How Endometrial Cancer Is Treated

Table of ContentsView AllTable of ContentsSurgeryRadiationChemotherapyHormone TherapyImmune Checkpoint InhibitorsComplementary MedicineFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Surgery

Radiation

Chemotherapy

Hormone Therapy

Immune Checkpoint Inhibitors

Complementary Medicine

Frequently Asked Questions

In the United States,endometrial canceris the most common cancer of the female reproductive system. The upside is that most women are diagnosed when the cancer is at an early stage. This means that for many women, endometrial cancer can be cured with surgery alone.

While surgery is the first-line treatment for endometrial cancer, some women will need to undergo additional therapies like radiation therapy or chemotherapy based on their risk of cancer recurrence after treatment.

To provide two examples, a woman with low-risk endometrial cancer will likely only undergo surgery for her treatment (without radiation therapy or chemotherapy). On the other hand, a woman with high-risk endometrial cancer may be treated with surgery, radiation, and chemotherapy.

Verywell / Emily Roberts

What is endometrial cancer?

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Surgery is the treatment of choice for most endometrial cancers, often consisting of a hysterectomy (removal of the uterus) along with the removal of the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy).

Total Abdominal Hysterectomy

A total abdominal hysterectomy, which refers to the removal of the uterus through the abdomen, can be accomplished through laparoscopy or laparotomy, depending on a woman’s situation and her surgeon’s preference.

With a laparoscopy, multiple small incisions are made in a woman’s abdomen. Then, using a thin instrument with a camera and light at the end, the surgeon will remove the uterus (and the ovaries and fallopian tubes). With a laparotomy, a larger skin incision is made in the abdomen in order to remove the above organs.

Vaginal Hysterectomy

Besides a total abdominal hysterectomy, the uterus can also be removed through the vagina (called a vaginal hysterectomy). Again, the type of surgery decided upon takes into account many factors and requires careful thought.

Endometrial cancer is the most common cancer of the female reproductive system in the United States.

Lymph Node Removal

In addition to surgical removal of the uterus, ovaries, and fallopian tubes, your surgeon will also likely remove pelvic and para-aortic lymph nodes. This is because while cancer begins in the uterus, it can spread to the lymph nodes (and other organs, like the cervix) if left untreated.

Lymph node removal can be done at the same time as the total abdominal hysterectomy. However, with a vaginal hysterectomy, lymph node removal will need to be performed laparoscopically.

Radical Hysterectomy

If the cancer has spread to the cervix, a radical hysterectomy is performed. This type of surgery entails removing the uterus, cervix, upper part of the vagina, and some tissue located next to the uterus. Of course, as with many hysterectomies, the fallopian tubes and ovaries are also removed.

Side Effects and Risks

A hysterectomy and bilateral salpingo-oophorectomy is a surgery performed in an operating room under general anesthesia. After surgery, a woman will have to recover in the hospital for up to one week, depending on the type of surgery performed.

Generally speaking, recovery time for laparotomy is longer than laparoscopic surgery.

As with any surgery, there are risks involved, which should be discussed carefully with your healthcare provider.

Some of these risks include:

Some premenopausal women opt to keep their ovaries if they are diagnosed with early-stage endometrial cancer (a choice that requires a careful discussion with their healthcare provider).

However, for some early-stage endometrial cancers, radiation therapy may be used alone. In less common situations, surgery may not be possible, potentially due to a woman’s older age, or if she has multiple other medical problems that make surgery too risky. In this case, radiation therapy with or without chemotherapy may be the treatment of choice.

Vaginal Brachytherapy

With vaginal brachytherapy (VBT), pellets of radioactive material are placed into a device which is then temporarily placed inside a woman’s vagina. Typically, a woman will undergo a radiation session (which lasts less than an hour) once weekly or daily at least three times.

External Beam Radiation Therapy:

With external beam radiation therapy (EBRT), a machine located outside the body focuses radiation beams on the cancer. This type of radiation is given daily, five days per week, for five to six weeks. A typical session is fairly quick, lasting less than thirty minutes or so.

Common short-term side effects of radiation include:

There are also potential long-term side effects of radiation therapy. For example, extreme vaginal dryness along with vaginal scarring and narrowing can make sex painful.

Urine leakage and pain or bleeding with bowel movements may also occur, due to radiation-induced inflammation of the bladder and bowel, respectively.

Lastly, lymphedema (impaired lymph fluid drainage leading to leg swelling) is another long-term side effect and occurs as a result of EBRT to the pelvis.

Chemotherapy refers to drugs that kill rapidly duplicating cells in the body, which happens to be cancer cells, along with some normal cells, such as those in the bone marrow or digestive tract (this is where the side effects of chemotherapy come into play).

With high-risk endometrial cancer, chemotherapy may be given after surgery, with or without radiation therapy, or along with radiation therapy (called chemoradiation) if a woman’s cancer is inoperable.

A typical chemotherapy regimen for endometrial cancer includes the two drugs carboplatin and paclitaxel, although some healthcare providers use a three-drug regimen that consists of cisplatin, Adriamycin (doxorubicin), and paclitaxel.

Chemotherapy is often given about four to six weeks after surgery and before radiation therapy is given (if radiation is part of the plan).

Depending on the chemo drugs used to treat your endometrial cancer, there are various potential side effects. That said, some of the more common ones include:

According to the American Cancer Society, there are four types of hormone therapy that may be used to treat endometrial cancer, with progestin being the primary one.

Hormone therapy is generally reserved for women who have advanced endometrial cancer who cannot undergo surgery or radiation therapy. Progestin may be given to certain premenopausal women with low-risk endometrial cancer who still want to have children.

Progestin

Progestins, like Provera (medroxyprogesterone acetate) or Megace (megestrol acetate) can help slow the growth of endometrial cancer cells.

Tamoxifen

Used traditionally to treat breast cancer, tamoxifen may be used to treat advanced endometrial cancer or endometrial cancer that has returned after treatment (called a recurrence).

Gonadotropin-Releasing Hormone (GnRH) Agonists

Aromatase Inhibitors

While most estrogen is produced in a woman’s ovaries, some estrogen is produced in the body’s fatty tissue (called adipose tissue). The aromatase inhibitors Femara (letrozole), Arimidex (anastrozole), and Aromasin (exemestane) reduce the formation of estrogen from adipose tissue. These drugs are still being investigated for their use in treating endometrial cancer.

Keytruda (pembrolizumab) and Jemperli (dostarlimab) boost the body’s immune response against cancer cells, which can shrink some tumors or slow their growth.

Keytruda

Keytruda has been approved in combination with lenvatinib (Lenvima, Eisai) for people with certain advanced endometrial carcinomas, typically after at least one other drug treatment has been tried and curative surgery or radiation isn’t possible.Keytruda can also be used alone to treat advanced endometrial cancers, typically after other treatments have been tried, and if the cancer cells have certain testable characteristics.

Jemperli

Jemperli has been approved for certain recurrent advanced endometrial cancers that have progressed on or following prior treatment.

Side effects can include:

Other, more serious side effects are possible:

Infusion reactions: Which include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing.

Autoimmune reactions: The immune system may attack other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, or other organs.

It’s very important to tell your healthcare provider right away about any side effects you experience—either during or after treatment.

Some patients find alternative interventions like massage, acupuncture, yoga, tai chi, hypnosis, meditation, and biofeedback helpful.

While several types of complementary therapies may provide benefits (for example, easing pain or stress), many have not been rigorously studied to confirm their overall safety or effectiveness.

In the end, implementing complementary medicine into your traditional endometrial cancer care is certainly possible and a reasonable goal. Be sure, though, to do so only under the guidance of your oncologist. This way you can be certain of their safety and avoid any undesirable side effects or interactions.

What Is Mistletoe?

Frequently Asked QuestionsNot at all. The most common form of endometrial cancer, type 1, tends to grow quite slowly, which is why it typically is caught early.As many as 70% of women with endometrial cancer are diagnosed while the disease is in stage 1, the earliest stage, meaning the cancer has notmetastasized(spread) beyond theuterus.The average five-year relative survival rates are based on the stage ofendometrial cancerat the time of diagnosis:Localized (the cancer has not spread beyond the uterine lining): 95%Regional (the cancer has spread to lymph nodes or structures near the original site of the tumor): 69%Distant (the cancer has spread to parts of the body far from the original cancer): 17%All stages combined: 81%The types are known as low-dose rate and high-dose rate. Low-dose rate brachytherapy requires a two to three day hospital stay, during which an intravaginal device delivers continuous radiation without removal or interruption.High-dose rate brachytherapy, which is administered on an out-patient basis, delivers radiation internally for 10 to 20 minutes at a time. At least three doses are given, either over the course of three days or several weeks.You may not have to wait at all. In fact, for most people, vaginal intercourse is OKduringtreatment, although it’s essential to clear this with your healthcare provider.After you’ve finished your treatment, sex may even be beneficial if the radiation has caused vaginal stenosis, a commonside effect of radiationin which scar tissue makes the vagina shorter and/or narrower.Targeted therapy is the use of medications aimed at specific molecules in cancer cells. It differs fromchemotherapyin that it doesn’t destroy healthy cells in the body. They have a different side effect profile from chemotherapy, which should be discussed with your oncologist. Drugs used to treat endometrial cancer in this way include:Lenvima (lenvatinib)Avastin (bevacizumab)Afinitor (everolimus)Torisel (temsirolimus)

Not at all. The most common form of endometrial cancer, type 1, tends to grow quite slowly, which is why it typically is caught early.As many as 70% of women with endometrial cancer are diagnosed while the disease is in stage 1, the earliest stage, meaning the cancer has notmetastasized(spread) beyond theuterus.

The average five-year relative survival rates are based on the stage ofendometrial cancerat the time of diagnosis:Localized (the cancer has not spread beyond the uterine lining): 95%Regional (the cancer has spread to lymph nodes or structures near the original site of the tumor): 69%Distant (the cancer has spread to parts of the body far from the original cancer): 17%All stages combined: 81%

The average five-year relative survival rates are based on the stage ofendometrial cancerat the time of diagnosis:

The types are known as low-dose rate and high-dose rate. Low-dose rate brachytherapy requires a two to three day hospital stay, during which an intravaginal device delivers continuous radiation without removal or interruption.High-dose rate brachytherapy, which is administered on an out-patient basis, delivers radiation internally for 10 to 20 minutes at a time. At least three doses are given, either over the course of three days or several weeks.

You may not have to wait at all. In fact, for most people, vaginal intercourse is OKduringtreatment, although it’s essential to clear this with your healthcare provider.After you’ve finished your treatment, sex may even be beneficial if the radiation has caused vaginal stenosis, a commonside effect of radiationin which scar tissue makes the vagina shorter and/or narrower.

Targeted therapy is the use of medications aimed at specific molecules in cancer cells. It differs fromchemotherapyin that it doesn’t destroy healthy cells in the body. They have a different side effect profile from chemotherapy, which should be discussed with your oncologist. Drugs used to treat endometrial cancer in this way include:Lenvima (lenvatinib)Avastin (bevacizumab)Afinitor (everolimus)Torisel (temsirolimus)

15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Memorial Sloan Kettering Cancer Center.Surgery for Uterine (Endometrial) Cancer.American Cancer Society.Surgery for Endometrial Cancer.American Cancer Society.Radiation therapy for endometrial cancer.American Cancer Society.Chemotherapy for Endometrial Cancer.American Cancer Society.Hormone Therapy for Endometrial Cancer.U.S. Food and Drug Administration.FDA grants regular approval to pembrolizumab and lenvatinib for advanced endometrial carcinoma. FDA.American Cancer Society.Immunotherapy for Endometrial Cancer.GSK Consumer Healthcare.GSK receives FDA accelerated approval for JEMPERLI (dostarlimab-gxly) for adult patients with mismatch repair-deficient (Dmmr) recurrent or advanced solid tumours. GSK.Abdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.2015;25(9):1724-1730. doi:10.1097/IGC.0000000000000549American College of Obstetricians and Gynecologists.Endometrial cancer.Memorial Sloan Kettering Cancer Center.Stages of uterine (endometrial) cancer.American Cancer Society.Survival Rates for Endometrial Cancer.UpToDate.Patient education: Endometrial cancer treatment after surgery (Beyond the Basics).American Cancer Society.How Radiation Therapy Can Affect the Sex Life of Females with Cancer.American Cancer Society.Targeted Therapy for Endometrial Cancer.Additional ReadingAbdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.25(9):1724-30.Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E.Endometrial cancer.Lancet.387(10023):1094-1108.U.S. National of Medicine.Endometrial Cancer Treatment: Health Professional Version.American Cancer Society. (2018).Hormone Therapy for Endometrial Cancer.American Cancer Society. (2018).Treating Endometrial Cancer.Plaxe S, Mundt AJ. (2017). Patient education: Endometrial cancer treatment after surgery (Beyindthe Basics). Goff B, ed. UpToDate. Waltham, MA: UpToDate Inc.

15 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Memorial Sloan Kettering Cancer Center.Surgery for Uterine (Endometrial) Cancer.American Cancer Society.Surgery for Endometrial Cancer.American Cancer Society.Radiation therapy for endometrial cancer.American Cancer Society.Chemotherapy for Endometrial Cancer.American Cancer Society.Hormone Therapy for Endometrial Cancer.U.S. Food and Drug Administration.FDA grants regular approval to pembrolizumab and lenvatinib for advanced endometrial carcinoma. FDA.American Cancer Society.Immunotherapy for Endometrial Cancer.GSK Consumer Healthcare.GSK receives FDA accelerated approval for JEMPERLI (dostarlimab-gxly) for adult patients with mismatch repair-deficient (Dmmr) recurrent or advanced solid tumours. GSK.Abdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.2015;25(9):1724-1730. doi:10.1097/IGC.0000000000000549American College of Obstetricians and Gynecologists.Endometrial cancer.Memorial Sloan Kettering Cancer Center.Stages of uterine (endometrial) cancer.American Cancer Society.Survival Rates for Endometrial Cancer.UpToDate.Patient education: Endometrial cancer treatment after surgery (Beyond the Basics).American Cancer Society.How Radiation Therapy Can Affect the Sex Life of Females with Cancer.American Cancer Society.Targeted Therapy for Endometrial Cancer.Additional ReadingAbdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.25(9):1724-30.Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E.Endometrial cancer.Lancet.387(10023):1094-1108.U.S. National of Medicine.Endometrial Cancer Treatment: Health Professional Version.American Cancer Society. (2018).Hormone Therapy for Endometrial Cancer.American Cancer Society. (2018).Treating Endometrial Cancer.Plaxe S, Mundt AJ. (2017). Patient education: Endometrial cancer treatment after surgery (Beyindthe Basics). Goff B, ed. UpToDate. Waltham, MA: UpToDate Inc.

Memorial Sloan Kettering Cancer Center.Surgery for Uterine (Endometrial) Cancer.American Cancer Society.Surgery for Endometrial Cancer.American Cancer Society.Radiation therapy for endometrial cancer.American Cancer Society.Chemotherapy for Endometrial Cancer.American Cancer Society.Hormone Therapy for Endometrial Cancer.U.S. Food and Drug Administration.FDA grants regular approval to pembrolizumab and lenvatinib for advanced endometrial carcinoma. FDA.American Cancer Society.Immunotherapy for Endometrial Cancer.GSK Consumer Healthcare.GSK receives FDA accelerated approval for JEMPERLI (dostarlimab-gxly) for adult patients with mismatch repair-deficient (Dmmr) recurrent or advanced solid tumours. GSK.Abdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.2015;25(9):1724-1730. doi:10.1097/IGC.0000000000000549American College of Obstetricians and Gynecologists.Endometrial cancer.Memorial Sloan Kettering Cancer Center.Stages of uterine (endometrial) cancer.American Cancer Society.Survival Rates for Endometrial Cancer.UpToDate.Patient education: Endometrial cancer treatment after surgery (Beyond the Basics).American Cancer Society.How Radiation Therapy Can Affect the Sex Life of Females with Cancer.American Cancer Society.Targeted Therapy for Endometrial Cancer.

Memorial Sloan Kettering Cancer Center.Surgery for Uterine (Endometrial) Cancer.

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American Cancer Society.Radiation therapy for endometrial cancer.

American Cancer Society.Chemotherapy for Endometrial Cancer.

American Cancer Society.Hormone Therapy for Endometrial Cancer.

U.S. Food and Drug Administration.FDA grants regular approval to pembrolizumab and lenvatinib for advanced endometrial carcinoma. FDA.

American Cancer Society.Immunotherapy for Endometrial Cancer.

GSK Consumer Healthcare.GSK receives FDA accelerated approval for JEMPERLI (dostarlimab-gxly) for adult patients with mismatch repair-deficient (Dmmr) recurrent or advanced solid tumours. GSK.

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American Cancer Society.Survival Rates for Endometrial Cancer.

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American Cancer Society.How Radiation Therapy Can Affect the Sex Life of Females with Cancer.

American Cancer Society.Targeted Therapy for Endometrial Cancer.

Abdallah R, Xiong Y, Lancaster JM, Judson PL.Complementary and Alternative Medicine Use in Women With Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Center.Int J Gynecol Cancer.25(9):1724-30.Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E.Endometrial cancer.Lancet.387(10023):1094-1108.U.S. National of Medicine.Endometrial Cancer Treatment: Health Professional Version.American Cancer Society. (2018).Hormone Therapy for Endometrial Cancer.American Cancer Society. (2018).Treating Endometrial Cancer.Plaxe S, Mundt AJ. (2017). Patient education: Endometrial cancer treatment after surgery (Beyindthe Basics). Goff B, ed. UpToDate. Waltham, MA: UpToDate Inc.

Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E.Endometrial cancer.Lancet.387(10023):1094-1108.

U.S. National of Medicine.Endometrial Cancer Treatment: Health Professional Version.

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