Understanding Endometrial Cancer
- “The Howard Stern Show” co-host Jada Robin Quivers, 71, is an inspiration to women suffering from hair loss by encouraging them to embrace their beauty inside and out. Quivers’ hair loss is linked to both her cancer treatment for endometrial cancer and alopecia (a condition that causes temporary or permanent hair loss).
- Endometrial cancer begins when cancerous cells form in the tissues of the endometrium or lining of the uterus.
- Treatment advancements for advanced endometrial cancer patients and those at higher risk for recurrence include combination therapies where immunotherapy is added to standard-of-care chemotherapy.
- Treatment for this cancer varies depending on the stage of the disease, the patient’s overall health, and other factors. In Quivers’ case she’s treating the disease with immunotherapy infusions.
The 71-year-old radio personality, who previously beat stage 3 endometrial cancer and experienced a relapse years later, is now proudly showing off her bald head as she undergoes immunotherapy infusions periodically.
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“The only reason you don’t see my head like this is because I freeze in the wintertime, because all the time the heat goes out of your head,” she explained.
“I’m very much aware of that now. So I have to cover my head in the wintertime.”
Quivers also noted that she doesn’t wear a wig at all times, so it’s nothing unusual for her to show off her bald head.
She light-heartedly added, “One of my helpers here saw me walking into the studio area and said, ‘Don’t forget your wig!’ And I said, ‘No, I’m showing them a new look today.'”
However, hair loss isn’t anything new to Quivers, as she previously dealt with alopecia prior to undergoing cancer treatment.
According to research published in JAMA, “alopecia areata is an inflammatory disease of the follicular unit that results in nonscarring patches of hair loss occurring on the scalp, eyebrows, eyelashes, and beard area.”
The condition tends to impact Black and Hispanic populations than white populations.
When you compile alopecia with the chemotherapy side effect of hair loss, Quivers was faced with this emotional stage of the cancer journey with added force.
“Your hair doesn’t fall out the way you think it’s going to fall out. It falls out in patches. It becomes this horror story,” Quivers said on an episode of the Howard Stern Show from September 2013.
“I had a barber shave my head the first time and teach me how to do it, and as soon as he was done, I said, ‘Is there anything about my head that should not be seen?”
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Robin Quivers’ Battle With Endometrial Cancer
Robin Quiver’s was diagnosed in 2012 with endometrial cancer, a disease which begins when cancerous cells form in the tissues of the endometrium or lining of the uterus, according to the National Cancer Institute.
Following a woman’s endometrial cancer diagnosis, her doctor will stage the cancer based on its spread within the body. A pelvic exam and imaging tests help your doctor learn if the cancer has spread or metastasized.
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Her symptoms began after she started having trouble urinating and feeling more fatigued. Quivers then went to the doctor to get some answers, and her CT scans, MRIs, and biopsies turned out to be inconclusive, a period of uncertainty she recounts as “scary” and “bizarre.”
Further tests finally found the culprit, a grapefruit-size mass on “every organ in her pelvic area.” Following the discovery, a hysterectomy was ordered, and the popular radio host underwent the procedure.
A hysterectomy is a procedure that removes part or all of the uterus (or womb), often along with the cervix, according to the National Cancer Institute. Women who receive a diagnosis of uterine, ovarian, and cervical cancer may have their cancer treated with a hysterectomy.
Following the procedure, Quivers began chemotherapy and radiation treatments that spanned 15 months.
“When you’re in and out of treatment, you’re always recovering and trying to get back to where you were,” Quivers said.
After undergoing intensive treatment, Quivers reached remission, which lasted for more than three years. Then, in late 2016, she experienced a relapse and needed additional treatment after the cancer returned and metastasized to her lymph nodes. After getting her cancer under control, she undergoes immunotherapy infusions periodically.
The immune system uses its white blood cells to attack abnormal or foreign cells in the body. Cancerous cells can prevent the immune system from doing its job and attacking foreign cells. Cancer produces certain proteins that protect the tumor from white blood cells. As a result, the body does not recognize the tumor as abnormal. However, immunotherapy treatments stop this from happening and ensure that the white blood cells recognize the cancer cell properly and attack it.
How is Immunotherapy Used for Advanced or Recurrent Endometrial Cancer?
Treatment Options For Endometrial Cancer
Treatment for this cancer varies depending on the stage of the disease, the patient’s overall health, and other factors. Here’s an overview of the treatment options available for endometrial cancer.
Surgery
When the disease is localized, surgery is usually the first treatment considered and that alone may be all that’s required. More advanced stages often require a newer, more targeted treatment approach such as immunotherapy.
The most common surgical procedure is a hysterectomy, which involves removing the uterus. In some cases, the surgeon may also remove the cervix and the fallopian tubes and sometimes the ovaries. Surgery helps to remove the cancerous tissue and is often followed by additional treatments to ensure that all cancer cells are eradicated.
“So in my practice, probably 90% of patients get surgery first as their first treatment for their endometrial cancer. And that is if you have a stage one or a stage two or a stage three, sometimes even a stage four cancer surgery is usually typically the first step in your treatment,” explains Dr. Dana Chase, an associate professor of UCLA Obstetrics and Gynecology in Los Angeles.
Radiation Therapy
Radiation therapy uses high-energy rays to stop cancer cells. It can be administered externally, where the radiation comes from a machine outside the body, or internally, where radioactive materials are placed inside the body near the cancer cells. Radiation therapy is often used after surgery to kill any remaining cancer cells and reduce the risk of recurrence.
“There are some features of the cancer that make you high risk for recurrence. And what that means essentially is the doctor could be scared that maybe even just a single cancer cell escape the uterus and could eventually grow back with time.,”Dr. Chase explains. “And if that’s the situation, your doctor might recommend radiation treatment.”
Chemotherapy
Chemotherapy involves using drugs to kill cancer cells. These drugs can be taken orally or injected into the bloodstream. Chemotherapy is often used in cases where the cancer has spread beyond the uterus or when there is a high risk of recurrence. It can be used alone or in combination with other treatments.
Chemotherapy is often given in conjunction with other therapies such as radiation or immunotherapy.
Dr. Marta Crispens, a professor and director of the division of gynologic oncology at Vanderbilt University Medical Center in Nashville, explains that when chemotherapy is given along side of other types of treatment it is even more effective. She points to studies that looked at combining standard chemotherapy with immunotherapy drugs that strengthen the immune system’s response for fighting cancer.
Dr. Jennifer Mueller, a gynecologic surgeon at Memorial Sloan Kettering Cancer Center, explains how surgery can help determine treatment path.
“If you gave the patient with advanced recurrent disease, endometrial cancer chemotherapy with standard chemotherapy for six treatments, which would be the standard combined with immunotherapy, followed by a maintenance period of immunotherapy, that patients had much better outcomes than if they were treated with chemotherapy alone,” Crispens says.
Immunotherapy
Immunotherapy is a newer form of treatment that helps the body’s immune system fight cancer.
“For a long time, patients with early-stage endometrial cancer generally do very well with a combination of surgery, maybe some radiotherapy,” says Dr. Shannon Westin, a professor in the department of gynecologic oncology and reproductive medicine at the University of Texas, MD Anderson Cancer Center in Houston, TX.
“However, there’s a population of patients that are diagnosed at a later stage, stage three or four, or that have their cancer come back after initial therapy. And those patients have had a really hard time,” she adds.
According to Westin, the latest treatments combine immunotherapy with standard chemotherapy plus a drug that prevents cancer cells from fixing their own DNA.
Hormone Therapy
Some endometrial cancers are hormone-sensitive, meaning they grow in response to hormones like estrogen. Hormone therapy involves taking medications that lower hormone levels in the body or block their effects on cancer cells. This type of therapy is often used for advanced or recurrent endometrial cancer.
“Hormonal therapy commonly works because most of endometrial cancers are estrogen receptor positive,” Dr. Michael Toboni, an assistant professor in the division of gynologic oncology at the University of Alabama at Birmingham notes to SurvivorNet. “So if you give progesterone, it can counteract the estrogen feeding the cancer. This is commonly given with multiple anti-estrogen medications or an anti-estrogen medication in combination with another medication that inhibits a common pathway in endometrial cancer.”
How to Navigate One of the Most Emotional Steps During a Cancer Journey
Hair loss is challenging for women and men alike, but it can be incredibly difficult for cancer patients. Losing your hair or seeing it thinning is a common side effect of some cancer treatments.
Chemotherapy can cause hair loss. It usually begins about three to four weeks after starting chemotherapy and continues throughout treatment.
It happens because this treatment targets quickly dividing cells throughout the body. That includes cancer cells but also hair cells.
“For cancer patients, losing one’s hair can be unbelievably stressful. To start with, the dread of losing one’s hair can lead to some sleepless nights and feelings of anxiety,” Dr. Samantha Boardman, a New York-based psychiatrist and author, told SurvivorNet.
WATCH: Hair loss during chemo.
To better cope with this emotional stage of the journey, Dr. Boardman suggests reaching out to other survivors who have been through a similar situation.
Radiation is another treatment that can lead to hair loss if the hair is in the path of the tumor being treated. Radiation for a brain tumor, for example, may cause hair loss.
“If you do lose hair, it will regrow several weeks or months after treatment,” radiation oncologist Dr. James Taylor told SurvivorNet.
“Fortunately, for most patients, hair loss is not a concern when having radiation therapy,” Dr. Taylor continued.
Fortunately, hair loss during cancer treatment is not all bad news. Most people can expect regrowth four to six weeks after treatment. However, when your hair grows back, you may notice some changes in its color and texture.
If losing your hair is a concern for you before cancer treatment, know you have options like wigs, hats, wraps, and scarves, among other things.
Another option that can minimize hair loss is cryotherapy, “just a fancy way for saying cold therapy,” says Dr. Renata Urban, gynecologic oncologist at the University of Washington in Seattle.
Cryotherapy involves wearing cold caps or special cooling caps before, during, and after each chemotherapy treatment.
WATCH: What is a scalp-cooling device?
The caps, which are tightly fitting and strap-on helmet-style, are filled with a gel coolant that’s chilled to between negative (-15) to (-40) degrees Fahrenheit.
The caps “cause vasoconstriction, or a narrowing of the blood vessels bringing blood to the scalp,” Dr. Urban explains. By constricting the blood flow to the scalp, the caps limit the amount of circulating chemotherapy that reaches the hair follicles, protecting them from some of the chemo’s damaging effects.
The cold also decreases the activity of the hair follicles, which slows down cell division and makes the follicles less affected by chemotherapy medicine.
“This has been shown to reduce hair loss by 50 percent,” Dr. Urban says. “I do try to let patients know it’s not a 100 percent prevention strategy, and it’s not been studied in all hair types, but it is at least an available strategy for patients to try.”
Keep in mind you will be experiencing some cold temperatures. Some women find the caps give them a headache. To help withstand the chilly temps, some women will dress warmly and bring blankets.
Of course, always talk with your doctor about potential treatments to mitigate the loss and the resources at your disposal for handling the loss.
Contributing: SurvivorNet Staff
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