There are so many treatments for endometrial cancer, it’s amazing. The types of treatments, aka therapies, that are the standard of care for uterine cancer range from surgery, radiation therapy, and chemotherapy, to hormone therapy, targeted therapy, and immunotherapy. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, your overall health, your age, and your personal preferences. This includes whether or how treatment will affect one’s fertility. Uterine cancer is treated by 1 or a combination of treatments that are often recommended, but they depend on the stage and characteristics of the cancer.
The surgical removal of the tumor and some surrounding healthy tissue is typically the first treatment used for uterine cancer. Depending on the outcome of the first surgery as well as the extent of cancer, the surgeon might perform a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues). If the patient has no cancer remaining in the tissue removed during a hysterectomy, additional treatment may not be needed. However, regular screening and testing to check for a return of the cancer is recommended.
At the same time as a hysterectomy, the surgeon may perform a procedure called a sentinel lymph node biopsy or lymphadenectomy which removes lymph nodes near the tumor to determine if the cancer has spread beyond the uterus. This procedure has become more common in uterine cancer than lymphadenectomy. The treatment options after surgery for endometrial cancer depend on the stage and grade of the cancer. For people who have had surgery and have grade 1 or 2 cancer that either has not spread to the myometrium or is more than halfway through the myometrium, additional treatment may be avoided. Radiation therapy is the use of high-energy X-rays or other particles to destroy cancer cells. The most common radiation to the pelvic region or the area designated by your radiation oncologist. Radiation that is delivered internally is called brachytherapy. External-beam radiation therapy can be given alone or in combination with brachytherapy.
For some patients, radiation therapy for the pelvis may be the best option to help prevent a return of the cancer. These patients include those with a grade 3 cancer that has spread through half or more of the myometrium; those with a cancer of any grade that has spread to tissue in the cervix; and those with a cancer that has spread outside the uterus to nearby tissue or organs. In these situations, the patient may need only radiation. The treatment plan may include medications to destroy cancer cells. Medication given through the bloodstream to reach cancer cells throughout the body is known as systemic therapy. This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. It may also be prescribed by a gynecologic medical oncologist, a doctor who specializes in treating cancers of the female reproductive system with medication. Medications are often given through an intravenous tube placed into a vein using a needle or as a pill or capsule that is swallowed. If you are given oral medications to take at home, be sure to ask your healthcare team about how to safely store and handle them.