Ovarian Preservation May Be a Safe Option in Endometrial Cancer

< Jan. 28, 2009 > -- Early-stage endometrial cancer may no longer warrant the removal of the ovaries in younger women, a new study affirms.

Women age 45 and younger who kept their ovaries while undergoing treatment for endometrial cancer showed no difference in survival rates compared to those that had their ovaries removed.

Results of A 16 Year Study

These findings were published in the Journal of Clinical Oncology as a result of a study spanning the years 1988 to 2004. The study involved 3,269 female participants age 45 or younger who had stage I endometrial cancer. All of the women were registered in a national cancer database.

The study participants all had a hysterectomy, and 12 percent who kept their ovaries tended to be younger and diagnosed later in the span of the study. They also had a low tumor grade and lived in the eastern United States.

The results of the study revealed that removing the ovaries had virtually no effect on five-year survival rates, the study found. Among women who underwent the procedure, 98 percent of those with stage IA cancer, 96 percent who had stage IB disease, and 89 percent with stage IC disease lived at least five years, compared with 98, 100, and 86 percent, respectively, of women who did not have their ovaries removed. 

Early Results Are Encouraging

Although the findings are encouraging, removal of the ovaries, called an oophorectomy, has long been a standard part of therapy for endometrial cancer. This is largely because of the concerns that the cancer might also affect the ovaries and that continued production of estrogen could fuel tumor growth.

However, "It appears that this is a safe thing if a women wants to go ahead and keep her ovaries", says Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, LA.

Dr. Jason D. Wright, assistant professor of obstetrics and gynecology at Columbia University College of Physicians & Surgeons in New York City and lead author of the study adds, "This is a retrospective study, so it's hard to say for sure that we should change practice based on this. But it's definitely a provocative finding, and it does appear that ovarian preservation is safe."

Dr. Wright continues, "This is something that needs to be discussed with young women - that this is available. Ideally, this would be tested in a prospective study."

The Potential Benefits

About 5 percent of endometrial cancer cases occur in women younger than 40. The average age is 60, and removing the ovaries is not really an issue for women after about age 50 because they have already undergone natural menopause, said Dr. Jeffrey Fowler, director of gynecologic oncology at the James Cancer Hospital and Solove Research Institute at Ohio State University in Columbus.

However, for some women, the benefits of preserving the ovaries would be considerable. Young women would be spared the discomfort of hot flashes, vaginal dryness, and other symptoms of induced menopause before their time.

Also, avoiding the procedure would reduce the risk of cardiac disease and bone loss and would probably result in a longer life span.

Case by Case Decisions

Individualization of treatment has been and should continue to be the standard, even with oophorectomy dominating treatment for this type of cancer, Dr. Fowler says.

Further, family history of cancer, the stage and grade of the tumor, and how aggressive the cancer is should all factor into treatment decisions.

The person's genetic vulnerability is also a factor. Specifically women carrying the BRCA cancer gene, for instance, probably have increased survival after undergoing ovary removal. In general, "We need to individualize and discuss the risks and benefits," Dr. Fowler affirms.

Always consult your physician for more information.

What is Endometrial Cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium.

About 75 percent of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early, according to the American Cancer Society (ACS).

The exact cause of endometrial cancer is not known, and there is no medical cure for it at this time. However, physicians believe that avoiding the known risk factors, when possible, controlling obesity, and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

Symptoms of endometrial cancer may include bleeding or discharge not related to menstruation, post-menopausal bleeding, difficult or painful urination, and pain during intercourse. Other symptoms such as pain and/or mass in the pelvic area and weight loss could also be a sign.

Endometrial cancer may be diagnosed by providing a medical history and undergoing a physical exam. This usually includes a pelvic exam to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic exam to examine cells from the cervix microscopically. In some cases, an endometrial biopsy may be performed which involves removing a tissue sample from the uterus.

Other tests such as dilation and curettage (D&C), which allows the removal of cells from the cervical canal and uterine lining and transvaginal ultrasound, which allows the thickness of the endometrium to be evaluated are also used to assist with making a diagnosis.

Specific treatment for endometrial cancer will be determined by your physician. But, in most cases your overall health, medical history and
extent of the disease are primary considerations.

The choice of treatment depends on the stage of cancer - whether it is just in the endometrium, or has spread to other parts of the uterus or other parts of the body.

Generally, treatment for patients with cancer of the endometrium includes one or more of the following:

• hysterectomy - surgical removal of the uterus

• salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries

• pelvic lymph node dissection - removal of some lymph nodes from the pelvis

• laparoscopic lymph node sampling - lymph nodes are removed through a viewing tube called a laparoscope, which is inserted through a small incision in the abdomen

• radiation therapy

• chemotherapy

• hormone therapy

Always consult your physician for more information.