Stage III uterine cancer extends outside the uterus, but remains confined to the pelvis. Stage IIIA cancers invade the lining of the pelvis or fallopian tubes or cancer cells can be found free in the pelvis. Stage IIIB cancer invades the vagina. Stage IIIC cancers invade the pelvic and/or para-aortic lymph nodes.
Optimal treatment of patients with stage III uterine cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving gynecologic oncologists and radiation oncologists. Survival following treatment of stage III uterine cancer is determined by the extent of spread of the cancer and the ability of the surgeon to remove all visible cancer.
In general, primary treatment of women with stage III uterine cancer is surgery. Women with stage III uterine cancer usually have a hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of the ovaries), and pelvic lymph node dissection with or without removal of the para-aortic lymph nodes. The surgeon will attempt to remove as much cancer as possible without causing major side effects. Unfortunately, some women with stage III uterine cancer cannot have all the cancer removed, especially when the cancer extends to the wall of the pelvis.
Following standard treatment with a total abdominal hysterectomy, a majority of patients will experience recurrence of their cancer. This is because many patients with stage III cancer have microscopic cancer cells (micrometastases) that have spread outside the uterus and therefore were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests. The presence of these micrometastases causes recurrence following treatment with surgery alone. Following surgery, patients may benefit from additional treatment (adjuvant therapy) to decrease the risk of cancer recurrence. There is a progressive increase in local and distant cancer recurrences in patients with well, moderately and poorly differentiated cancers following treatment with surgery alone. To learn more about surgery, go to Surgery & Uterine Cancer.
Adjuvant Radiation Therapy
Patients with stage III uterine cancer who have complete surgical removal of all cancer are candidates for adjuvant radiation therapy. The objective of adjuvant radiation therapy is to kill cancer cells that persist after surgery for a maximum probability of cure with a minimum of side effects. Radiation is usually given in the form of high-energy beams that deposit the radiation dose in the body where cancer cells are located (external beam radiation therapy) or is delivered directly to the cancer by placing an isotope in the area of the cancer (brachytherapy). Radiation therapy, unlike chemotherapy, is considered a local treatment. Cancer cells can only be killed where the actual radiation is delivered to the body. If cancer exists outside the radiation field, the cancer cells are not destroyed by the radiation. Treatment of stage III uterine cancer with surgery followed by adjuvant brachytherapy and/ or external beam radiation therapy has been reported to cure approximately 50% of patients.
Despite adjuvant radiation therapy, many patients will experience a cancer recurrence. Further treatment with systemic hormonal and/or chemotherapy, instead of or in addition to radiation therapy, may be required to further decrease the risk of cancer recurrence in patients with stage III cancer.
Radiation Therapy as Primary treatment
Patients who are inoperable at diagnosis can be treated with a combination of brachytherapy and external-beam radiation therapy. For more information, go to radiation therapy and cancer of the uterus.
Adjuvant Systemic Therapy
Because patients treated with surgery and radiation develop cancer recurrence outside the pelvis, adjuvant therapy that can reach and destroy these cancer cells may improve treatment. Because patients with advanced uterine cancer do respond to treatment with hormonal agents and various combinations of chemotherapy clinical trials evaluating drug combinations for adjuvant therapy alone or in combination with radiation are ongoing.
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