Your provider will tailor your specific treatment plan for you. Below are examples of common treatment pathways for endometrial cancer and pelvic masses.
Endometrial cancer
Biopsy
Endometrial cancer, which occurs in the uterus, is typically diagnosed with a biopsy of the lining of the uterus that is then reviewed by a pathologist. Many patients have this done by their primary care physician or OB/GYN provider. If cancer is found on this biopsy, you will then be referred to a gynecologic oncologist.
Imaging
Most cancers of the uterus do not require any specific imaging prior to removing the uterus. Some women will be recommended to get a pelvic ultrasound, a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or even a positron emission tomography (PET) scan. This imaging may be recommended before or after surgery depending on the specific diagnosis.
Surgery
Hysterectomies are recommended for most women with endometrial cancer. A hysterectomy for endometrial cancer typically involves removing the uterus, cervix, fallopian tubes, ovaries, and lymph nodes. These surgeries are often done laparoscopically (a minimally invasive procedure that requires only small incisions). But sometimes patients do require an open incision. For some women with endometrial cancer there are options other than surgery.
Genetic testing
The tumor in your uterus will be screened to see if you may have a genetic condition that put you at a higher risk of getting an endometrial cancer. If your screening test is positive we may recommend that you meet with a genetic counselor and have blood drawn, which can provide more information about your genetic makeup.
Your gynecologic oncologist will present your case to a panel of experts at Dartmouth Cancer Center, called a tumor board. The tumor board includes gynecologic oncologists, radiation oncologists, pharmacists, and geneticists. The team works together to develop a treatment plan.
You may not require any additional treatment following a hysterectomy, or we may recommend that you have radiation to the top of the vagina (called brachytherapy), whole pelvic radiation, and/or chemotherapy. You may get an offer to participate in a clinical trial.
Follow-up
After you have completed treatments, your gynecologic oncologist will meet with you to come up with an individualized follow-up plan. Most women should undergo pelvic exams with a visual inspection of the top of the vagina at regular intervals.
Pelvic mass/ovarian cancer
Imaging
Women with a pelvic mass have typically either undergone a transvaginal ultrasound or a CT scan to detect the mass. Some women may also get an MRI scan.
Surgery/diagnosis
Depending on the exact characteristics of the mass, your gynecologic oncologist may recommend surgically removing the mass. We do not typically biopsy these masses. Rather, we recommend removing the entire mass. Your surgeon may recommend a laparoscopic surgery or a surgery through an open incision.
Once the mass is removed, it is sent to the pathologist who looks at the specimen under the microscope. If there is cancer present, you may require additional surgery. This can often be completed in one surgery. Some women may have ovarian cancer that has spread to other organs prior to surgery. In this case, your doctor can safely recommend a biopsy before any treatments to confirm a diagnosis.
Treatment plan
Your gynecologic oncologist presents your case to the tumor board. The team works together to develop a treatment plan. If you have an ovarian cancer, you will likely undergo chemotherapy.
Chemotherapy
Chemotherapy is recommended for most women with ovarian cancer. In women diagnosed with metastatic ovarian cancer (cancer that has spread to other organs), your doctor may recommend chemotherapy before surgery. Clinical trials may be offered as an option.
Genetic testing
Genetic testing is recommended for all women with ovarian cancer. Your provider will offer you a referral to a genetic counselor who reviews the available tests and the meaning of possible results. Genetic testing is often covered by insurance.
Follow-up
After you complete treatments, your gynecologic oncologist will meet with you to come up with a follow-up or surveillance plan tailored to your needs. Pelvic exams at regular intervals are recommended for most women. Some women may also be candidates for maintenance therapies.