Cancer of the uterus (endometrial carcinoma) is the most common gynecologic cancer, affecting more than 40,000 women in the US annually. Fortunately, more than 80 percent of the disease is diagnosed early, which results in effective endometrial cancer treatment for many patients.

Endometrial Cancer Stages and Treatment Options by Stage

Endometrial cancer treatment depends on the stage when the disease is diagnosed and treated:

Stage 1 Endometrial Cancer

Only the uterus is affected.

Treatment options:

• Surgery only
• Surgery + radiation therapy/chemotherapy
• Hormone therapy using oral drug or IUD with progesterone
• Surgery + radiation therapy + chemotherapy

Stage 2 Endometrial Cancer

The uterus and the cervix are affected.

 Treatment options:

• Surgery + radiation therapy/chemotherapy
• Surgery + radiation therapy + chemotherapy

Stage 3 Endometrial Cancer

Cancer spread to the pelvis, with surrounding lymph nodes affected.

Treatment options:

• Surgery + radiation therapy/chemotherapy
• Surgery + radiation therapy + chemotherapy

Stage 4 Endometrial Cancer

Cancer spread to the abdominal organs, including the bowel, bladder, or other organs.

Treatment options:

• Surgery
• Hormone therapy
• Radiation therapy
• Chemotherapy

Note: Cancer may also be described in grades according to how the cancer grows and spreads, from Grade 1 (least aggressive) to Grade 3 (most aggressive).

Treatment Options for Endometrial Cancer

There are four types of endometrial cancer treatment:

1. Surgery

Surgical removal of the uterus (hysterectomy) is recommended for most patients with endometrial cancer. The ovaries and fallopian tubes may also be removed (salpingo-oophorectomy). After a hysterectomy, you will not be able to conceive a baby. Removal of the ovaries will result in premature menopause in young women.

During surgery, areas around the uterus are inspected to check if cancer has spread. Lymph nodes may be examined through biopsy to determine your cancer stage.

2. Radiation Therapy

Radiation therapy (RT) uses high-energy x-rays to destroy cancer cells and prevent them from growing further. It can also be used as adjuvant therapy to decrease your risk of recurrence.

RT can be delivered in two ways: through vaginal brachytherapy or external beam radiation.

Vaginal brachytherapy is an in-patient procedure that uses a device placed inside your vagina to deliver high doses of radiation directly to the uterus. This helps minimize the side effects of radiation on other healthy tissues. Vaginal brachytherapy can be delivered either at a low-dose or a high-dose rate.

External beam radiation therapy is an outpatient procedure, which uses radiation that is delivered outside your body. However, the area to be treated is carefully designed to limit your body’s exposure to radiation. The treatment only takes a few seconds, once daily, 5 days/week, for 5-6 weeks.

Side effects of radiation therapy include short-term effects and long-term effects. Short-term adverse effects include:

• Tiredness
• Need to empty bladder frequently
• Urination discomfort
• Loose stools, frequent bowel movement
• Temporary hair loss in pubic area

Chronic problems include:

• Leakage of urine
• Painful bowel movements, bleeding
• Vaginal narrowing/scarring

3. Chemotherapy

Chemotherapy uses drugs to destroy and stop cancer cell growth. It is usually given as adjuvant treatment after surgery with intent to cure. High risk patients are given a combination of chemotherapeutic agents (a regimen), which usually consists of paclitaxel and carboplatin. Some doctors may prescribe a combination of three drugs - doxorubicin, cisplatin, and paclitaxel.

Chemotherapy is given in cycles, which typically lasts for 21 or 28 days. The body is then allowed to recover from side effects before starting another cycle. Treatment usually starts within 4-6 weeks after surgery, before radiation therapy.

Side effects of chemotherapy include:

• Feeling tired
• Nausea, vomiting
• Temporary loss of hair
• Diarrhea
• Decreased blood counts
• Numbness, tingling of fingers and toes (neuropathy)
• Menopausal symptoms (hot flashes, vaginal dryness,night sweats)

4. Hormonal Therapy

Hormone therapy is often used for advanced endometrial cancer treatment. This involves medications that affect your hormone levels to inhibit cancer cell growth. There are two options:

• Use of medications (synthetic progestin) to raise progesterone levels in your body.
• Use of medications to lower estrogen levels in your body.

Watch this video to learn more about the treatment options.

What Is the Prognosis?

Your probable outcome or prognosis of endometrial cancer is good if you are diagnosed and treated early, when the cancer is limited to the uterus and has not yet spread. The early stage of endometrial cancer is often detected by abnormal bleeding, which alerts women to see a doctor immediately.

Cure is less likely, but possible, if the disease is detected and treated late. Treatment often aims to slow down cancer progression.

The information provided above is general. Endometrial cancer treatment is continuously developing. Newer treatments are still being developed. Talk to your specialist for more accurate information about your disease and treatment and how your cancer is likely to respond to these treatments.