Radiation Therapy After Surgery for Endometrial Cancer

July 6, 2015

To help doctors provide their patients with the highest quality care, the American Society of Clinical Oncology (ASCO) issued an endorsement of a guideline developed in 2014 by the American Society for Radiation Oncology (ASTRO). This guideline provides recommendations for using radiation therapy after surgery for endometrial cancer.

Understanding endometrial cancer

Endometrial cancer is a type of cancer that starts in a woman’s uterus. The uterus has three sections:

  • The narrow, lower portion called the cervix

  • The broad, middle section called the isthmus

  • The dome-shaped top, called the fundus

The inside of the uterus is made up of two layers of tissue:

  • The inner layer is called the endometrium

  • The outer layer, called the myometrium, which is made up of muscle

Endometrial cancer begins in the cells of the endometrium. To help plan treatment, it is useful to assign a stage and a grade. The stage describes where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. The grade describes the appearance of cells, from normal to abnormal. A lower grade means the cells look more like healthy cells and are less likely to grow and spread quickly. Learn more details about endometrial cancer staging.

Treatment for endometrial cancer

Surgery is usually the first treatment given for endometrial cancer. The most common surgery used to treat endometrial cancer is a hysterectomy, which is the removal of the uterus. Women may also need to have nearby lymph nodes removed during surgery to find out if the cancer has spread or to remove any cancer in the lymph nodes.

After surgery, other treatment options include radiation therapy and/or chemotherapy. Radiation therapy may include external beam radiation, which is radiation given from a machine outside the body. For endometrial cancer, the radiation is usually directed at the entire pelvis. Radiation therapy may also be given as implants temporarily inserted into the vagina, a procedure known as brachytherapy. The side effects of radiation therapy may include fatigue, diarrhea, urinary problems, and vaginal scarring or dryness.

Recommendations for treatment after surgery

Doctors are constantly working to find better ways to provide the right care for each patient. Radiation therapy and/or chemotherapy after surgery are used to prevent cancer from coming back. However, it may also cause a variety of side effects that affect a woman’s quality of life. So, the following recommendations help better identify which women will benefit from additional treatment after surgery and which ones may skip additional treatment.

When additional treatment may not be needed

Women who do not need additional treatment should continue to receive regular screening and testing to check for a return of the cancer. Women who may avoid additional treatment include:

  • Women who have had a hysterectomy with no cancer remaining in the tissue removed during surgery

  • Women with a grade 1 or grade 2 cancer that either has not spread to the myometrium or more than halfway through the myometrium

Some women who have cancers such as those described above may need vaginal brachytherapy. However, whether it is needed depends on the grade of the cancer, a woman’s age, and whether the cancer has spread to blood or lymphatic vessels.

When vaginal brachytherapy may be needed

Some women may be able to have vaginal brachytherapy instead of radiation therapy to the pelvis. Women for whom this is an option include:

  • Those with a grade 1 or grade 2 cancer that has spread through half or more of the myometrium

  • Those with a grade 3 cancer that has spread through less than half of the myometrium

When radiation therapy to the pelvis may be needed

For some women, radiation therapy to the pelvis may be the best option to help prevent a return of the cancer. These women 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, called the stroma

  • Those with a cancer that has spread outside the uterus to nearby tissue or organs. In these situations, a woman may need only radiation therapy after surgery, only chemotherapy, or a combination of radiation therapy and chemotherapy.

Radiation therapy to the pelvis may also be considered for some women with grade 1 or grade 2 cancers that has spread through half or more of the thickness of the myometrium, depending on factors such as age and whether the cancer had spread to blood or lymphatic vessels.

What this means for patients

The treatment options after surgery for endometrial cancer depend on the stage and grade of the cancer. When considering your options for treatment, talk with your doctor about how each treatment will affect you. It’s important to weigh the benefits of treatment to possibly keep the cancer from returning with the risks of the treatment. The risks of treatment may include the short- and long-term side effects and a possible decrease in your quality of life. What you consider a decrease in quality of life is very personal. This is why it is important to talk with your doctor about possible side effects, how long they will last, and how they might affect you now and in the future.

In addition, women who have had a hysterectomy are no longer able to bear children. If you are diagnosed with endometrial cancer and are interested in preserving your fertility, talk with your doctor about your options before starting treatment.

Questions to Ask Your Doctor

  • What stage and grade of endometrial cancer do I have?

  • What are my treatment options?

  • Which treatment option do you recommend? Why?

  • What are the side effects of each treatment option?

  • What is my risk of having the cancer come back after treatment?

  • If the cancer does come back, what are my treatment options?

Helpful Links

Read the entire guideline endorsement at www.asco.org/endorsements/endometrial

Guide to Uterine Cancer

What is Radiation Therapy?

Fertility Concerns and Preservation for Women