These are the slides that accompany the video found on www.aboutcancer.com

1. Cancer of the Uterus or
Endometrium
Robert Miller MD
www.aboutcancer.com

2. Uterine cancer is the most common gyn
malignancy with a 2.6 % lifetime risk
The average age is 61 years. The majority are
diagnosed at an early stage (68 percent)

3. Anatomy

4. Internal Anatomy of the Uterus
fundus
body
isthmus
Internal Endometrium
orifice
Myometrium
cervix
Cervical
vagina canal

5. Cross section anatomy of the female pelvis

6. PET Scans may be more useful than CT
scans in GYN cancers

7. Endometrial cancer – adenocarcinoma of the
lining of the uterus
1. Ovary, 2. Endometrial Cancer, 3. Uterus, 4. Urinary Bladder, 5.
Rectum, 6. Vagina

8. Prognostic Factors in Endometrial Cancer
 Stage (has it spread to the cervix,
ovaries or lymph nodes)
 Muscle Invasion (deep invasion in more
serious)
 Grade (higher grade is more serious)
 Histology (certain types like serous
cancer or sarcoma are more serious)

9. T and N Stage of Uterine Cancer
T1: confined to the uterus
T1a : less than halfway into muscle
T1b: deeper than half
T2: into cervix (stromal connective tissue)
T3a: into serosa or adnexa
T3b: into vagina or parametrium
T4a: into bladder or rectum
N1: pelvic nodes
N2: para-aortic nodes

10. Stages of Uterine Cancer
 Stage I (T1N0)
 Stage II (T2N0)
 Stage IIIa (T3aN0)
 Stage IIIb (T3bN0)
 Stage IIIC1 (T1-3N1)
 Stage IIIC2 (T1-3N2)
 Stage Iva (T4)
 Stage IVb (M1)

11. Uterine cancer can spread to lymph nodes

12. PET Scan
Single area of
metastases in
right para-aortic
lymph nodes
Biopsy
confirmed
recurrent cancer

13. Internal view (cross section) from PET

14. PET Scan = mets in para-aortic and
pelvic nodes so stage IIIC endometrial
cancer

15. Uterine
cancer that
has spread
to para-
aortic and
pelvic nodes
as seen on
PET scan

16. 5 Year Survival for Endometrial Cancer
based on the Stage

17. 5 Year Survival for Endometrial Cancer
based on the histology of the cancer

18. Treatment of Endometrial Cancer
For most stages surgery (hysterectomy, TAH-BSO-
PPLND) is performed and postOp radiation is
indicated for high risk features:
•Deep muscle invasion (stage T1b)
•Involvement of cervix (stage T2)
•Spread to nodes, ovaries or tubes (Stage T3)
•High risk pathology: high grade, vascular invasion, serous
or clear cell

19. Adverse prognostic factors are used to stratify women with intermediate-
risk endometrial cancer:
•outer one-third myometrial invasion
•grade 2 or 3 differentiation
•lymphovascular invasion within the cancer.
High-intermediate risk – This is based on a combination of age and
number of prognostic factors present:
•Patients of any age with all three factors
•Patients 50 to 69 years old with two factors
•Patients 70 years or older with only one factor

22. Guidelines for the use of radiation after a
hysterectomy

23. Guidelines for the use of radiation after a
hysterectomy

24. Dose Guidelines

25. CT scan is obtained at the time of
simulation
CT images are then imported
into the treatment planning
computer

26. In the simulation
process the CT
and PET scan
images are used
to create a
computer plan

27. In the treatment
the lasers are
used to line up
the beam and the
patient receives
the radiation
treatment

28. Radiation for advanced uterine cancer to
treat pelvis plus para-aortic lymph nodes

29. Tomotherapy for Advanced Uterine Cancer

30. Computer reconstruction of radiation fields to
cover groin and pelvic lymph nodes but avoid
the bladder and rectum in vulva cancer patient

31. Combine a CT scan and linear accelerator to ultimate in
targeting (IGRT) and ultimate in delivery (dynamic, helical
IMRT) ability to daily adjust the beam (ART or adaptive
radiotherapy)

32. Tomotherapy fields used to hit the groin and
pelvic nodes but avoid the bladder and
rectum

33. HDR = high dose rate machine that can run
radiation through a tube that reaches the
patient through vaginal applicators

34. Internal radiation devices
Procedure can be performed in
hospital and the patient stays over
night using a Cesium isotope
applicator or the procedure can be
done as an outpatient with a faster
technique (called high dose rate or
HDR) using an Iridium isotope source
(Iridium 192 with half life of 74 days)

35. Vaginal cylinder is
inserted into the
vagina, the radiation
tube or wire stays
inside the tube and
doesn’t touch the
patient’s skin

36. A Wire or Tube connects the vaginal cylinder
the machine that holds the radioactive
(Iridium) source

37. The woman lays on the radiation table and the treatment
usually takes about 5 minutes and then the cylinder is
removed

38. PostOp radiation for endometrial cancer is
generally vaginal vault cylinder with HDR

39. Very little radiation reaches the bladder or
rectum

40. Side Effects of Pelvic Radiation

41. Small
bowel

42. Rectum

43. Bone

44. Bladder

45. Vagina

46. Side Effects of Vaginal Cylinder
HDR Radiation
•Vaginal irritation or
discharge
•Bladder irritation or
frequency
•Bowels more
frequent, soft or mild
rectal irritation

47. Cancer of the Uterus or
Endometrium
Robert Miller MD
www.aboutcancer.com