Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for endometrial cancer depends on:
- the type of endometrial cancer
- where it is in the body
- whether the cancer has spread, and where it has spread to
- your general health
- your personal preferences.
Treatment options can include surgery, chemotherapy, radiation therapy and hormone therapy.
Endometrial cancer is usually treated with surgery to remove the uterus, cervix, fallopian tubes or ovaries, and sometimes lymph nodes as well.
Hysterectomy and bilateral salpingo-oophorectomy
A total hysterectomy is the surgical removal of the uterus and cervix. Your doctor may also remove part of your vagina, called a radical hysterectomy.
In most cases, the fallopian tubes and ovaries are also removed – this is called a bilateral salpingooophorectomy. The ovaries are removed either because the cancer may have spread to the ovaries, or because the ovaries produce oestrogen, a hormone that may cause the cancer to grow.
The operation can be either:
- open surgery, where a large cut is made in your belly
- laparoscopic surgery (also called keyhole surgery), where several small cuts are made in your belly and a thin telescope is used to see inside. Your uterus and any other organs will be taken out through your vagina.
Surgery can affect your ability to have children (see Effects of treatment on fertility).
Lymph node removal
Lymph nodes (also called lymph glands) are small, bean-shaped organs that are part of the lymphatic system in your body. There are major lymph nodes in the neck, armpits, groin and abdomen. The lymphatic system is an important part of the immune system.
If endometrial cancer has spread into the muscular wall of the uterus, this increases the risk that it will spread to other areas near the uterus and to the pelvic lymph nodes. Your doctor may discuss the need to remove some of the lymph nodes in your pelvic region, to make sure the cancer does not spread further. Surgically removing your lymph nodes is called a lymphadenectomy.
Lymph node removal is not recommended for all women. If cancer is found in the lymph nodes, your doctor may advise more therapy, called adjuvant therapy.
Radiation therapy (also called radiotherapy) uses high-energy X-rays to kill cancer cells. It is often used after surgery to destroy any remaining cancer cells and reduce the risk of the cancer coming back.
You might have external radiation therapy to your pelvic area to treat endometrial cancer. Radiation therapy may also be recommended if the cancer has come back or spread, or, very rarely, if you are not well enough for a major operation.
You may also have a type of radiation therapy called vaginal brachytherapy. This is when a source of radiation is placed in your vagina, like a tampon. This allows the radiation treatment to target the area more precisely.
If you are premenopausal and have not had a hysterectomy or bilateral salpingo-oophorectomy, you should avoid getting pregnant during your during your radiation therapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor urgently.
Chemotherapy uses drugs to destroy cancer cells or slow their growth, and may involve a number of treatments (‘cycles’) over several months. Chemotherapy is commonly used to treat stage 3 or 4 endometrial cancer.
If you are premenopausal and have not had a hysterectomy or bilateral salpingo-oophorectomy, you should avoid getting pregnant during your chemotherapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor urgently.
Hormones are produced by glands in the body and circulate in the bloodstream. Some cancers of the uterus depend on hormones produced by the ovaries (such as oestrogen) for their growth. Progesterone is a common hormone therapy used to treat endometrial cancer. Other hormone therapies used include aromatase inhibitors such as anastrozole, or letrozole which reduce the amount of oestrogen in the body.
Targeted therapy is treatment with drugs that targe certain factors or changes in the cancer cells. Targeted therapy may be used to treat some types of endometrial cancer:
- Lenvatinib is a kinase inhibitor used to treat some advanced endometrial carcinomas. It can be used in combination with immunotherapy.
- Bevacizumab may be used to treat endometrial cancers that have spread to the fallopian tubes or ovaries.
Both these therapies work by preventing the cancer cells from forming new blood vessels, which slows their growth.
Other targeted therapies include mTOR inhibitors, such as pazopanib.
Cancer cells use different proteins, called “checkpoints” to stop the immune system from attacking them. Immunotherapies, called immune checkpoint inhibitors can help the immune system to destroy the cancer cells. Some commonly used immunotherapy drugs used in bladder cancer are avelumab and nivolumab.
For further information regarding immunotherapy, see Immunotherapy
Pembrolizumab, a type of immunotherapy, is used to treat some advanced endometrial carcinomas. It works by ‘boosting’ your body’s response against cancer cells.
See more about immunotherapy
Recurrent or advanced disease
Recurrent endometrial cancer is cancer that has recurred (come back) after it has been treated. It grows back from the cells of the original primary cancer that have not responded to treatment. Secondary cancer, or metastasis, is cancer that has spread from the original site to another part of the body.
Endometrial cancer may come back in the uterus or in other parts of the body.
The treatment options for recurrent endometrial cancer are similar to those for primary endometrial cancer.