www.womanthismonth.com January 2019 27 showcase of the uterus. Adjuvant radiation with or without chemotherapy is administered to decrease relapse, particularly if the disease is limited to the pelvis. Doctors will need to consider many aspects of both the patient and the cancer in order to decide on the best treatment. The cornerstone of treatment is surgery. Radiotherapy and chemotherapy used after surgery are called adjuvant therapies, meaning that they are used in addition to surgery. Even a tailored and recommended surgery performed by a skilled gynaecological oncologist will impact the patient’s prognosis. Treatments have their benefits, their risks and their contraindications. It is recommended to ask doctors about the expected benefits and risks of every treatment in order to be informed of the consequences of the treatment. For some patients, several treatment possibilities are available and the choice should be discussed according to the balance between expected benefits and risks. Regular check-ups and screening related to age are a very important milestone of early diagnostic and excellent prognosis of uterine cancer. Screening consists of performing an examination in order to detect cancer at an early stage, before any sign of the disease appears. A systematic screening is proposed if a safe and acceptable exam can be performed and if this exam is able to detect cancer in the majority of cases. It should also be proved that treating screened cancers is more effective than treating cancers diagnosed because signs of cancer were present. For example, this has been demonstrated for the Pap smear test used in cervical cancer screening. Cancer surveillance Experts recommend close follow-up after the completion of treatment for endometrial cancer, particularly in the first three years after diagnosis, when the risk of recurrence is highest. This usually includes a history and physical exam every three to six months for several years. Other tests, like Pap smears, blood tests and computed tomography (CT) scans or other radiology tests, should be done only as needed. If the cancer does not come back after five years, women can usually stop seeing the oncologist and return to their primary care provider or women's healthcare provider. Women should call their doctor if they develop any symptoms of vaginal bleeding, pain in the belly or pelvis, a cough that will not go away or unintentional weight loss. These could be signs that the cancer has come back. Treating menopausal symptoms Premenopausal women who have had their ovaries removed as part of treatment usually experience symptoms of menopause. This may include hot flashes, night sweats, and vaginal dryness. The most effective treatment for these symptoms is the female hormone oestrogen. Most experts think that oestrogen is a reasonable option for women with endometrial cancer. You should discuss the potential risks and benefits of oestrogen with your doctor. For women receiving adjuvant treatment, some experts recommend waiting six to 12 months after finishing treatment before beginning oestrogen therapy. Other non-hormonal treatments for menopausal symptoms are available; these are discussed separately. Sexual issues after treatment Changes in the vagina are common after endometrial cancer treatment. Pelvic or vaginal radiation can cause the vagina to shorten, narrow and feel dry. These changes can cause pain with sex (also called dyspareunia). Many of these problems are treatable: Ask your doctor or nurse about using vaginal dilators to prevent and treat narrowing of the vagina. Use a vaginal moisturiser or lubricant during sex to treat dryness. Women with endometrial cancer may be able to use a vaginal oestrogen (a cream, vaginal ring or pill) to treat dryness. Pelvic physical therapy and counselling for sexual or psychological difficulties can be helpful. Patients should undergo follow-up visits every three to four months with physical and gynaecological examination for the first two years, and then with a six-month interval until five years. Further investigations can be performed, if clinically indicated. It can be hard to live with the idea that the cancer can come back. From what is known today, no specific way of decreasing the risk of recurrence* after completion of the adjuvant* treatment can be recommended. As a consequence of the cancer itself and of the treatment, return to normal life may not be easy for some people. Questions related to body image, sexuality, fatigue, work, emotions or lifestyle may be of concern to you. Discussing these questions with relatives, friends or doctors may be helpful. Dr Murat as an internationally known minimal invasive gynaecologist, gynaecological oncologist and breast surgeon, providing the fully equipped and standard-based diagnostic and treatments in Dr Murat Women’s Clinic. From genetic testing, to all kinds of imaging with surgical options included. At the same time Dr Murat is the director of the Gynaecological Oncology Unit of King Hamad University Hospital and is providing diagnostics and surgeries for female patients in Bahrain. He is at the same time a referral centre for female cancers in Bahrain.
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