Treatment & Management

of Uterine Cancer

Treatment for uterine cancer is tailored to each individual and may include surgery, radiation, and chemotherapy or precision cancer medicines. The specific treatment can depend on the stage and genomic profile of the cancer.  Optimal treatment of patients with uterine cancer often requires more than one therapeutic approach. Thus, it is important for patients to be treated at a medical center that can offer multi-modality treatment involving gynecologic oncologists and radiation oncologists.

Surgery: Surgery for uterine cancer is typically performed in order to remove the cancer and learn additional information about the stage or extent of spread of the cancer. A surgeon who specializes in treatment of disorders of the female reproductive tract is known as a gynecologist. Gynecologic oncologists are gynecologists who have special training in treatment of cancers of the female reproductive tract. Gynecologic oncologists have developed expertise in performing surgical treatment of uterine cancer.

The standard surgery for treatment of uterine cancers is a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries). In addition to removing the uterus and ovaries, the surgeon will often sample or remove the pelvic and para-aortic lymph nodes to determine if cancer has spread.

Patients with early stage uterine cancer are curable with surgical removal of the cancer.1,2

Radiation Therapy:  Radiation therapy, or radiotherapy, is the treatment of cancer using ionizing radiation. This radiation can be delivered externally or internally.  Radiation therapy, unlike chemotherapy, is considered a local treatment. Cancer cells can only be killed where the radiation is delivered to the body. If cancer exists outside the radiation field, the cancer cells are not destroyed by the radiation.  Radiation therapy is the most commonly used as adjuvant therapy for early-stage uterine cancers. The objective of adjuvant radiation therapy is to kill cancer cells that were not removed by surgery for a maximum probability of a cure. Women who are candidates for adjuvant radiation therapy may be treated with external beam radiation therapy to the pelvis and/or vaginal brachytherapy.1

Learn more about radiation therapy.

Radiation guidelines

Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy

Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Some patients with early stage cancers already have small amounts of cancer that have spread outside uterus. These cancer cells cannot be treated with surgery or radiation and require systemic treatment to decrease the chance of cancer recurrence.  More advanced cancers that cannot be treated with surgery and radiation can only be treated with systemic therapy.

Systemic therapies commonly used in the treatment of cancer include:

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.

Most chemotherapy drugs cannot tell the difference between a cancer cell and a healthy cell.  Therefore, chemotherapy often affects the body’s normal tissues and organs, which can result in complications or side effects. In order to more specifically target the cancer and avoid unwanted side effects researchers are increasingly developing precision cancer medicines.3

Precision Cancer Medicines

The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed. Precision medicines are just beginning to undergo evaluation in uterine cancer and patients should ask their doctor about whether testing is appropriate.

Treatment of Uterine Cancer by Stage

In order to learn more about the most recent information available concerning the treatment of uterine cancer, click on the appropriate stage.

Stage I: Cancer does not spread outside the body of the uterus.

Stage II: Cancer involves the body of the uterus and the cervix.

Stage III: Cancer extends outside the uterus, but is confined to the pelvis.

Stage IV: Cancer involves the bladder or bowel or distant sites.

Recurrent: Cancer has returned after initial treatment.

Next: Radiation Therapy for Uterine Cancer

Next: Surgery for Uterine Cancer

References


1 Lu KH. Management of early-stage endometrial cancer. Seminars in Oncology. 2009;36:137-144.

2 Frederick PJ, Straughn JM. The role of comprehensive surgical staging in patients with endometrial cancer. Cancer Control. 2009;16:23-29.

3 Miller DS, Fleming G, Randall ME. Chemo- and radiotherapy in adjuvant management of optimally debulked endometrial cancer. Journal of the National Comprehensive Cancer Network. 2009;7:535-541.