Treatment for Endometrial Cancer

Treatment Types

Chemotherapy

Usually chemotherapy is used to treat endometrial cancer only if the cancer has already metastasized, or spread, outside of the uterus by the time of surgery or if the cancer has come back after earlier treatment.

You may receive one chemotherapy drug or a combination of two or more. Your chemotherapy drugs will be given by infusion into a vein. Then they enter your bloodstream and travel throughout your body, killing cancer cells that may have spread from the original site.

The reason chemotherapy works is that it kills fast-growing cells, which include cancer cells but also other cells, such as hair follicles, white blood cells, and platelets. This is one reason for many of the typical side effects of chemotherapy treatment, including hair loss and low levels of blood cells (low blood counts).

Common Drugs

Endometrial cancer may be treated with one or more of the following chemotherapy drugs:

• Carboplatin (Paraplatin)
• Cisplatin (Platinol)
• Doxorubicin (Adriamycin)
• Ifosfamide (Ifex)
• Liposomal doxorubicin (Doxil)
• Paclitaxel (Taxol)

Your Schedule

Chemotherapy for gynecologic patients is given at the UW Medical Center on various schedules, depending in part on which drugs you receive. Most people receive chemotherapy every three weeks. Some chemotherapy regimens require weekly treatments. Treatment typically continues for three to six months. You may bring a friend or family member to sit with you during your treatment, which may last two to three hours.

Side Effects of Chemotherapy

The side effects of chemotherapy vary according to the drugs that are used. The most common side effects include nausea, vomiting, hair loss and fatigue. Other possible side effects include mouth sores and an increased chance of bleeding, infection or anemia. Patients tolerate chemotherapy much better than in the past because of new drugs that help control side effects.

Your team at Fred Hutch will talk with you about the specific side effects you might experience, and we will help you prevent, reduce or manage these effects as best as possible. You can find general information in the symptom management section.

Hormonal Therapy

Like chemotherapy, hormonal therapy is a systemic therapy — one that circulates through the bloodstream to attack cancer cells throughout the body.

Hormonal therapy works because hormones can affect the growth of some cancer cells. Reducing or stopping hormone production helps prevent the growth of these cancer cells in people whose cancers are hormone-receptor positive. Hormonal therapy may be used to treat endometrial cancer if the cancer has metastasized, or spread, beyond the abdomen or if the cancer has come back after earlier treatment.

Your physician may suggest using one of these hormonal therapies to slow the growth of your cancer:

Progestins: These drugs are the main hormonal therapies for endometrial cancer. They are like the hormone progesterone that occurs naturally in your body. The most common are medroxyprogesterone acetate (Provera) and megestrol acetate (Megace).
Tamoxifen: This drug helps prevent any estrogens that are circulating in your body from stimulating the growth of the cancer cells.
Aromatase inhibitors: If your ovaries have been removed (or no longer function), your body fat still makes estrogen. Drugs called aromatase inhibitors can stop this estrogen from being made. Examples of aromatase inhibitors include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).

Radiation Therapy

If you have endometrial cancer, your first treatment is likely to be surgery. Then, after a pathologist examines your cancer, your physician may recommend that you have radiation therapy. This may be a combination of external-beam radiation therapy and internal radiation therapy.

For a small minority of people with endometrial cancer, physicians may advise against removing the cancer surgically. Your physician may feel surgery is not the best treatment for you because of the size or location of the cancer or because you have other health problems. In this case, your physician is likely to recommend that you be treated with radiation therapy, chemotherapy, or both.

External-Beam Radiation Therapy

Typically, external-beam radiation therapy is given five days a week (Monday to Friday) for five to six weeks using a machine called a linear accelerator. The procedure is not painful, and each treatment lasts only about five to seven minutes.

Patients being treated by Fred Hutch may receive external-beam radiation therapy for endometrial cancer at these locations:

• Fred Hutch Radiation Oncology at South Lake Union Clinic, under the supervision of UW Medicine radiation oncologist Wui-Jin Koh, MD, who specializes in treating people with gynecologic cancers
• Fred Hutch Radiation Oncology at UWMC-Northwest
• Cancer Center at University of Washington Medical Center

Internal Radiation Therapy

Internal radiation therapy, also known as brachytherapy, is a procedure that delivers radiation to a tumor using radioactive material placed inside the body. For endometrial cancer, this means radioactive seeds are sealed in a rod that is inserted into the vagina or uterus.

Depending on your specific situation, you might need a high-dose radiation source that’s inserted for a short time (and then removed). Or you might need a low-dose radiation source that’s inserted and left for two to three days.

For Fred Hutch patients, this type of radiation therapy is done under the supervision of Dr. Koh.

Learn more about external-beam radiation therapy and internal radiation therapy in the section on radiation oncology

Radiation Plus Chemotherapy

Clinical trials are currently underway at Fred Hutch, and elsewhere to evaluate the combination of radiation therapy plus chemotherapy in the treatment of endometrial cancer. All of our gynecologic oncologists and radiation oncologists are involved in this research.

Side Effects of Radiation Therapy

Radiation therapy can cause side effects, which may depend on exactly how and where the radiation is given. Your team at Fred Hutch will talk with you about the specific side effects you might experience, and we will help you prevent, reduce, or manage these effects as best as possible. You can find general information in the symptom management section.

Surgery

The most common, and usually the first, treatment for endometrial cancer is surgery to remove all of the cancer or as much cancer as possible. Some people need only surgery followed by checkups to monitor their condition. Others have radiation therapy or other treatments after surgery.

For a small minority of women with endometrial cancer, doctors may advise against removing the cancer surgically. Your physician may feel surgery is not the best treatment for you because of the size or location of the cancer or because you have other health problems. If your cancer cannot be removed surgically, your physician may recommend that you be treated with radiation therapy, chemotherapy, or both.

Hysterectomy

Most people with endometrial cancer have a total hysterectomy—surgery to remove the uterus, including the cervix. If your cancer has spread to your cervix or the tissue around your cervix (parametrium), your surgeon will also remove the parametrium, the ligaments that connect your uterus to your sacrum, and the upper part of your vagina. This is called a radical hysterectomy.

With either type of hysterectomy, you will very likely have your fallopian tubes and ovaries removed (bilateral salpingo-oophorectomy) at the same time because these are places where endometrial cancer may spread.

Lymph-Node Removal

Your surgeon will also remove lymph nodes from your pelvic area and around the major artery (aorta) in your abdomen (pelvic and para-aortic nodes). The lymph nodes are biopsied to determine whether the cancer has spread through your lymph system.

Other Steps

At the start of your surgery, your surgeon may wash your abdominal and pelvic cavities with salt water (peritoneal lavage). This fluid is sent to a laboratory to be checked for cancer cells. The results can add another piece of information to help your physician recommend a treatment plan for you. The surgeon may also remove abdominal fat (omentum) and small samples of the lining of your abdominal and pelvic cavities (peritoneum) for testing.

Laparoscopic and Robot-Assisted Surgery

Hysterectomies, lymph-node removals, and the other elements of surgery to stage endometrial cancer can now be performed using minimally invasive techniques. The surgeon can operate laparoscopically, either inserting instruments directly through small incisions or using a robotic system, like the da Vinci Surgical System, to assist with the surgery. The da Vinci system allows surgeons to do surgery without a large incision. This has been shown to improve patient outcomes by reducing postoperative pain, infection, blood loss and recovery time.

Open laparotomy—abdominal surgery with a larger incision—is still done, too. In certain situations, it is the best option. If you need open surgery, your surgeon will explain the reasons.

Surgery for Fred Hutch patients is performed at UW Medical Center by gynecologic oncology surgeons who provide care at both UW Medical Center and Fred Hutch.