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Uterine Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Uterine Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the uterus

The pear-shaped uterus is hollow and located in the pelvis of a woman between the bladder and rectum. The uterus is also known as the womb, where a baby grows when a woman is pregnant. It has three sections: the narrow, lower section called the cervix, the broad section in the middle called the isthmus, and the dome-shaped top section called the fundus. The wall on the inside of the uterus has two layers of tissue: endometrium (an inner layer), and myometrium (outer layer), which is muscle tissue.

Every month during a woman's childbearing years, the lining of the uterus grows and thickens in preparation for pregnancy. If the woman does not get pregnant, this thick, bloody lining passes out of her body through her vagina during menstruation. This process continues until menopause, which is when a woman’s ovaries stop releasing eggs.

About uterine cancer

Uterine cancer is the most common cancer of a woman’s reproductive system. Uterine cancer begins when normal cells in the uterus change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. Noncancerous conditions of the uterus include fibroids, which are benign tumors in the muscle of the uterus. Another noncancerous condition is endometriosis, which describes the condition when endometrial tissue, typically lining the uterine cavity, is on the outside of the uterus or other organs.  Endometrial hyperplasia, which is an increased number of cells in the uterine lining, can also happen and can be noncancerous.

There are two major types of uterine cancer:

Adenocarcinoma. This makes up more than 80% of uterine cancers. It develops from cells in the lining of the uterus called the endometrium. This cancer is also commonly called endometrial cancer. A common type of endometrial adenocarcinoma is called endometrioid carcinoma, and treatment varies depending on the grade of the tumor, how far it goes into the uterus, and the stage or extent of disease (see Stages and Grades). A less common type is called endometrial serous carcinoma, and this form is treated in a fashion similar to ovarian cancer which is also commonly of the serous type.

Sarcoma. This type of uterine cancer develops in the supporting tissues of the uterine glands or in the myometrium, which is the uterine muscle. Sarcoma accounts for about 2% to 4% of uterine cancers. Sarcomas are treated differently than adenocarcinomas in most situations.  Types of endometrial cancers with some elements of sarcoma include leiomyosarcoma, endometrial stromal sarcoma or carcinosarcoma. Learn more about sarcoma.

Cancer specifically in the uterine cervix is treated differently than uterine cancer; learn more about cervical cancer. The rest of this section covers the more common endometrial (adenocarcinoma) cancer.

Looking for More of an Overview?

If you would like additional introductory information, explore the following item. Please note these links take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available in PDF) that offers an easy-to-print introduction to this type of cancer.

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Uterine Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find information about how many people learn they have uterine cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 52,630 women in the United States will be diagnosed with uterine endometrial cancer. It is estimated that 8,590 deaths from this disease will occur this year. The incidence of endometrial cancer is rising due largely to increased incidence of obesity, which is an important risk factor for this disease. Uterine cancer is the fourth most common cancer and the seventh most common cause of cancer death for women in the United States. Although uterine cancer rates are higher among white women than black women, black women are more likely to die from uterine cancer than white women.

The one-year relative survival rate is the percentage of people who survive at least one year after the cancer is detected, excluding those who die from other diseases. For uterine cancer, the one-year relative survival rate is 92%. The five-year survival rate for a woman with a local (without spread) uterine cancer at diagnosis is about 95%. If the cancer is diagnosed with regional spread, the five-year survival rate is about 68%, and if diagnosed after the cancer has spread more distantly, it is 17%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with uterine cancer. Because the survival statistics are measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication,
Cancer Facts & Figures 2014.

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Uterine Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find a basic drawing about the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Women's Cancers Anatomy

Larger image

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Uterine Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman’s risk of developing uterine cancer:

Age. Uterine cancer most often occurs in women over 50; the average age is 60.

Obesity. Fatty tissue in women who are overweight produces additional estrogen, a sex hormone which can increase the risk of uterine cancer. This risk increases with an increase in body mass index (BMI; the ratio of a person's weight and height). About 40% of cases are linked to obesity.

Race. White women are more likely to develop uterine cancer than black women.

Genetics. Uterine cancer may run in families where colon cancer is hereditary. For instance, women in families with hereditary non-polyposis colorectal cancer (HNPCC), or Lynch syndrome, have a higher risk for uterine cancer. It is recommended that women under the age of 60 with endometrial cancer should have their tumors tested for Lynch Syndrome even if they don’t have a family history of bowel cancer or other cancers. About 2% to 5% of women with endometrial cancer have Lynch Syndrome. In the United States, about 1,000 to 2,500 women diagnosed with endometrial cancer each year may have this genetic condition. Read about Lynch Syndrome.

Other health conditions. Women may have an increased risk of uterine cancer if they have had endometrial hyperplasia or if they have diabetes.

Other cancers. Women who have had breast, colon, or ovarian cancer have an increased risk of uterine cancer.

Tamoxifen. Women taking the drug tamoxifen (Nolvadex) to prevent or treat breast cancer have an increased risk of developing uterine cancer. However, the benefits of tamoxifen usually outweigh the risk of developing uterine cancer, but all women should discuss the benefits and risks of tamoxifen with their doctor.

Radiation therapy. Women who have had previous radiation therapy for another cancer in the pelvic area, which is the lower part of the abdomen between the hip bones, have an increased risk of uterine cancer.

Diet. Women who eat foods high in animal fat may have an increased risk of uterine cancer.

Estrogen. Longer exposure to estrogen and/or an imbalance of estrogen is relevant to many of the following risk factors:

  • Women who started having their periods before age 12 and/or go through menopause later in life. Learn more about menopause and cancer risk.
  • Women who take hormone replacement therapy (HRT) after menopause, especially if they are only taking estrogen, which is also an important risk factor. The risk is lower for women taking estrogen with another sex hormone called progesterone.
  • Women who have never been pregnant.

Prevention

Research has shown that certain factors can lower the risk of uterine cancer:

  • Taking birth control pills, especially over a long period of time
  • Considering the risk of uterine cancer before starting HRT, especially estrogen replacement therapy alone
  • Maintaining a healthy weight
  • If diabetic, maintaining good disease control such as regularly monitoring blood glucose levels

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer. 

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Uterine Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Women with uterine cancer may experience the following symptoms or signs. Sometimes, women with uterine cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during or after menopause is often a sign of a problem.

  • Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).
  • Difficulty or pain when urinating
  • Pain during sexual intercourse
  • Pain in the pelvic area

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. 

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Uterine Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily done to evaluate for cervical cancer.  However, sometimes a Pap test may occasionally find abnormal glandular cells, which are caused by uterine cancer.

In addition to a physical examination, the following imaging tests may be used to diagnose uterine cancer:

Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to obtain the pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see below).

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. This is particularly useful to get detailed images if the treatment option is primarily hormone management (see Treatment Options).

Doctors also use the following surgical tests to establish a diagnosis:

Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes about one minute. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon after and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. However, patients who have abnormal vaginal bleeding before the test may still need a dilation & curettage (D&C; see below) even if no abnormal cells are found during the biopsy.

Dilatation and Curetage  (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, lighted flexible tube in the vagina, through the cervix, and into the uterus.

Once endometrial tissue has been removed either during a biopsy or D&C, the sample is checked for cancer cells, endometrial hyperplasia, and other conditions. In the past, there was concern that a D&C would push cancer cells out of the uterus into other reproductive organs. However, research studies have shown that this has no effect on patients who received a D&C combined with a hysteroscopy.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, additional testing will be performed to describe how far the disease has grown. This helps to categorize the disease by stage and directs the type of treatment that will be needed.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.  

Uterine Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. In addition, doctors may need information based on samples of tissue from surgery, so staging may not be complete before surgery to remove the tumor (see Treatment Options). Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a woman's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

The Roman numerals are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO. The FIGO system is the standard system used by most doctors to stage uterine cancer

Here are more details on each part of the TNM and FIGO system for uterine cancer:

Tumor. Using the TNM system, "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail.

TX: The primary tumor cannot be evaluated due to a lack of information. More tests may be needed.

T0 (T plus zero): There does not seem to be a primary tumor in the uterus.

Tis: This condition is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the uterus and has not spread to deeper tissues of the uterus.

T1/FIGO I: The tumor is found only in the corpus uteri (the body of the uterus).

T1a/FIGO IA: The tumor is found only in the endometrium has spread to less than one-half of the myometrium.

T1b/FIGO IB: The tumor has spread to one-half or more of the myometrium.

T2/FIGO II: The tumor has spread to the cervical stroma (the connective tissue of the cervix) but has not spread beyond the uterus.

T3a/FIGO IIIA: The tumor involves the serosa (the layer of tissue that covers the outer surface of the uterus) and/or the tissue of the fallopian tubes and ovaries.

T3b/FIGO IIIB: The tumor has spread to the vagina or next to the uterus.

T4/FIGO IVA: The tumor has spread to the lining of the bladder mucosa (lining of the bladder) and/or the bowel mucosa (lining of the bowel).

Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the uterus are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no spread to regional lymph nodes.

N1/FIGO IIIC1: The cancer has spread to the regional pelvic lymph node(s).

N2/FIGO IIIC2: The cancer has spread to the para-aortic lymph nodes, which are located in the mid and upper abdomen, with or without spread to the regional pelvic lymph nodes.

Distant metastasis. The "M" in the TNM system describes whether the cancer has spread to other parts of the body.

M0 (M plus zero): The cancer has not metastasized.

M1/FIGO IVB: There is distant spread, including to the abdomen and/or inguinal

lymph nodes, which are in the groin or lower abdomen

Cancer stage grouping

Doctors assign the stage of endometrial cancer by combining the T, N, and M classifications.

Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in one layer of cells and has not spread (Tis, N0, M0).

Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body (T1, N0, M0).

Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium (T1a, N0, M0).

Stage IB: The tumor has spread to one-half or more of the myometrium (T1b, N0, M0).

Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body (T2, N0, M0).

Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area (T3, N0, M0).

Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body (T3a, N0, M0).

Stage IIIB: The tumor has spread to the vagina or next to the uterus (T3b, N0, M0).

Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes (T1 to T3, N1, M0).

Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes (T1 to T3, N2, M0).

Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).

Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).

Grade

Grade. Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

The letter "G" is used to define a grade for uterine cancer.

GX: The grade cannot be evaluated

G1: The cells are well differentiated

G2: The cells are moderately differentiated

G3: The cells are poorly differentiated

G4: The cells are undifferentiated

Recurrent uterine cancer

Recurrent cancer is cancer that has come back after treatment. Uterine cancer may come back in the uterus, pelvis, lymph nodes of the abdomen, or another part of the body. Approximately 70% of recurrent uterine cancer happens within three years of initial treatment. Some symptoms of recurrent cancer are similar to those experienced when the disease was first diagnosed.

  • Vaginal bleeding or discharge
  • Pain in the pelvic area, abdomen, or back of the legs
  • Difficulty or pain when urinating
  • Weight loss
  • Chronic cough

If there is a recurrence, more testing will help to determine the extent of disease. Then, you and your doctor should talk about treatment options.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Uterine Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Your health care team should include a gynecologic oncologist, which is a doctor who specializes in the cancers of the female reproductive system.

Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Combinations of treatments are often recommended. Each treatment option is described below, followed by an outline of treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the woman’s overall health, and her age and her personal preferences, including whether or how treatment will affect the ability to have children. Women with uterine cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is typically the first treatment used for uterine cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Common surgical procedures for uterine cancer include:

Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either 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). For patients who have been through menopause, the surgeon will also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries. 

A hysterectomy may be performed as a traditional surgery with one large incision or by laparoscopy, which uses several smaller incisions. A hysterectomy when there is the possibility of cancer is usually performed by a gynecologic surgeon, which is a surgeon that specializes in surgery of the woman’s reproductive system. Robotically assisted hysterectomy may also be available. In this type of surgery, a camera and instruments are inserted through small, keyhole incisions. The surgeon then directs the robotic instruments to remove the uterus, cervix, and surrounding tissue. Talk with your doctor about whether your treatment center offers this procedure and how the side effects and results compare to traditional surgery or laparoscopy.

Lymph node dissection. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.

Sentinel lymph node biopsy. Sometimes a sentinel lymph node biopsy is performed. A sentinel lymph node biopsy is a procedure that helps the doctor find out whether cancer has spread to the lymph nodes. This procedure is proven to be useful for breast and other cancers, and doctors are researching its usefulness in uterine cancer.

Side effects of surgery. After surgery, the woman may remain in the hospital for several days. Woman who received laparoscopic or robotically assisted surgery often have a shorter hospital stay than women who received traditional surgery. The most common short-term side effects include pain and extreme tiredness. If a woman is experiencing pain, her doctor will prescribe appropriate medicine. Other immediate side effects may include nausea and vomiting, as well as difficulty emptying the bladder and having bowel movements. The woman's diet may be restricted to liquids, followed by a gradual return to solid foods.

After a hysterectomy, a woman can no longer become pregnant. If the ovaries are removed, this ends the body's production of sex hormones, resulting in premature menopause (if the woman has not already gone through menopause). While a hysterectomy substantially reduces the sex steroids that are produced by the body, the adrenal glands and fat tissues will provide some steroids as well. Soon after surgery, the woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness. Before the operation, women are encouraged to talk with their doctors about sexual and emotional side effects, reproductive health concerns, and ways to address these issues before and after cancer treatment. 

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Some women with uterine cancer need both radiation therapy and surgery. The radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy as another option.

Radiation therapy options for endometrial cancer may include radiation directed towards the whole pelvis, or applied only to the vaginal cavity often called intravaginal radiotherapy or IVRT.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements and will depend on the extent of radiation therapy given. Most side effects usually go away soon after treatment is finished but long term side effects causing bowel or vaginal symptoms are possible.

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.

Learn more about radiation therapy. For more information about radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist or gynecologic oncologist, a doctor who specializes in treating women’s reproductive cancer with medication.  For patients with endometrial cancer, chemotherapy is given usually after surgery, either with or instead of radiation therapy.  Chemotherapy is also used if the endometrial cancer returns after initial treatment.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects. Although chemotherapy can be given orally (by mouth), most drugs used to treat uterine cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a catheter, which is a thin tube inserted into a vein.

The side effects of chemotherapy depend on the individual, the type of chemotherapy, and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Advances in chemotherapy during the last ten years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting and hormones to prevent low white blood cell counts if needed.

Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant and early menopause, if the patient has not already had a hysterectomy. Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Hormone therapy

Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors.  Hormone therapy for uterine cancer often involves the sex hormone progesterone, given in a pill form. Other hormone therapies include the aromatase inhibitors (AIs) often used for the treatment of women with breast cancer, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). An AI is a drug that reduces the amount of the hormone estrogen in a woman's body by stopping tissues and organs other than the ovaries from producing it. Hormone therapy may also be used for women who cannot have surgery or radiation therapy or in combination with other types of treatment.

Side effects of hormone therapy in some patients include fluid retention, increase in appetite, insomnia, muscle aches and weight gain. Most side effects are manageable. Talk with your doctor about what you can expect.

Treatment options by stage

You may be recommended one or a combination of these treatment types depending a variety of factors, such as the tumor type, the tumor’s stage, and other medical problems you may have.

Stage I

  • Surgery alone
  • Surgery with radiation therapy or chemotherapy
  • Hormone therapy with a progesterone-type drug. This is given orally or through an intra-uterine device that is used in special circumstances.
  • Surgery, radiation therapy, and chemotherapy

Stage II

  • Surgery with radiation therapy or chemotherapy
  • Surgery, radiation therapy, and chemotherapy

Stage III

  • Surgery with radiation therapy or chemotherapy
  • Surgery, radiation therapy, and chemotherapy

Stage IV

  • Surgery
  • Radiation therapy
  • Hormone therapy
  • Chemotherapy

It is important to ask your doctor about the various treatment options, including clinical trials that are available to you.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care

Metastatic uterine cancer

If cancer has spread to another location in the body, it is called metastatic cancer.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes radiation therapy, especially for recurrent cancer in the pelvis. Hormone therapy may be used for cancer that has spread to distant parts of the body. A cancer that is high grade or that does not respond to hormone therapy is treated with chemotherapy. Women with stage IV uterine cancer are encouraged to consider participating clinical trials. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Find out more about recurrent uterine cancer in Stages.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as hormone therapy, radiation, and chemotherapy but they may be used in a different combination or given at a different pace. Sometimes surgery is suggested for a return of cancer that is small or confined, called localized recurrences. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced cancer.

This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Uterine Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat women with uterine cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

Women who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Women decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating uterine cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future women with uterine cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, women must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that she understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for uterine cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Uterine Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about uterine cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

New Therapies. The most notable development in the treatment of endometrial cancer, as with many tumors, is our increasing understanding of tumor genomics, which seeks to identify mutations in genes in the tumor that might “drive” or cause the tumor to grow.  Testing can be done on your tumor sample to look for these mutations and the results will help decide whether your treatment options include a type of treatment called targeted therapy, including through clinical trials.

One such example in endometrial cancer has already shown that mutations in a pathway called PI3K/AKT/MTOR are commonly found, and patients with recurrent disease may benefit from using a drug that targets this pathway called everolimus (Afinitor, RAD001). Other drugs that target this pathway are also available.

Another type of targeted therapy recently shown to have activity for patients with endometrial cancer are called angiogenesis inhibitors, such as with the drug bevacizumab (Avastin) that targets blood vessel growth that feeds tumors as one mechanism of its action. 

Other research includes immunotherapy, which are treatments designed to boost the body's natural defenses to fight the cancer. There is much interest in a specific area of immunotherapy called “checkpoint inhibitors,” such as PD-1 or CTLA4 targeted agents.  Examples are nivolumab or ipilimumab (Yervoy). These agents help the immune system activate and often cause tumors to shrink. Some of these agents work better in combination with other treatment types, and clinical trials about each agent and different combinations for uterine cancer, are ongoing.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current small bowel cancer treatments in order to improve patients’ comfort and quality of life.

Patients are strongly encouraged to talk with the doctor about clinical trials to consider when treatment options are being made.

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Uterine Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for uterine cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with uterine cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor. 

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Uterine Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for uterine cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

In addition to a physical examination, follow-up care may include pelvic examinations, blood tests, yearly Pap tests, and x-rays. These tests may be done more frequently in the first and second year after treatment. Tell your doctor about any new symptoms, especially a loss of appetite, bladder or bowel changes, pain, vaginal bleeding, or weight changes. These symptoms may be signs that the cancer has come back or signs of another medical condition.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

Women recovering from uterine cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Uterine Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of uterine cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage of the cancer? What does this mean?
  • What is the grade of the tumor? What does this mean?
  • What are my options for treatment?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • Is hormone therapy one of the treatment options for this type and stage of uterine cancer?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Whom should I call for questions or problems?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of each treatment, both in the short-term and the long-term?
  • Will this treatment affect my ability to become pregnant? Should I talk with a fertility specialist before treatment begins?
  • Could this treatment affect my sex life? If so, how and for how long?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • [If applicable] If I take tamoxifen to prevent breast cancer and later develop cancer of the uterus, will that affect my chances for successful treatment?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Uterine Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Uterine Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the woman diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

- Explore next steps a woman can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Uterine Cancer. Use the menu on the side of your screen to select another section, to continue reading this guide.