Endometrial cancers

• • Hyperestrogenism: excess of circulating estrogen over progesterone, common in obese patients;

• • Early onset of men struation or late menopause, which increase the total number of menstrual cycles and thus estrogen exposure;

• • Absence of pregnancy, which reduces elevated progesterone phases;

• • Hormone replacement therapy with estrogen alone, without the addition of progesterone.

In contrast, the use of the combined birth control pill (estrogen + progesterone) is a protective factor.

• • Obesity: adipose tissue produces estrogen, disrupting the normal balance between estrogen and progesterone and increasing the risk of endometrial cancer;

• • diabetes mellitus: metabolic conditions that adversely affect hormone balance;

• • high blood pressure: often associated with metabolic syndrome, which includes obesity and insulin resistance, increasing the risk of endometrial cancer.

It is a typical cancer in patients over 50 years old, with higher incidence in post-menopausal age.

• • Lynch syndrome(a hereditary disease also associated with colorectal cancer and other malignancies) significantly increases the risk of developing endometrial cancer later in life (about 70% compared with 3% in the general population);

• • A family history of endometrial or colon cancer may indicate an increased risk.

In selected cases of very early cancers that have not yet infiltrated the uterus, in women who are pre-menopausal, inoperable, or at a young age or who wish to have children in the future, there is the possibility of using local treatment:

• progesterone IUDs

• ventual endometrial ablation by hysteroscopy

These approaches aim to regress the neoplasm while avoiding surgery.

Standard treatment for endometrial cancer begins withsurgical removal of the uterus and ovaries by advanced laparoscopic surgery and robotic surgery.

Even in cases of advanced disease at diagnosis, first-line surgical treatment remains the preferred choice, provided the disease is completely removable and the patient is anesthesiologically fit.

What it consists of

While in the past surgical treatment also included pelvic lymphadenectomy (i.e., removal of all lymph nodes in the pelvis and, in some cases, the lumboaortic region), today this approach is being replaced by the sentinel lymph node technique, which is less invasive and has a lower rate of complications.

This technique involveslocating and removing only the first lymphnode that receives lymphatic drainage from the tumor-the so-called “sentinel lymph node”-because it is the most likely point of arrival of any cancer cells.
To identify it, a tracer (such as fluorescent indocyanine green) is injected near the uterus during surgery, allowing the surgeon to visualize and remove only those lymph nodes that are truly at risk. Analysis of this lymph node makes it possible to tell if the disease has spread without having to remove all the lymph nodes, thus reducing the risk of leg swelling (lymphedema) and other postoperative complications.

After surgery and after analysis of the molecular classification of the tumor, other therapeutic strategies such as chemotherapy or radiation therapy will be decided.

After surgery, analysis of the molecular classification of the tumor guides the decision on subsequent therapies, which may include chemotherapy and radiation therapy.

In recent years, experimental studies have shown the efficacy of immunotherapy in certain patient subgroups.

The cancer patient is often a fragile patient, who needs help and support in her disease journey: when she experiences an ailment, whether related to the disease or a side effect of therapy, she needs to be able to receive a specialist’s opinion quickly, through a “fast track.”

For this reason, at the Candiolo Institute there is an assistance service every day, Monday through Friday from 8 a.m. to 5 p.m.: just call the secretary of the Oncology Day Hospital (011 993 3775) reporting the need for an urgent consultation, and the patient is quickly contacted by his or her specialist doctor.

The impact of cancer in a person’s life also affects the psychological sphere: falling ill with cancer is in fact always a traumatic event that affects all dimensions of the person and can generate anxiety, fear, anger, depression.

At the Candiolo Institute, alongside cutting-edge therapies, the treatment and care pathway always includes a qualified psycho-oncological support that helps the patient cope positively not only with treatment but also with the delicate phase of physical and psychological recovery.

It is also possible to participate in support groups psychological to compare with other people who have gone through or are going through the same experience.

To ensure timely and direct support and receive timely answers to concerns and questions, a dedicated support service is in place at the Candiolo Institute for all patients.

From Monday to Friday, from 8 a.m. to 5 p.m., you can contact the secretariat of the oncology day hospital at 011.993.3775, reporting the need for urgent consultation.

The patient will be quickly put in touch with his or her medical specialist, to receive clear answers and immediate support.

The cancer patient is a person with complex needs that requires multidisciplinary support not only for the cancer disease, but also for all related issues.

At the Candiolo Institute, patients who need or require it have access to specialists in different areas to receive nutritional support, physical therapy, pain therapy and management of other associated conditions.

The Social Service Department of the Candiolo Institute conducts information and orientation interviews to patients and their families on how to access services in the area and how to obtain welfare and social security benefits provided by law (disability, benefits for aids and prostheses, work leave, etc.).

The service operates on Wednesdays and Fridays from 9 a.m. to 1 p.m. (phone: 011 9933059).

With the conclusion of the course of treatment, the follow-up period begins during which, through a series of examinations and visits, the side effects of the therapies performed and their effectiveness are monitored and the patient’s functional recovery is assessed.

Follow-up visits are especially important to intercept any recurrences early, so that appropriate therapy can be intervened. For the patient, they are also a valuable opportunity for dialogue with her medical specialist.

It is the same specialist physician who schedules follow-up visits, in which the patient’s health condition is assessed and reports of any required tests are viewed.

Due to the high number of cases treated each year, the Candiolo Institute is a national reference for taking care of esophageal cancer. Our experience enables us to deal with even the most complex situations, always with a personalized approach built on the clinical and personal profile of each patient.

Establishing the treatment plan always starts with an accurate and timely diagnosis. Patients have access to state-of-the-art imaging technologies that allow accurate assessment of the extent of the disease.

In addition, the Institute offers advanced and sophisticated laboratory investigations, including molecular and genomic analyses, which are critical for identifying biological features of cancer and guiding therapeutic decisions.

When indicated, surgery is performed with minimally invasive techniques (laparoscopic or thoracoscopic), which reduce operative trauma, promote faster recovery, and improve postoperative quality of life. Every treatment choice is defined within the GIC, ensuring a consistent and integrated approach.

As an IRCCS, the Candiolo Institute combines clinical practice with a strong vocation for scientific research. Patients can be evaluated for inclusion in active clinical trials, which represent a real chance to access innovative therapies not yet available in standard practice. Collaboration between care and research is a distinctive value that translates into concrete opportunities for the patient.

The Interdisciplinary Care Group takes care of the person at every stage: from diagnosis to treatment to follow-up, with attention to nutritional support, psychological health, and reintegration into daily life. The organization of checkups, visits and treatment is designed to ensure continuity and serenity, always valuing the human dimension of care.