Uterine Cancer and Infertility: Robotic-assisted surgery empowers new hope

About Author: With over a decade of experience, Dr. Rohit Ranade currently serves as a Consultant Gynecological Oncologist and Robotic Surgeon at Narayana Health Mazumdar Shaw Cancer Centre in Bangalore. Dr. Ranade specializes in minimal access surgery, laparoscopy, and robotics, and has a particular interest in peritoneal surface oncology and HIPEC procedures. He is an active member of professional organizations such as the Association of Gynecologic Oncologists of India (AGOI) and the International Gynecological Cancer Society (IGCS).

Infertility can be a challenging and emotionally taxing experience for women. In some cases, the journey to determine the cause of infertility may lead to a diagnosis of uterine cancer, also known as endometrial cancer. While this type of cancer has traditionally been associated with women above the age of 50 who have reached menopause, there has been a noticeable increase in younger women being diagnosed with uterine cancer in recent years.

Over the past five years, the increase in uterine cancer cases has been linked to risk factors such as obesity, hypertension, and diabetes, which contribute to hyperestrogenism, a leading cause of the most common form of endometrial cancer. Furthermore, a small percentage of cases can be attributed to genetic factors or acquired causes, such as infertility treatments, which have been linked to an increased incidence of uterine and endometrial cancer.

That being said, uterine cancer (including endometrial cancer and uterine sarcoma) has been shown to have a good survival rate when detected early. In fact, the five-year survival rate for stage one endometrial cancer is over 95%1. Fortunately, advancements in medical technologies have significantly enhanced the diagnosis and treatment of uterine cancer. Technologies like transvaginal ultrasound, hysteroscopy, endometrial biopsy, MRI, and CT scans enable accurate visualization and assessment of the uterus, facilitating early detection. Notably, robotic-assisted surgery has also emerged as a highly effective treatment modality.

Understanding Uterine Cancer and Infertility:

While uterine cancer does not necessarily hinder pregnancy in all cases, women with cancerous growths or pre-cancerous conditions affecting the endometrium may face challenges in conceiving due to compromised uterine lining quality. In such situations, a thorough diagnosis is crucial to promptly identify and treat uterine cancer.

For a select group of young women with endometrial cancer, temporary treatment options such as hormone-releasing intrauterine devices or oral tablets may be employed. Once the woman becomes tumour-free, the possibility of pregnancy can be explored. However, it is important to follow up with a hysterectomy after completing desired pregnancies to ensure long-term cancer control. Robotic-assisted surgery allows surgeons to skillfully remove the entire uterus and associated structures, enabling the removal of tumours and lymph nodes while minimizing damage to surrounding structures such as blood vessels, nerves, and the ureter.

Recognizing Symptoms and Early Detection:

Postmenopausal bleeding, occurring after menses have ceased, is a significant symptom often associated with uterine cancer and requires immediate medical attention. In younger women, symptoms may manifest as excessive bleeding during normal cycles or intermenstrual bleeding. This is a crucial factor, as women who have not yet reached menopause may not pay much heed to heavy or intermenstrual bleeding, leading to delayed diagnosis.

Treatment Approaches and the Role of Robotic-Assisted Surgery:

The treatment of uterine cancer depends on the stage and extent of the disease. In stage one, a hysterectomy is the primary form of treatment, which may involve the removal of the fascia of the uterus and selective or comprehensive pelvic and para-aortic lymph node dissection. Stage two cancers, involving the cervix, require a radical hysterectomy that includes the removal of the uterus, fascia, and associated ligaments. In stage three cancers, treatment involves hysterectomy and the removal of affected areas and ovarian masses.

Robotic-assisted surgery, using the da Vinci surgical system, has revolutionized the approach to treating uterine cancer, particularly in stages one and two. The precision and benefits offered by robotic-assisted surgery, including 3D vision, enhanced depth perception, and improved access to challenging pelvic areas, make it an ideal choice, especially considering the complex nature of the pelvic region. Achieving precision in removing lymph nodes while preserving vital structures such as blood vessels, nerves, and the ureter is possible through robotic-assisted surgery. Additionally, it proves particularly beneficial for obese patients with a BMI above 35, as moving the patient and accessing critical anatomical structures can be more challenging in traditional surgeries. Robotic-assisted surgery mitigates these issues, facilitating smoother surgical removal. Moreover, it is also highly advantageous for patients with diabetes or hypertension, reducing the risk of complications and infections.

Patients undergoing robotic-assisted surgery experience reduced pain, faster recovery, earlier resumption of normal activities, and a decreased risk of infection. For patients requiring additional treatments such as radiation or chemotherapy, robotic surgery allows for an earlier start.

Promoting Awareness and Early Intervention:

Raising awareness about uterine cancer is crucial, as early detection significantly improves treatment outcomes. While there is currently no screening protocol for uterine cancer, recognizing signs and symptoms is paramount. Fortunately, uterine cancer typically progresses slowly, especially in the case of the most common types.

Uterine cancer poses a growing concern worldwide and in India. However, with advancements in robotic-assisted surgery, the treatment landscape has undergone a remarkable transformation. This innovative approach offers precise surgical interventions, faster recovery, and improved outcomes for patients. By fostering awareness, promoting early intervention, and embracing cutting-edge technologies such as robotic-assisted surgery, significant strides can be made in combating uterine cancer and providing better lives for women affected by this disease.