Stages and treatment of endometrial cancer

Treatment for endometrial cancer depends on the stage of the cancer. Treatment often includes a combination of surgery, radiation, and/or chemotherapy. People with advanced cancers (stage 3 or 4) may also benefit from immunotherapy or targeted therapy. Clinical trials may be available for any stage of cancer.

Stages of cancer

The stage of a cancer refers to whether it has spread beyond the uterus, and if it has, the location in the body where it has spread. Measuring the stage of endometrial cancer helps doctors decide how to treat it. 

• Stage 1 is confined to the uterus
• Stage 2 has spred to the cervix
• Stages 3 and 4 the cancer has spread to the lymph nodes and beyond

Doctors may order additional tests such as chest XRAYS, chest, pelvic and abdominal CT, MRI or PET scans to learn if the cancer has spread beyond the uterus. 

Types of treatment

Most endometrial cancer is treated with a combination of one or more of the following treatments:

• Surgery
• Radiation
• Chemotherapy
• Hormone therapy
• Targeted therapy 
• Immunotherapy

Surgery

 During surgery, the uterus and cervix (hysterectomy), and often both ovaries and fallopian tubes (salpingo-oophorectomy) are removed. Surgery may also include removal of lymph nodes to check for cancer cells. Sparing the ovaries may be safe for some stage I, premenopausal patients.

Radiation therapy

Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. Your doctor may recommend radiation therapy to reduce your risk of endometrial cancer coming back after surgery (also known as recurrence). Sometimes, radiation therapy is recommended before surgery or instead of surgery. There are two types of radiation therapies used to treat endometrial cancer:

• External beam radiation is delived from a machine outside your body. During external beam radiation, patients lie on a table while a machine directs radiation to specific points on the body.
• Internal radiation (brachytherapy) involves placing radiation in smalll seeds, wires or a cylinder inside the vagina for a short period of time.

Chemotherapy

Treatment for endometrial cancer usually includes a combination of chemotherapy drugs. The most common chemotherapy agents used to treat endometrial cancer include:

• Carboplatin
• Paclitaxel (Taxol) 

These two agents are often used together. In some cases, a targeted therapy known as Herceptin (trastuzumab) may be added. These medications are typically given through the IV or a port as an outpatient.  

Hormone therapy

Hormone therapy used to treat endometrial cancer includes:

• Oral progesterone
• Intrauterine device that releases progesterone
• Tamoxifen
• Megestrol acetate

Treatment for stage 1 endometrial cancer

For patients with stage I endometrial cancer, treament usually includes:

• Surgery: during surgery, the uterus and cervix, and often both ovaries and fallopian tubes are removed. Surgery may also include removal of lymph nodes to check for cancer cells. Sparing the ovaries may be safe for some premenopausal patients.
• Radiation or chemotherapy: after surgery, some patients may be recommended to undergo additional treatment with radiation or chemotherapy.
• Hormone therapy may be given to patients who have additional medical problems which prevent surgery.

Treatment for stage 2 endometrial cancer

For patients with stage II endometrial cancer, treatment typically includes:

• Surgery: during surgery, the uterus and cervix, and both ovaries and fallopian tubes are removed. Surgery often includes removal of lymph nodes. 
• Radiation: after surgery, most patients will need radiation.
• Chemotherapy may be given to some patients 

Treatment for stage 3 and stage 4 endometrial cancer

• Surgery may be performed first to remove the uterus and cervix (hysterectomy), fallopian tubes and ovaries (salpingo-oophorectomy), and lymph nodes. However, in some cases, the cancer cannot be removed with surgery.
• Chemotherapy will be given to most patients.
• Radiation may have benefit for some patients with advanced cancer. 
• Tumor biomarker testing can help guide decisions about targeted therapy and immunotherapy.