Uterine Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with uterine cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for uterine cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

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

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the common types of treatments used for uterine cancer are described below, followed by an outline of treatments based on the stage of the disease. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, your overall health, age, and personal preferences, including whether or how treatment will affect your ability to have children, called fertility. Uterine cancer is treated by 1 or a combination of treatments, including surgery, radiation therapy, chemotherapy, and hormone therapy. Combinations of treatments are often recommended, but they depend on the stage and characteristics of the cancer.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for uterine cancer because there are different treatment options. Learn more about making treatment decisions.

Concerns about sexual health and having children

Women with uterine cancer may have concerns about if or how their treatment may affect their sexual health and fertility. These topics should be discussed with the health care team before treatment begins. Premenopausal women who are still potentially able to get pregnant and want to preserve their fertility should talk with their oncologist and/or a reproductive endocrinologist (REI), also called a fertility specialist, before treatment begins. During these conversations, ask what options for fertility preservation are covered by your health insurance.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue, called a margin, during an operation. It is typically the first treatment used for uterine cancer. A gynecologic oncologist is a doctor who specializes in treating gynecologic cancer using surgery. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have (see “Side effects of surgery” below). Learn more about the basics of cancer 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 typically also perform a bilateral salpingo-oophorectomy, which is the removal of both fallopian tubes and ovaries.

    A hysterectomy may be performed by abdominal incision, by laparoscopy or robotically, which uses several small incisions, or vaginally. A hysterectomy is usually performed by a gynecologic surgeon, which is a surgeon who specializes in surgery of the woman’s reproductive system. In robotic-assisted surgery, a camera and instruments are inserted through small, keyhole-size incisions. The surgeon directs the robotic instruments to remove the uterus, cervix, and surrounding tissue. Talk with your doctor about the risks and benefits of the different surgical approaches and which approach might be best for you.

  • Lymph node removal. 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. This may be done through a procedure called a sentinel lymph node biopsy or lymphadenectomy. A sentinel lymph node biopsy might involve an injection of dye into the uterus during the hysterectomy and removal of the few lymph nodes where dye collects. This procedure has become more common in uterine cancer than lymphadenectomy. A lymphadenectomy, or lymph node dissection, is a surgical procedure in which a group of lymph nodes is removed.

Side effects of surgery

After surgery, the most common short-term side effects include pain and tiredness. If a woman is experiencing pain, her doctor will prescribe medications to relieve the pain. 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.

If the ovaries are removed, this ends the body's production of sex hormones, resulting in early menopause (if the woman has not already gone through menopause). While removal of the ovaries substantially reduces the sex hormones that are produced by the body, the adrenal glands and fat tissues will still provide some hormones. Soon after removing the ovaries, a woman is likely to experience menopausal symptoms, including hot flashes and vaginal dryness.

If a lymphadenectomy is done, some women may get swelling in their legs, called lymphedema.

After a hysterectomy, a woman can no longer become pregnant. For this reason, premenopausal women who wish to preserve their fertility and have children in the future should talk with their doctor about all their options before any treatment begins. Sometimes, fertility preservation is possible and might include less extensive surgery followed by hormone therapy (see below). Your doctor can talk with you about the potential risks and benefits of this approach and provide information to help you make an informed decision.

Before any operation for uterine cancer, women are also encouraged to talk with their doctors about sexual and emotional side effects, including ways to address these issues before and after cancer treatment.

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, or schedule, usually consists of a specific number of treatments given over a set period. 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 surgery (see above) and radiation therapy. The radiation therapy is most often given after surgery to destroy any remaining cancer cells. Radiation therapy is occasionally given before surgery to shrink the tumor. If a woman cannot have surgery, the doctor may recommend radiation therapy instead.

Options for giving radiation therapy to treat uterine cancer may include radiation therapy directed towards the whole pelvis and/or applied only to the vaginal cavity, often called vaginal brachytherapy.

Researchers are always looking for new ways to improve radiation therapy to reduce side effects and improve its effectiveness. One method being studied is MRI-guided radiation therapy. During this treatment, an MRI is combined with a linear accelerator, which delivers the radiation therapy. The MRI provides real-time pictures of the area being treated with radiation therapy, so the radiation can be directed with more accuracy and precision. This helps reduce the amount of healthy tissues exposed to the radiation and focuses the treatment more on the tumor and affected organs. There is currently 1 system for MRI-guided radiation therapy approved by the U.S. Food and Drug Administration (FDA). Other methods of MRI-guided radiation therapy are being studied.

Side effects from radiation therapy will depend on the extent of radiation therapy given and may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished, but long-term side effects are possible. Talk with your radiation oncologist about what you can expect and how side effects will be managed.

Learn more about the basics of radiation therapy. For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers (PDF; please note that this link takes you to a separate, external website).

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. It may also be prescribed by a gynecologic oncologist, a doctor who specializes in treating women’s reproductive cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for uterine cancer include:

  • Chemotherapy

  • Hormone therapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. When recommended for endometrial cancer, chemotherapy usually is given after surgery, either with or without radiation therapy. Chemotherapy is also considered if the endometrial cancer returns after initial treatment.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

The goal of chemotherapy is to destroy cancer remaining after surgery or to shrink the cancer and slow the tumor's growth if it comes back or has spread to other parts of the body. Although chemotherapy can be given orally, most drugs used to treat uterine cancer are given by 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 after treatment is finished. Advances in chemotherapy during the last 10 years include the development of new drugs for the prevention and treatment of side effects, such as antiemetics for nausea and vomiting and growth factors to prevent low white blood cell counts.

Other potential side effects of chemotherapy for uterine cancer include the inability to become pregnant in the future and experiencing early menopause, if the patient has not already had a hysterectomy (see “Surgery” above). Talk with your doctor before treatment starts if you want to preserve your fertility. Rarely, some drugs cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously to protect their kidneys. Talk with your doctor about what side effects you may experience with chemotherapy and how they can be prevented or managed.

Learn more about the basics of chemotherapy.

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 a high dose of the sex hormone progesterone given in pill form. Other hormone therapies include hormone-expressing intrauterine devices (IUDs) and the aromatase inhibitors (AIs), such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin), which are often used for the treatment of breast cancer. 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 it can be used in combination with other types of treatment.

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

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Targeted therapy for uterine cancer is available in clinical trials and includes:

  • Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin) is a type of anti-angiogenesis therapy used to treat uterine cancer.

  • Mammalian target of rapamycin (mTOR) inhibitors. In endometrial cancer, mutations in a pathway called mTOR are commonly found. People with advanced or recurrent uterine cancer may be treated with a drug that blocks this pathway, such as everolimus (Afinitor). Other drugs that target this pathway are being studied, such as ridaforolimus and temsirolimus (Torisel), a targeted therapy approved to treat a type of kidney cancer called renal cell carcinoma.

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Immunotherapy (updated 09/2019)

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Uterine cancers with mismatch repair defects (dMMR; see Introduction) are more sensitive to immunotherapy. The immunotherapy drug pembrolizumab (Keytruda) is approved to treat tumors that have either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor's location in the body. Pembrolizumab can be used to treat uterine tumors with dMMR if other previous treatments have not worked.

A combination of lenvatinib (Lenvima) and pembrolizumab is approved to treat advanced endometrial cancer. This combination can be used to treat disease that is not MSI-high or dMMR, has not been controlled by systemic therapy, and cannot be cured with surgery or radiation therapy.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer 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, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic uterine cancer

If cancer spreads to a part of the body that is different from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include radiation therapy, especially for recurrent cancer in the pelvis, or surgery. 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 in clinical trials. Palliative care will be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and may be difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may 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 having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. A key goal of follow-up care is to watch for a recurrence and to manage possible late effects and long-term side effects from treatment. Learn more about coping with the fear of recurrence.

If the cancer returns 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). 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

  • Persistent cough/shortness of breath

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

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

If treatment does not work

Recovery from uterine cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

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

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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 in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with uterine cancer. Use the menu to choose a different section to read in this guide.