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NCCN Guidelines for Patients Uterine Cancer

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NCCN GUIDELINES FOR PATIENTS® 2021 Uterine Cancer Endometrial Carcinoma Uterine Sarcoma NATIONAL COMPREHENSIVE CANCER NETWORK Presented with support from: FOUNDATION Guiding Treatment. Changing Lives. Available online at NCCN.org/patients Ü Uterine Cancer It's easy to get lost in the cancer world Let NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients® Uterine Cancer, 2021 1 UterineAbout Cancer National Comprehensive Cancer Network® NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology for Patients (NCCN Guidelines®) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Uterine Neoplasms, Version 3.2021 — June 3, 2021. © 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 Uterine Cancer NATIONAL COMPREHENSIVE CANCER NETWORK FOUNDATION Guiding Treatment. Changing Lives. NCCN Guidelines for Patients are supported by funding from the NCCN Foundation® To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients® Uterine Cancer, 2021 3 NCCN Guidelines for Patients® Uterine Cancer, 2021 4 Uterine Cancer Contents 6 Uterine cancer basics 12 Treatment planning 21 Treatments for uterine cancer 35 Endometrial cancer treatment 49 Uterine sarcoma treatment 57 Survivorship 62 Making treatment decisions 70 Words to know 73 NCCN Contributors 74 NCCN Cancer Centers 76 Index NCCN Guidelines for Patients® Uterine Cancer, 2021 5 1 Uterine cancer basics 7 The uterus 8 About cancer 9 Two main types of uterine cancer 11 Key points NCCN Guidelines for Patients® Uterine Cancer, 2021 6 1 Uterine cancer basics The uterus There are two main types of cancer There is one ovary and one fallopian tube on that start in the uterus—endometrial each side of the uterus. The fallopian tubes carcinoma and uterine sarcoma. connect to the top part of the uterus. The lower Endometrial carcinoma is common part of the uterus is called the cervix. The and is often found before it has spread cervix connects the uterus to the vagina. Even beyond the uterus. Uterine sarcoma though the cervix is part of the uterus, cancer is rare and can be hard to treat. This of the cervix (cervical cancer) is diagnosed and treated differently than uterine cancer. This patient guide explains treatment options patient guide does not discuss treatment of for both. cervical cancer. To understand uterine cancer, it helps to understand the structure of the uterus. The The uterus uterus has three main layers: The uterus, also sometimes called the womb, The endometrium is the thin layer of is part of the female reproductive system. It tissue that lines the inside of the uterus. is where a baby grows and develops during The myometrium is the muscular, middle pregnancy. The uterus is normally about layer of the uterine wall. the size and shape of a pear, and is hollow in the middle. The other parts of the female The perimetrium, or serosa, is the thin, reproductive system are the ovaries, the outer lining of the uterus. fallopian tubes, the cervix, and the vagina. The female reproductive system The uterus, cervix, vagina, fallopian tubes, and ovaries make up the female reproductive system. The uterus is where a baby grows and develops during pregnancy. NCCN Guidelines for Patients® Uterine Cancer, 2021 7 1 Uterine cancer basics About cancer About cancer Normal cells listen to signals from nearby cells telling them to “stop” when they get too close. The human body is made of over 30 trillion Cancer cells ignore the “stop” signals from cells. All cells have built-in rules that tell nearby cells and invade nearby tissues. them how to act. These rules, or instructions, are called genes. Genes are a part of your Normal cells stay in the area of the body where deoxyribonucleic acid (DNA). Changes (called they belong. For example, stomach cells stay mutations) in genes can cause normal cells to in the stomach. Cancer cells can travel to other become cancer cells. parts of your body (metastasize). They can then grow and make more tumors in the new Cancer cells don’t act like normal cells. Normal area of your body. cells grow and then divide to make new cells when needed. They also die when old or damaged. Cancer cells make new cells that are not needed and do not die quickly when old or damaged. Over time, some types of cancer cells form a lump called a tumor. Types of uterine cancer Endometrial cancer Uterine sarcoma 9 Endometrioid carcinoma (most common) 9 Uterine leiomyosarcoma (uLMS) 9 Serous carcinoma 9 Endometrial stromal sarcoma (ESS) 9 Clear cell carcinoma 9 Undifferentiated uterine sarcoma 9 Carcinosarcoma, also known as (UUS) malignant mixed Müllerian tumor (MMMT) 9 Undifferentiated/dedifferentiated carcinoma NCCN Guidelines for Patients® Uterine Cancer, 2021 8 1 Uterine cancer basics Two main types of uterine cancer Two main types of uterine lining of the uterus. Endometrial carcinoma cancer is often referred to as simply endometrial cancer. Both names are used interchangeably There are two main types of cancer that start throughout this patient guide. in the uterus: The most common symptom of endometrial Endometrial carcinoma carcinoma is abnormal vaginal bleeding. Often, this means bleeding during or after Uterine sarcoma menopause. Premenopausal patients may have unusually long and/or heavy menstrual The differences between these two types of bleeding (periods). uterine cancer are described next. There are different types of endometrial Endometrial carcinoma carcinoma. The most common type is called Endometrial carcinoma is common and is often endometrioid cancer. Most of the information found before it has spread beyond the uterus. in this book and elsewhere on endometrial It is called endometrial carcinoma because it cancer applies to endometrioid cancer. starts in the endometrium, which is the inner Endometrial cancer risk factors Many of the risk factors for endometrial cancer are related to having too much of the hormone estrogen in the body. Obesity is a major risk factor because fatty tissue in the body can change natural steroids in your body into estrogen. 9 Age 55 or older 9 Obesity 9 Too much estrogen 9 Tamoxifen use 9 Never gave birth 9 Periods started early 9 Periods stopped late 9 Lynch syndrome NCCN Guidelines for Patients® Uterine Cancer, 2021 9 1 Uterine cancer basics Two main types of uterine cancer There are other, less common types of endometrial cancer, there are also different endometrial cancer. They are considered high- types of uterine sarcomas. This patient guide risk types because they grow more quickly discusses the following types of uterine and are harder to treat. High-risk endometrial sarcomas: cancer types include: Uterine leiomyosarcoma (uLMS) Serous carcinoma Endometrial stromal sarcoma (ESS) Clear cell carcinoma Undifferentiated uterine sarcoma (UUS) Carcinosarcoma, also known as malignant mixed Müllerian tumor (MMMT) There are other, even rarer types of uterine sarcomas called soft tissue sarcomas. They Because of the more aggressive nature of include adenosarcomas, PEComas, and these cancers, they are treated differently than rhabdomyosarcomas. These types are not most endometrioid cancers. These types are covered in this patient guide. addressed separately in Part 4: Endometrial cancer treatment. See the NCCN Guidelines for Patients®: Soft Tissue Sarcoma at NCCN.org/ After being diagnosed with cancer, it is normal patientguidelines to learn more. to wonder why this happened. Some cancers are hereditary, meaning a higher risk was passed down to you by your parents through your genes. For other cancers, your lifestyle plays a bigger role than your genes. For many types of cancer, both your genes and your lifestyle can play a role in whether you get that kind of cancer.
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