Endometrial (Uterine) Cancer: Treatment Overview

Content provided by Healthwise

Treatment Overview

Endometrial cancer detected in its early stages can be cured with surgery and close follow-up. Treatment choices depend on where the cancer is and how much it has grown. Treatment may include one or more of the following:

• Hysterectomy with bilateral salpingo-oophorectomy surgery to remove the uterus, ovaries, fallopian tubes, and sometimes the pelvic lymph nodes
• Lymphadenectomy surgery to remove lymph nodes
• Radiation therapy to kill cancer cells
• Progestin hormone therapy to block cancer growth
• Chemotherapy to kill cancer cells

Initial treatment

After a diagnosis of endometrial cancer is confirmed, your doctor may recommend surgery to remove the uterus, ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). All tissues removed in surgery will be examined to determine the stage and grade of the cancer. Lymph nodes near the uterus will be examined to determine whether cancer has spread outside of the uterus.⁴

Treatment for endometrial cancer depends on the size of the cancer, as well as the extent of the cancer's growth, and how the cancer cells look under the microscope.

• Stage 1 is curable with a hysterectomy and bilateral salpingo-oophorectomy. If you are premenopausal and your cancer is in a very early stage and grade, you may be able to have progestin hormone therapy rather than a hysterectomy and thus retain your ability to have children.⁹ However, the effectiveness of hormone therapy is not fully known, so it is not considered a standard treatment for stage 1 cancer. If you choose this form of treatment, your doctor will probably recommend a hysterectomy when you are done having children. If cancer is found deep in the uterine muscle (myometrium), a hysterectomy may be followed by radiation therapy.
• Stage 2 is treated with a radical hysterectomy. This removes the uterus, cervix, ovaries, structures that support the uterus, and pelvic lymph nodes (lymphadenectomy). If cancer is found in the connective tissue of the cervix (stroma), radiation therapy may be used after surgery. Radiation therapy may be used if you cannot have surgery, but the cure rate is lower.
• Stage 3 is treated with a hysterectomy and radiation therapy. Sometimes, chemotherapy is used instead of radiation.¹⁰ When cancer has spread to the wall of the pelvis and cannot be removed during surgery, radiation therapy alone may be used. In the rare case that radiation therapy is not recommended, progestin hormone therapy may be used. Women with stage 3 endometrial cancer may be candidates for clinical trials of new treatment options.
• Stage 4 is treated with radiation therapy if the spread of cancer (metastasis) is confined to the pelvic area. If the cancer is in distant areas of the body, progestin hormone therapy may be used. Chemotherapy may also be used for treating stage 4 endometrial cancer.

Women who have a hysterectomy or radiation therapy to treat endometrial cancer can no longer become pregnant.

Use home treatment measures to help manage the side effects of treatment. For more information, see the Home Treatment section of this topic. Nausea and vomiting may be managed with medications prescribed by your doctor.

Controlling nausea and vomiting caused by chemotherapy

If you have recently been diagnosed with endometrial cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have endometrial cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

What to think about during initial treatment

Most treatments for endometrial cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

• Your surgeon and oncologist will explain the possible side effects of your surgery. A hysterectomy means you will no longer be able to become pregnant. Surgery to your lower abdomen may cause difficulty with urination or bowel problems, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.
• Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
• Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, anemia, or infections.

Your quality of life becomes a critical issue when considering your treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

Some women with endometrial cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of endometrial cancer.

Ongoing treatment

After initial treatment for endometrial cancer, it is important to receive follow-up care.

• Schedule checkups every 3 to 4 months for the first 2 years following your diagnosis to ensure that changes in your health are noted and problems are treated early. Most experts recommend checkups every 6 months thereafter up to 5 years after diagnosis.
• Checkups include physical exams and pelvic exams and may include blood and urine tests, chest X-rays, and other laboratory tests. A Pap test may indicate recurrence of cancer in the vagina, which is highly curable.

Treatment if the condition gets worse

Endometrial cancer may come back (recur). But this is not likely when the first cancer is caught early and is low-risk. Of those cancers that do come back, nearly all do so within 3 years of the first diagnosis. This is why regular follow-up is extremely important after initial treatment.⁷

Cancer that comes back only in the pelvic area sometimes is treated with radiation therapy. This may stop the progress of cancer and may even cure it if it is only in the vagina. If cancer has spread to other parts of the body, radiation therapy often provides relief (palliation) from symptoms. Chemotherapy may also be used.¹⁰ In addition, progestin hormone therapy often is used to slow the growth of cancer that has recurred or spread. Survival is significantly improved in up to 30% of women who receive progestin hormone therapy.¹¹

Participation in clinical trials to test new treatments may be appropriate if cancer has spread to other parts of the body and hormonal therapy is ineffective in stopping the growth.

What To Think About

If you are perimenopausal or have not yet reached menopause, your menstrual period will end immediately after most treatments for endometrial cancer. If your uterus and ovaries have been removed or have had radiation therapy, your body will have a decrease in estrogen. Estrogen normally prevents:

• Your bones from becoming thin and brittle (osteoporosis). Several medications are available to prevent or treat osteoporosis. For more information, see the topic Osteoporosis.
• Menopausal symptoms, such as hot flashes and insomnia. Talk with your doctor about how to manage your symptoms if they are bothersome. For more information, see the topic Menopause and Perimenopause.

Complementary therapies

Complementary therapies are not a substitute for the standard treatment recommended for endometrial cancer. But for some people, they can play an important part in managing stress and pain.

In addition to conventional medical treatment, you may wish to try complementary therapies, such as:

• Acupuncture.
• Herbs.
• Biofeedback.
• Meditation.
• Yoga.
• Visualization.
• Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the hope of cure or relief. But this isn't the end of treatment. Palliative care of cancer can improve your quality of life.

It can be difficult to decide when to stop treatment aimed at prolonging life and shift the focus to end-of-life care. For more information, see the topics:

• Care at the End of Life.
• Hospice Care.

E-mail This | Print This Previous Chapter | Next Chapter

Last updated:	November 27, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Ross Berkowitz, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman