Your specific treatment plan will depend on many factors, including:

• The stage of the cancer
• The grade of the cancer
• The histotype and/or molecular subtype of the cancer (meaning, the type of cells the cancer is made of and/or the cancer’s genetic features)
• Age and general health
• Future fertility goals, if any

Before deciding on a treatment plan, a pathologist looks at the cancer tissue under a microscope to understand what type of endometrial cancer it is, how aggressive the endometrial cancer is, and how far it has spread. They also do molecular tests, such as checking for certain proteins or changes in the DNA. This information helps doctors understand:

• How likely it is that surgery alone will be enough to treat the cancer
• Whether additional treatments are needed
• The risk of the cancer spreading or coming back

Surgery for endometrial cancer

Surgery is the first step in treating most endometrial cancers. Surgical options can sometimes be adjusted based on age, health, and personal wishes:

• For some younger patients with precancer or early-stage cancer, the ovaries may be left in place to prevent early menopause. This can slightly increase the chance of the cancer coming back.
• For people who still wish to have children, surgery may be postponed, and other treatments may be used first, such as hormonal therapy (progesterone), to treat the cancer.
• If surgery isn’t safe because of other health conditions, treatments such as radiation or hormone treatment may be recommended instead.

Who performs surgery for endometrial cancer?

Endometrial cancer surgery should be done by a gynecologic oncologist.

Depending on the report from the pathologist, a gynecologic oncologist will decide if lymph node testing or more complex surgery is needed. A gynecologic oncologist is a specialist doctor with advanced training in cancers of the female reproductive system.

What does surgery for endometrial cancer involve?

Surgery can be performed using minimally invasive techniques (such as laparoscopic or robotic surgery) or through an open incision in the abdomen (known as a laparotomy).

In most cases, the surgeon removes the uterus, fallopian tubes, and ovaries. This is called a total hysterectomy with bilateral salpingo-oophorectomy. The surgeon may also remove lymph nodes in the pelvis or near the (the body’s main artery) to see if the cancer has spread. Sometimes, other tissue samples, like a small piece of the omentum (a fatty layer in the upper abdomen), are taken to check for signs of spread. All the samples taken are reviewed closely under the microscope by the pathologist.

What happens after endometrial cancer surgery?

After surgery, the doctor or nurse will explain what happened during surgery, including what tissues were removed. They will also share the results of the pathology report, including the cancer type, stage, grade, and molecular classification. Based on these results, additional treatments may be suggested.

For many patients, no further treatment is required after surgery because the cancer is detected at an early stage, when the likelihood of recurrence is low.

Is Radiation Used to Treat Endometrial Cancer?

Radiation therapy may be used to treat endometrial cancer following surgery. It uses a very high localized dose of radiation to damage the DNA of the cancer cells so that they can no longer divide and grow. This is a different approach to chemotherapy which destroys cancer cells throughout the body.

How is radiation given to treat endometrial cancer?

Radiation is given in two main ways:

• A small tube is inserted into the vagina. It delivers radiation directly to the area where the cancer was, then is removed after a few minutes

• External beam radiation therapy: A machine outside the body aims radiation at the tumor, similar to getting an X-ray.

Sometimes both types are used. In most of these cases, external beam radiation is given first, followed by brachytherapy.

The type of radiation – and the areas to be treated – will be based on stage (how far the cancer has spread) and grade (how the cancer cells look under a microscope).

What are the side effects of radiation treatment?

Side effects of radiation treatment may :

• Fatigue
• Mild redness/skin sensitivities
• Loss of appetite
• Hair loss in the pelvic region
• Nausea and vomiting
• Diarrhea or constipation
• Gas
• Bladder problems (frequent urination, discomfort, bleeding)
• Treatment-induced menopause
• Vaginal irritation
• Low blood counts
• Sexual changes

These side effects typically fade once radiation therapy ends.

Is chemotherapy used to treated endometrial cancer?

Chemotherapy is often used as a treatment for endometrial cancer. It is most commonly given after surgery, but sometimes it is given before surgery.  Chemotherapy involves using chemicals to target and kill cancer cells. Chemotherapy can be taken orally or may be administered through an IV. The chemotherapy drug is administered to the whole body, as compared to radiation therapy, which is usually to a specific, localized area of the body. Therefore, chemotherapy is considered a systemic therapy. There are many different types of chemotherapy protocols for endometrial cancer.

When is chemotherapy used to treat endometrial cancer?

• Chemotherapy is used as a treatment for high stage or aggressive endometrial cancer, most commonly given after surgery.
• Chemotherapy given after surgery (called ‘adjuvant’ chemotherapy), is used to destroy any remaining cancer cells and is often accompanied by radiation therapy.
• Chemotherapy given before surgery (called ‘neoadjuvant’ chemotherapy), reduces the size of the tumour and treats any accompanying fluid (ascites), making it easier to remove the cancer during surgery or to treat it with radiation.

Which chemotherapy drugs are used to treat endometrial cancer?

Chemotherapy to treat endometrial cancer typically includes a combination of two different chemotherapy drugs; carboplatin and paclitaxel. These are administered intravenously (IV) so that they can circulate through the bloodstream.

What other treatments are used for endometrial cancer?

Hormone therapy is used to treat some endometrial cancers. It is believed to be most effective for endometrial cancers belonging to the NSMP molecular subtype and that have strong estrogen receptor expression (ER positive). The most common hormone therapy consists of a progesterone, either given by mouth or in an intra-uterine device (IUD – a small device placed inside the uterus). It is given most commonly in these situations:

• For younger patients who wish to preserve fertility and keep their uterus
• For advanced cancer (stage III or IV)
• If the cancer has come back after treatment (recurrence)
• For people with early-stage cancer who cannot have surgery for health reasons

Immunotherapy and Targeted Therapy are also used to treat some endometrial cancers. These are newer types of treatments and most of these treatments are intravenous, but some are taken orally. They work by focusing on specific features of the cancer. Whether these treatments are recommended depends on the molecular classification of the cancer.

What Happens After Endometrial Cancer Treatment?

Follow-up tests and treatments will vary once treatment is complete. Patients will have scheduled visits with their doctor to:

• monitor their response to treatment
• recognize and immediately deal with any treatment-related complications
• monitor for a recurrence of the cancer

The frequency of visits will vary according to a patient’s specific situation, although a general guideline is:

• year 1-2: every 3-5 months
• years 3-5: every 6 months
• years 5+: annually

After treatment is completed, patients may experience feelings of insecurity, loneliness, and fear of recurrence. They may also feel a heightened sense of responsibility for their own health. For those experiencing worry or stress, there are resources and support services available to help.