Cervical and Uterine Cancer Treatment

With globally around 420,000 cases every year, uterine cancer is the fifth most common type of cancer in women and the most common gynecologic cancer in North America, Australia and Europe. Worldwide around 660,000 patients are diagnosed with cervical cancer every year, with most cases occurring in middle- and low-income regions. In high-income countries however, cervical cancer is much better prevalant among the population than uterine cancer, often leading to better outcomes for patients. Regular preventive examinations and the possibility of vaccination against human papillomavirus (HPV), one of the main risk factors for cervical cancer, would greatly benefit patients in low-income countries. When these types of gynecologic cancer and its precursors are detected early, the prognosis for most patients is good.

In this article, we present established methods for treating cervical cancer and uterine cancer. We will introduce you to new treatment options, such as personalized therapy. Moreover, we will explain the factors that contribute to determining the most appropriate treatment procedure for affected individuals.

Please note: Since the uterus is not always removed during gender reassignment surgery, trans* men can also develop uterine cancer or cervical cancer. It is therefore essential to have regular check-ups in order to detect cancer at an early stage and initiate appropriate treatment if there are signs of uterine cancer.

There are two types of uterine cancer (uterine carcinoma), depending on the location of the cancer. Either this gynecologic cancer has affected the lining of the uterus: this is known as endometrial carcinoma or corpus carcinoma, or the cancer has affected the cervix: this is known as cervical carcinoma. When uterine cancer is discussed in general, it usually refers to a tumor located in the lining of the uterus. Sometimes this cancer is also explicitly referred to as endometrial cancer or womb cancer. 90% of cancers in the uterus are endometrial cancer. A second subtype of uterine cancer is uterine sarcoma, which develops in the smooth muscle or connective tissue of the womb. This rare disease only makes up 4% of womb cancer diagnoses. After endometrial cancer, cervical cancer is the next most common type.

Uterine cancer (Endometrial Carcinoma / Corpus Carcinoma)

In uterine cancer, the tumor affects the mucous membrane inside the uterus (endometrium). Cancer of the endometrium is also referred to as endometrial carcinoma or corpus carcinoma. This cancer develops when the cells of the uterine lining degenerate, multiply uncontrollably and grow into the surrounding tissue, destroying it.

The most common symptom of endometrial cancer is unusual bleeding from the vagina, especially after the menopause. Menopausal patients should always have regular screenings and get a check-up if they have these symptoms.

The tumors are divided into two types. Type I accounts for around 80% of the disease. These tumors are estrogen-dependent and usually form between the ages of 55 and 65 from malignant thickenings of the uterine lining. The prognosis is usually good if the cancer is detected early. Type II comprises of several estrogen-independent tumor types that usually occur between the ages of 65 and 75. These are more aggressive, so the prognosis for patients is usually worse.

Uterine cancer (endometrial cancer) can develop into cervical cancer (cervical carcinoma) as the disease progresses and spreads to other areas of the uterus.

Cervical cancer (Cervical Carcinoma)

Cervical carcinoma affects the lower part of the uterus (cervix), where it narrows and merges into the vagina. Cervical carcinoma also refers to changes in the mucous membrane. However, a tumor typically develops at the junction between the uterine and vaginal mucosa, whose cells and functions differ. The most important risk factor is infection with certain human papillomaviruses (HPV).

Symptoms that may indicate cervical cancer are unusual vaginal discharge, bleeding outside the menstrual cycle, after the menopause or after sexual intercourse, or pain during sexual intercourse.

Tumors that arise from the cervix are referred to as squamous cell carcinoma. Tumors located further up from the glandular tissue of the uterus are called adenocarcinomas. The first type is the most common, accounting for approx. 70-80% of all cases. In rare cases, other tumor types (e.g. a mixture of squamous cell and adenocarcinoma) also occur.

Cervical cancer (cervical carcinoma) can develop into endometrial cancer as the disease progresses and spreads to other areas of the uterus.

The treatment methods for cervical or uterine cancer therapy depends on the location of the tumor (the tumor type) and the stage of the disease. The earlier a tumor is detected, the higher the chances of successful treatment. If the cancer is already at an advanced stage, it may only be possible to alleviate the symptoms in order to improve the patient's quality of life.

Both cervical carcinoma and endometrial carcinoma are staged according to the TNM classification: Tumor, Node, Metastasis. “T” indicates the spread of the primary tumor, “N” indicates the involvement of lymph nodes and “M” indicates the presence of distant metastases.

Stages of The Cervical Carcinoma

Stage 0: Early stage or advanced precancerous stages. The cancer or the altered cells grow exclusively in the upper tissue layers of the cervix. The cancer is “in situ” and can be removed by surgery.
Stage I: The tumor is limited to the cervix and is usually only visible under a microscope or only just visible to the naked eye. Here, too, an operation is usually performed for treatment. If there is an increased risk of recurrence, a so-called “chemoradiotherapy” (combination of chemotherapy and radiotherapy, also known as CRT) may also be useful.
Stage II: The tumor grows in the upper third of the vagina (IIA). In IIB, the supporting apparatus of the uterus (parametria) is also affected.
Stage III: The cancer has spread to the lower third of the vagina (IIIA). In stage IIIB, the pelvic wall is also affected or the tumor causes kidney congestion. If the lymph nodes are affected by the cancer, the cervical cancer is always classified as stage IIIB, at least. In stage IIIA, surgery is usually performed with additional chemoradiotherapy. In IIIB, chemoradiotherapy is usually the main method for treatment.
Stage IV: The cancer is very advanced. In IVA, the cancer has grown into the mucous membrane of the bladder or intestine or is growing into the abdominal cavity. As soon as distant metastases are present, the cervical cancer is classified as stage IVB. Then, a full recovery is very difficult. In IVA, radiation chemotherapy is often used. In IVB, chemotherapy or radiotherapy is generally carried out to prevent the tumor from spreading and to alleviate symptoms.

Stages of The Endometrial Carcinoma

Stage I: In the early stages, the tumor is limited to the mucous membrane in the uterine body. In the later stages, the cancer cells have already grown into the muscle layer of the uterus. The basic treatment for stage I endometrial cancer is surgery. If there is a high risk of recurrence, radiotherapy can be carried out afterwards.
Stage II: The cancer has spread to the cervix. However, it has not yet grown into the surrounding tissue. Surgery is also usually performed at this stage. Radiotherapy may also be carried out. If there is a high risk of recurrence, chemotherapy may be administered after the operation.
Stage III: In the advanced stages IIIA and IIIB, the ovaries, the vagina or the ligaments holding the uterus (parametria) are affected by the cancer. In stages IIIC1 and IIIC2, the tumor has already metastasized to the pelvic lymph nodes or para-aortic lymph nodes (on the aorta). Depending on the spread of the tumor, a combination of surgical therapy, radiotherapy and/or chemotherapy is often implemented.
Stage IV: The uterine cancer is very advanced. In IVA, it has already spread to the mucous membrane of the bladder or rectum. In IVB, the tumor has formed distant metastases in other organs. A cure is then difficult to achieve. In IVA, surgery is usually combined with Chemoradiotherapy. In IVB, radiotherapy and chemotherapy are often used to alleviate symptoms. Hormone therapy can also be useful for certain types of the tumor.

Doctors also take personal factors into account when choosing the appropriate treatment for uterine or cervical cancer. These include whether there is a desire to have children, whether the cancer occurred before or after menopause and what long-term consequences of the treatment are to be expected. Other factors such as the patient's general state of health, age or certain risk factors are also taken into account when developing the therapy plan.

The individual treatment plan is then determined following a detailed consultation between the patient and specialized doctors. The therapy can be based on oncology guidelines like the ESMO guidelines for endometrial cancer and the ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up for cervical cancer. These are guidelines that are valid throughout Europe, have been drawn up by medical associations and are updated at regular intervals.

Different regions may use other national or international guidelines as access to gynecologic care may vary.

Operation

Cervical cancer is often treated surgically. There are three main types of surgery:

Conization: During conization, a cone-shaped piece of tissue is removed from the cervix. This procedure is used to diagnose and treat preliminary stages or very small tumors, often in the early stages of the disease. It is also a treatment option if the patient still wishes to have children, as it allows the uterus to be retained.
Trachelectomy: This method removes the cervix and the upper vagina, leaving the uterus intact. It is particularly suitable for young patients who wish to have children. Lymph nodes and surrounding tissue can also be removed during this procedure to prevent the cancer from spreading.
Hysterectomy: A simple hysterectomy, where only the uterus is removed, is used in early stages. When tumors are advanced, a radical hysterectomy is performed, in which surrounding tissue such as pelvic lymph nodes are also removed to ensure complete removal of all cancer cells.

Radiation Therapy

Radiation therapy can be used both externally (teletherapy) and internally (brachytherapy). It aims to destroy tumor cells using high-energy radiation. It is often used for locally advanced cervical cancer - sometimes in combination with chemotherapy - to increase the chances of recovery. Radiotherapy can be used in combination with surgery as adjuvant (after surgery) or neoadjuvant (before surgery) therapy. Adjuvant therapy is intended to destroy residual cancer cells, neoadjuvant therapy to shrink the tumor before surgery.

Chemotherapy

Chemotherapy is used for advanced cervical cancer or metastatic tumors. It is usually combined with radiotherapy (Chemoradiotherapy).
Cytostatic drugs act systemically on the body to destroy cancer cells or inhibit their growth. It can also be used to shrink the tumor before surgery. In addition, chemotherapy helps to fight cancer cells that may have already spread to other parts of the body.

Chemoradiotherapy

This combination therapy uses radiotherapy and chemotherapy at the same time. It increases the effectiveness of both therapies, particularly in the case of locally advanced cervical cancer. Cytostatic drugs increase the sensitivity of tumor cells to radiation. The high-energy radiation damages the DNA of the cancer cells and disrupts their growth. Chemoradiotherapy can also be used after surgery or as the main therapy for non-operable tumors.

Operation

The main treatment for uterine cancer is surgery. It usually involves the removal of the entire uterus (hysterectomy), ovaries and fallopian tubes. This is often done laparoscopically, i.e. microinvasive surgery, which is less stressful for the body. In advanced cases, the lymph nodes are also systematically removed. The decision on the extent of the operation depends on the stage and type of tumor. Surgery is often curative, especially in early stages, and is also used to make a more accurate diagnoses and determine the extent of cancer spread.

Radiation Therapy

Radiation therapy is used to kill any remaining cancer cells after surgery. It can also be the primary treatment method for advanced or inoperable cancer. Vaginal brachytherapy, in which radiation sources are placed close to the tumor, is used to prevent recurrence. External radiation, which takes place over several weeks, targets the entire pelvic area to treat local and lymph node metastases. If a cure is no longer possible, radiotherapy can relieve pain and slow tumor growth.

Chemotherapy

Chemotherapy is used when the cancer is very advanced, has not responded to other therapies or has relapsed. It inhibits the growth of cancer cells by interfering with their cell division. Typical chemotherapeutic agents for uterine cancer include carboplatin and paclitaxel. These drugs can act systemically throughout the body and are often used when the cancer has spread to other organs. Chemotherapy is often used after surgery and in combination with radiotherapy to destroy any remaining cancer cells.

Hormone Therapy

As many endometrial cancers are hormone-dependent, hormone therapy is used to slow down tumor growth. Gestagens (female hormones) are usually prescribed. It is particularly suitable for advanced cancer or as an alternative to surgery in older patients or patients with severe health problems. The combination with anti-estrogens are also being investigated. Young patients whose hormone-dependent cancer has a low risk of metastasis or recurrence and who wish to preserve their fertility can also be treated with this therapy.

Chemotherapy and radiotherapy are often linked to severe side effects on the patient's entire body. For this reason, cancer research is constantly looking into possible new therapies for cervical and endometrial cancer, which should enable more targeted treatment of cancer cells. Targeted therapies and immunotherapies are newer approaches in the treatment of cervical cancer and endometrial cancer. They attack specific characteristics of the tumor cells or strengthen the immune system in order to fight cancer cells more effectively. These methods are used for metastatic or therapy-resistant tumors, in particular, and are still in development in some cases.

The RGCC International teams consist of researchers from a wide range of disciplines who are active in an international laboratory network. Our experts combine cutting-edge research with state-of-the-art technology to develop targeted cancer therapies. We work every day to further improve patient outcomes and reduce the number of ineffective therapies.

The RGCC cancer therapies listed here are generally suitable for use in the treatment of cancer of the womb or cervix. Whether targeted therapy or immunotherapy should be used and which method a doctor chooses can be clarified with the help of a cancer blood test in conjunction with further diagnoses by the attending medical team.

Q-REstrain

Q-REstrain consists of microRNA molecules with the ability to regulate the gene expression of a specific target. The short dsRNAs (double-stranded RNAs) are derived by cleavage of long dsRNA from Dicer and can be microRNAs (miRNAs). miRNAs then assemble with RNA-induced silencing complex (RISC) and cause gene silencing. RNAi has been used in the therapy of different diseases including cancer, viral infections, respiratory diseases, etc. Targeting of specific proteins, through degradation of their mRNA, is very common in cancer treatment of different types of cancer or other infections. Q-REstrain contains microRNAs isolated by the patient’s sample, leading to the degradation of specific mRNA molecules, which are overexpressed in this specific sample, thus regulating the expression. Q-REstrain is for autologous use only and is provided through the RGCC network.

Clavic-Q-RE

Clavic-Q-RE is an adoptive cell therapy aiming to generate a robust anti-tumor immune response. Clavi-Q-RE contains different cell populations, isolated by the patient’s sample.

They include monocytes, natural killer cells, as well as dendritic cells that are already activated in vivo against tumor antigens, which are expressed on cancer samples, cytotoxic T lymphocytes, and plasma cells that have been already differentiated in vivo against tumor antigens.

Clavic-Q-RE is for autologous use only and is provided through the RGCC network.

Vaccine Prep (ATA)

Vaccine Prep (ATA) is a new type of immunotherapy that activates or strengthens specific immune cells. The body's own cells are specifically designed to recognize and destroy cancer cells. We use the cellular fragments of dying tumor cells (CTCs). These include organelles, mitochondria, cell membranes, cellular RNA and DNA and tumor protein fragments.

Dentric Cell Therapy

The aim of dendritic cell therapy is to activate or strengthen the immune system. In immunotherapy, specific immune cells are used to target cancer cells. The therapy method uses so-called dendritic cells, which can recognize specific antigens on the surface of cancer cells. Thanks to improved tumor defense and a reduction in systemic side effects, the therapy is considered a promising treatment approach.

In order to be able to initiate personalized treatment for cervical cancer or uterine cancer, a cancer blood test must be carried out. This test examines specific biological characteristics of the tumor. The results of the cancer test and other diagnostic procedures provide doctors with the basis on which they determine the individual treatment plan for their patients. This includes the selection of suitable treatment methods and the best possible combination of these. The following of our tests can be used to diagnose cervical or endometrial cancer by a doctor, to detect specific biomarkers during screenings and to personalize cancer treatment:

Oncotrace

establishes baseline values for CTC count, phenotype markers, and stemness markers in the bloodstream. These parameters provide a…

Show test
Oncocount

detects the presence of CTCs and quantifies their concentration in the bloodstream. A higher number of CTCs might…

Show test
Oncotrail RGCC

is designed for specific cancers. It benchmarks the aggressiveness of the tumor and is used to track…

Show test
Metastat

investigates the proteins that are related to the distant spread of cancer and the potential metastatic properties of…

Show test
Onconomics

provides highly detailed and accurate information about how effective specific anti-cancer drugs and targeted therapies are in treating…

Show test
Onconomics Plus

provides information about the effect of specific anti-cancer drugs, targeted therapies and natural treatments on the cancer…

Show test
Onconomics Extracts

is a unique and highly detailed test that provides information on how effective natural substances and plant…

Show test
Onconomics Extracts +

Onconomics Extracts+ provides highly detailed and accurate information about how effective specific natural substances and plant extracts are. Furthermore,…

Show test
ChemoSNiP

analyzes how each body reacts to a chemotherapy agent. It helps clinicians make superior decisions on which medication(s)…

Show test
Immune-Frame

provides insights into the current state of a patient’s immune system. It is used to guide treatment and…

Show test
ArrayCGH RGCC

helps identify chromosomal abnormalities and genetic disorders.

Show test
CAMBISeq

is used to predict cancer treatment response. The test analyzes 500+ genes, which are used as biomarkers to…

Show test
Onco-D-Clare

Early detection can make all the difference. Onco-D-Clare can help identify cancer risk even before symptoms appear.

Show test
InVyomma Plus

focuses on gut microbiome profiling, including analysis of short-chain fatty acids, and their association with cancer.

Show test

The researchers at RGCC International work every day to address unmet medical needs and contribute to more targeted cancer treatment. We want to support doctors and patients with our tests and therapies so that cancer can be treated even more effectively.

Would you like to have an early cancer diagnosis, an analysis of the disease or therapy monitoring carried out using a blood test? Then please get in touch with us! Our state-of-the-art tests and therapies are available exclusively to doctors in the RGCC network. In addition to uterine cancer treatment, our procedures can also be used for other types of cancer such as breast cancer, bladder cancer, colon cancer, lung cancer or prostate cancer. Do you have any questions? Contact the highly specialized team at our help desk! We will be happy to assist you.