausal syndrome; bone marrow suppression is manifested by decreased white blood cell and platelet counts; other side effects may include dizziness, nausea, vomiting, irregular vaginal bleeding, amenorrhea, etc.

Chemotherapy

Chemotherapy can be considered for patients who are in the late stage and cannot undergo surgery or who relapse after treatment. Commonly used chemotherapy drugs include doxorubicin, fluorouracil (5-FU), cyclophosphamide (CTX), mitomycin (MMC), etc.; they can be used alone, in combination with several drugs, or combined with progesterone.