Endometrial cancer starts in the endometrium, the lining of the uterus. Advanced or late-stage endometrial cancer has spread to other parts of the belly or to distant organs like the liver, lungs, or brain. Surgery to remove the tumor is often the first treatment for early-stage endometrial cancer. But by the time the cancer is advanced, it may have spread too far to completely remove surgically.
Advanced endometrial cancer treatment can still involve surgery. But it usually also includes treatments like radiation therapy, chemotherapy, targeted drugs, and immunotherapy.
Treatments for late-stage endometrial cancer have improved in recent years. Molecular testing, which checks your blood and cells for certain genes, proteins, or other substances that help the cancer grow, makes it easier for your doctors to tailor treatment to you. Having more treatment options can give you a better outcome.
As you start the treatment process, it's important to know your choices and how they might affect you. The more you understand, the better you can advocate for yourself and be an active part of care decisions with your medical team.
Surgery
This treatment may be an option if the cancer has spread to lymph nodes in your belly but not to other organs. Taking out as much of the tumor as possible, called debulking, could improve your outlook.
A total hysterectomy is the most common surgery for endometrial cancer. It removes the uterus and cervix. The surgeon may also take out both fallopian tubes and the ovaries, called bilateral salpingo-oophorectomy, as well as any lymph nodes that contain cancer.
A hysterectomy can be done in a few ways:
- Open hysterectomy. The surgeon makes one cut in the front of your belly and removes your uterus, and possibly your fallopian tubes and ovaries. Doing the surgery through one incision makes it easier for your doctor to find and take out as much of the cancer as possible.
- Laparoscopy (minimally invasive surgery). The surgeon makes a few small cuts in your belly and places a thin tube with a camera at the end and other instruments into these incisions. Your doctor may remove your uterus through your vagina. Because laparoscopic openings are smaller than an open hysterectomy incision, recovery time is often quicker.
- Robot-assisted laparoscopy. Some surgeons sit at a control panel and perform the hysterectomy with robotic arms. The recovery time is similar to that of a laparoscopy.
If the cancer has spread to other organs in your belly, you may need a bigger procedure called pelvic exenteration. The surgeon removes your uterus, ovaries, and fallopian tubes. They may also take out your bladder, urethra, and rectum if cancer has spread there, and then reconstruct these organs.
Recovery after hysterectomy
Your recovery depends on the method your surgeon used to perform the hysterectomy. After an open hysterectomy, you'll stay in the hospital for two to seven days. Full recovery can take four to six weeks. With a laparoscopic hysterectomy, you'll go home the same day or the next day. Recovery takes three to four weeks.
It's normal to have some pain, redness, bruising, swelling, and itching around the incisions while you heal. These symptoms can last for one to two months.
After a hysterectomy, your periods will stop. You won't be able to get pregnant. If your ovaries are removed, you'll go into menopause, with symptoms like hot flashes, night sweats, mood swings, and vaginal dryness. Your risk of bone loss (osteoporosis) also increases. A hysterectomy can affect your sex life. Ask your oncologist and gynecologist about hormone therapy and other non-medicine treatments for menopause and sexual symptoms.
The goal of a hysterectomy is to get rid of as much cancer as possible, but this treatment can cause a lot of anxiety and stress. Everyone responds to surgery differently. If you're struggling emotionally after the procedure, you could ask for help from a mental health professional or join a support group for people with late-stage endometrial cancer.
Radiation Therapy
This treatment uses radioactive materials to kill cancer cells that have spread outside of the uterus. You may get radiation therapy after surgery, to remove any cancer cells that were left behind, or on its own.
You'll get radiation therapy in a hospital or radiation treatment center. The radiation is delivered to your body in one of two ways:
External beam radiation therapy (EBRT). A machine called a linear accelerator aims the radiation at your pelvis. Usually, you'll get this treatment five days a week for four to six weeks. You lie on a table while a machine rotates around you. The treatment takes 15 to 20 minutes.
Brachytherapy. The radioactive material is in an applicator that goes inside your body near the cancer. The radiation may stay in your body for a few minutes or a few days. For advanced endometrial cancer, treatment often involves a combination of brachytherapy and EBRT.
Side effects
Most people who get radiation therapy for endometrial cancer have no problems. But short-term or long-term side effects can affect the parts of your body that are exposed to radiation. Adding chemotherapy to radiation therapy can increase the side effects.
You're more likely to have problems like these with EBRT than with brachytherapy:
- Tiredness
- Nausea and vomiting
- Belly cramps
- Diarrhea
- Skin redness and peeling
- Pain when you pee
- Irritation and discharge from the vagina
Your doctor has treatments to manage some of these side effects. They should go away after you finish radiation therapy.
Radiation therapy can also cause long-term side effects such as:
- Dryness in the vagina
- Painful sex
- Urinary tract infections (UTIs)
- A blockage or sores in the intestines
- Lymphedema – swelling in the legs from a buildup of lymph fluid
Chemotherapy
This treatment uses strong medicines to kill cancer cells and stop them from dividing. It's an option when the cancer has spread outside of the uterus, and to get rid of any cancer cells left behind after surgery.
It's common to take two or more chemotherapy drugs together. The most common chemo combination for advanced endometrial cancer is carboplatin plus paclitaxel.
Your doctor may add an immunotherapy drug like durvalumab (Imfinzi) or pembrolizumab (Keytruda) to chemo to help it work better. Or you may get radiation before, after, or during chemotherapy treatment.
Usually, you'll get chemotherapy through a thin tube placed directly into a vein. The medicine is given in cycles. You receive chemotherapy for a certain number of weeks, called a cycle, and then rest for a period of time to let your body recover.
Side effects
Chemotherapy drugs can damage healthy cells along with cancer cells. Which side effects they cause depend on the type of medicine you take and how long you take it.
The most common chemotherapy side effects are:
- Nausea and vomiting
- Appetite loss
- Hair loss
- Numbness or tingling from nerve damage
- Mouth sores
- Infections from a low white blood cell count
- Bleeding or bruising from low platelets in the blood
- Tiredness or anemia from low red blood cells
Most of these side effects will get better once you finish chemotherapy treatment. Others last longer or start after treatment ends. Chemotherapy can cause long-term damage to the heart, kidneys, and bladder. It also can make it difficult to get pregnant. Before you start chemotherapy, ask your medical team about all the possible side effects and how to manage them.
Targeted Therapy
These medicines target abnormal substances, like proteins or gene changes, in endometrial cancer cells. The doctor can test your cancer for biomarkers like these to show whether you're a good candidate for targeted therapy:
HER2. A couple of medicines target this protein, which helps cancer cells grow and divide. Trastuzumab (Herceptin) is a monoclonal antibody that's given with chemotherapy. Trastuzumab deruxtecan (Enhertu) attaches to the HER2 protein on cancer cells and then delivers a chemo drug directly to the cancer.
New blood vessels. Tumors make new blood vessels to supply them with the blood they need to survive. Bevacizumab (Avastin) and lenvatinib (Lenvima) block the growth of new blood vessels. Lenvima is given together with the immunotherapy drug pembrolizumab (Keytruda) to treat late-stage endometrial cancer. Avastin may be given with chemotherapy or on its own.
mTOR inhibitors. Everolimus (Afinitor) and temsirolimus (Torisel) block the protein mTOR, which helps endometrial cancer cells grow and divide. Afinitor is a pill. Torisel comes as an infusion into a vein.
Multikinase inhibitor. Cabozantinib (Cabometyx) blocks kinase proteins, which help the cancer grow. It also stops new blood vessels from forming. You may get this medicine if your cancer progressed while you were on another medicine.
NTRK inhibitors. A small number of endometrial cancers have a gene change called an NTRK fusion that helps them grow. Entrectinib (Rozlytrek) and larotrectinib (Vitrakvi) are NTRK inhibitors that treat advanced endometrial cancer.
Side effects
Targeted therapies cause a variety of side effects. Some are mild. Others are more serious. The side effects are different for each drug but can include:
- Fever
- Nausea and vomiting
- Diarrhea or constipation
- Tiredness or weakness
- Appetite loss
- Headache
- Mouth sores
- Muscle and joint pain
Immunotherapy
Immunotherapy drugs called checkpoint inhibitors help your immune system become a more effective cancer fighter. Checkpoints are proteins on the surface of immune cells. They act like on/off switches, turning off to protect your own healthy cells, and on to attack bacteria and other harmful invaders. Cancer cells sometimes use checkpoints to protect themselves from the immune system.
Checkpoint inhibitors block the proteins PD-1 and PDL-1 on immune cells to rev up your immune system response against the cancer. These medicines include:
- Avelumab (Bavencio)
- Dostarlimab (Jemperli)
- Durvalumab (Imfinzi)
- Nivolumab (Opdivo)
- Pembrolizumab (Keytruda)
Immunotherapy is often reserved for late-stage endometrial cancer that tests positive for the biomarker microsatellite instability-hypermutated (MSI-H) or mismatch repair deficiency (MMRd). Research shows that for people with these biomarkers, adding immunotherapy to other treatments improves survival.
Side effects
Checkpoint inhibitors can cause side effects like these:
- Tiredness
- Fever
- Nausea
- Cough
- Appetite loss
- Muscle or joint pain
- Allergic reactions from the infusion, like a fever, rash, itchy skin, and trouble breathing
Rarely, immunotherapy can cause the immune system to mistakenly attack other organs like the lungs, liver, or kidneys. Your doctor will monitor and treat you for these and other side effects. Let your treatment team know right away if you have any problems while taking an immunotherapy drug.
Clinical Trials
All the endometrial cancer medicines available today were first tested in clinical trials. Joining one of these studies could give you access to a treatment that isn't available to the public yet and that may work better than current endometrial cancer drugs.
To learn about clinical trials, ask your cancer doctor. You can also check with ClinicalTrials.gov, a cancer hospital in your area, or an organization like the National Cancer Institute.
Show Sources
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SOURCES:
American College of Obstetricians and Gynecologists: "7 Things You Didn't Know About Hysterectomy."
American Cancer Society: "Chemotherapy for Endometrial Cancer," "Endometrial Cancer Stages," "Immunotherapy for Endometrial Cancer," "Radiation Therapy for Endometrial Cancer," "Surgery for Endometrial Cancer," "Targeted Therapy for Endometrial Cancer," "Treatment Choices for Endometrial Cancer, By Stage."
Annals of Oncology: "Adding Immunotherapy to First-Line Treatment of Advanced and Metastatic Endometrial Cancer."
Cleveland Clinic: "Hysterectomy."
Facing Our Risk of Cancer Empowered: "Endometrial Cancer: Targeted and Immunotherapies."
Gynecologic Oncology Reports: "Advanced endometrial cancer – The next generation of treatment: A society of gynecologic oncology journal club clinical commentary."
Medscape: "Endometrial Cancer Treatment Protocols."
Memorial Sloan Kettering Cancer Center: "Surgery for Uterine (Endometrial) Cancer," "Uterine (Endometrial) Cancer Clinical Trials."
NYU Langone Health: "Radiation Therapy for Endometrial Cancer."
University of Rochester Medical Center: "Endometrial Cancer: Chemotherapy."
