Progress in Endometrial Cancer Care: Sparing Fertility and Life

Endometrial cancer, also known as uterine or womb cancer, develops in the lining of the uterus – the hollow, pear-shaped organ in a biological woman’s pelvis. It is the most common gynecologic cancer in the United States, and incidence rates have been on the rise in recent years. In fact, endometrial cancer is the fourth most prevalent cancer among women worldwide, with more than 417,000 new cases diagnosed each year. The sudden surge in cases continues to perplex the scientific and medical communities, but factors such as hormonal changes and weight gain may play a role.

Endometrial cancer can be life-threatening if not detected and treated early, making it crucial for women to be aware of the many risk factors and treatment options.

Who Is at Risk of Developing Endometrial Cancer?

According to data from the American Cancer Society, about 66,200 women may develop uterine cancer in 2023. Of those women, approximately 13,030 may succumb to the disease. In 2022, a total of 12,550 women died from this malignancy. The increasing number of estimated deaths has prompted researchers to identify more risk factors and develop innovative treatments.

In a 2018 umbrella review, Raglan et al. identified 171 meta-analyses investigating the link between 53 risk factors and endometrial cancer. The following stood out:

  • Anthropometric indices
  • Medical conditions
  • Dietary intake
  • Physical activity
  • Biochemical markers
  • Hormonal therapy use
  • Smoking 
  • Gynecological history

Of 127 meta-analyses, including cohort studies, the researchers graded three uterine cancer risk factors with strong evidence:

  • Being overweight (as measured by body mass index) increases the risk of uterine cancer in women who have not gone through menopause.
  • Having a higher waist-to-hip ratio is associated with a higher risk of a specific uterine cancer type.
  • Having children (parity) lowers the risk of disease.

In addition, the American College of Obstetricians and Gynecologists notes that (1) menopausal women over 60, (2) levels of progesterone and estrogen in a woman’s body, and (3) genetics also play a role in endometrial cancer occurrence. However, remember that having risk factors does not necessarily mean you will develop the disease.


Conventional Treatments for Endometrial Cancer

Widespread treatment options for endometrial cancer include:

  • Surgery: Involves the removal of tumors responsible for endometrial cancer progression.
  • Chemotherapy: Uses oral or intravenous drugs to stop tumor growth and development.
  • Radiation therapy: Uses high-energy electromagnetic radiation to inhibit the growth of tumors and stimulate regression.

An oncologist can determine which treatment to employ based on several factors, including the patient’s age, general condition, symptoms, cancer type and stage, medical history, and previous treatments received. In many cases, an oncologist combines two or more of these treatments to improve efficacy.

Unfortunately, these options may cause complications. For example, obese patients typically endure longer surgery duration and hospitalization, as well as significant blood loss, following traditional and laparoscopic methods. Younger patients undergoing chemotherapy or radiation therapy are also at high risk of losing ovarian function, leading to ovarian failure and permanent infertility.


Emerging Treatments for Endometrial Cancer

The delicate and intricate nature of the female reproductive system makes treating endometrial cancer a challenge. Due to the invasive nature of conventional treatments and the probable complications that may arise, researchers have been looking for less invasive and/or non-toxic alternative therapies for womb cancer. Here are some of the most recent breakthroughs:

1. Fertility-Sparing Treatments for Endometrial Cancer

Fertility-sparing methods focus on preserving a woman’s ability to become pregnant while also eliminating cancer cells, particularly among patients with early-stage endometrial cancer.

Treatments designed to protect the womb include:

  • Hormonal therapy: Uses a high dose of progesterone or drugs called progestins to slow the growth of uterine cancer cells, particularly those with receptors to the hormones on them. A patient may undergo hormonal therapy alone or in combination with other treatments.
  • Hysteroscopic tumor resection: This minimally invasive procedure involves inserting a small camera into the uterus to remove the cancerous tissue.

Aspiring mothers’ need for fertility-sparing treatments for endometrial cancer has gained consensus among authorities in the field of gynecologic oncology, many of whom are currently working to measure the effectiveness of hormonal therapy and hysteroscopic tumor resection in preserving fertility.


2. Immunotherapy

Immunotherapy harnesses the power of the immune system to recognize and attack cancer cells. In endometrial cancer, this treatment may improve prognoses through the following:

  • Immune checkpoint inhibitors: These drugs block the signals cancer cells use to evade the immune system. Almost like removing their “cloak of invisibility,” immune checkpoint inhibitors allow the immune system to recognize and invade cancer cells. In 2023, the FDA approved dostarlimab-gxly for treating recurrent and advanced endometrial cancer.
  • CAR T-cell therapy: One of the breakthroughs shaping the future of cancer care, this approach involves genetically modifying a patient’s own T cells to recognize and attack cancer cells. CAR T-cell therapy is currently ongoing clinical trials for treating gynecologic malignancies, including endometrial cancer.
  • Vaccines: Cancer vaccines stimulate the immune system to identify and fight cancer cells. These potentially life-saving vaccines are in the early stages of development for endometrial cancer, but they show promise as a powerful treatment option.

A patient may combine immunotherapy with other methods, including conventional chemotherapy or radiation therapy.


3. Molecular Targeted Therapy

Targeted therapy for endometrial cancer uses drugs designed to target malignant cells and their molecular pathways while minimizing harm to healthy cells. Here’s how it works against cancer of the uterus or womb:

  • PI3K inhibitors: Some endometrial cancers have mutations in the PI3K pathway, which is involved in cell growth and survival. PI3K inhibitors block this pathway, preventing cancer cells from growing and multiplying. The FDA has approved five PI3K inhibitors to treat various malignancies.
  • Anti-HER2 therapy: HER2 is a protein overexpressed in some endometrial cancers. Anti-HER2 therapy targets said protein, preventing cancer cell growth and metastasis.
  • Anti-angiogenic agents: These drugs prevent new blood vessels from forming, which some endometrial cancers rely on for growth. Anti-angiogenic agents block the formation of new blood vessels, preventing cancer cells from getting the oxygen and nutrients they need to progress.

Endometrial cancer patients can also receive molecular targeted therapy in combination with other treatments.


Favorable Prognoses and High Survival Rates Await

Fertility-sparing treatments, immunotherapy, and targeted therapy hold promise in improving outcomes. These treatments offer new options for patients with advanced or recurrent endometrial cancer, especially for women whose bodies no longer respond to traditional methods. With continued research and innovation from leading experts, women with endometrial cancer or risk factors for the disease have a positive future ahead.

Conversely, some of these treatments may already be available at New Hope Medical Center in Mexico. As leading providers of alternative cancer treatments, we specialize in healthcare and medical procedures not yet available in developed countries. Contact us for more information regarding medical tourism and your options. 

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