Endometrial Cancer: Standard Therapy

Treatment for Endometrial Cancer

Doctors base treatment recommendations for endometrial cancer on several factors, including:

• Stage of cancer
• Subtype based on pathology
• Additional testing, including biomarkers and other tests
• How fast the cancer is growing or how likely it is to spread
• Whether the cancer is newly-diagnosed or has recurred after one or more treatments

Most endometrial cancers are treated with one or more of the therapies listed in these sections. Every treatment has potential risks and side effects. Before any new treatment or surgery, make sure your healthcare team tells you about what to expect.

Surgery

During surgery, the uterus and cervix (hysterectomy) and often both fallopian tubes and ovaries are removed. Sparing the ovaries may be safe for some stage I, premenopausal patients. Surgery may also include removal of lymph nodes to check for cancer cells. Many endometrial cancer patients may be able to have minimally invasive surgery, which uses small incisions and an instrument called a laparoscope to remove the cancer. 

In the case of cancers that have spread into surrounding tissue, the surgeon may not be able to remove all the cancer with hysterectomy alone. In this case, they may do debulking surgery to remove as much of the cancer as is safely possible. Debulking surgery may be followed by one or more of the treatments listed below.   

Radiation therapy

Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. Doctors may recommend radiation therapy to reduce the 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 delivered 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 small 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 by stage

• Stage 1 cancers are typically treated with surgery. Some patients may also receive radiation or chemotherapy. Hormone therapy may be given to patients who have additional medical problems which prevent surgery.
• Stage 2 cancers are typically treated with surgery and radiation. Some patients may also receive chemotherapy. 
• Stage 3 and stage 4 endometrial cancers are treated with surgery. Most patients will also receive chemotherapy. Radiation may have benefit for some patients with advanced cancer. Tumor biomarker testing can help guide decisions about targeted therapy and immunotherapy. 

Treatment side effects

Your healthcare team should explain what you should expect from all treatments, including:

• all of the possible risks and side effects of each treatment.
• which side effects may be serious and how to tell. 
• when and who you should call if you experience a side effect.
• what can be done to treat or alleviate each side effect. 

Make sure you let your healthcare team know if you experience any side effects of your treatment. For more information about possible treatment side effects, see our section on Cancer Treatment by Treatment Type. 

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