If you are diagnosed with endometrial cancer, you will be referred to a gynaecological oncologist who works in a multidisciplinary team.
If you live in a rural area and can’t go to a specialist clinic for gynaecological cancers, a multidisciplinary team from a specialist clinic will discuss your situation and advise your doctors.
The following options may be available to treat endometrial cancer.
Endometrial cancer is usually treated with surgery to remove the uterus, cervix, fallopian tubes or ovaries, and sometimes also lymph nodes as well. Your doctor will discuss what type of surgery might be best for you.
See more about the side effects and later effects of surgery, and tips on recovering from surgery.
Hysterectomy and bilateral salpingo-oophorectomy
A total hysterectomy is the surgical removal of the uterus and cervix. In most cases, the fallopian tubes and ovaries are also removed – this is called a bilateral salpingo-oophorectomy. The ovaries are removed either because the cancer may have spread to the ovaries, or because the ovaries produce oestrogen, a hormone that may cause the cancer to grow.
The operation can be either:
- open surgery, where a large cut is made in your belly
- laparoscopic surgery (also called keyhole surgery), where several small cuts are made in your belly and a thin telescope is used to see inside.
Your uterus and any other organs are removed through your vagina.
Lymph node removal
Lymph nodes (also called lymph glands) are small, bean-shaped organs that are part of the lymphatic system in your body. There are major lymph nodes in the neck, armpits, groin and abdomen. The lymphatic system is an important part of the immune system.
If endometrial cancer has spread into the muscular wall of the uterus, this increases the risk that it will spread to other areas near the uterus and to the pelvic lymph nodes. Your doctor may discuss the need to remove some of the lymph nodes in your pelvic region, to make sure the cancer doesn’t spread further. Surgically removing your lymph nodes is called a lymphadenectomy.
Lymph node removal is not recommended for all women. If cancer is found in the lymph nodes, your doctor may advise additional (adjuvant) therapy.
Radiation therapy (radiotherapy) uses high-energy X-rays to kill cancer cells. It is often used after surgery to destroy any remaining cancer cells and reduce the risk of the cancer coming back.
You might have radiation therapy to your pelvic area to treat endometrial cancer. Radiation therapy may also be recommended if the cancer has come back or spread, or, very rarely, if you are not well enough for a major operation.
If you have not had a hysterectomy or have not been through menopause, you should avoid getting pregnant during your radiation therapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor urgently.
Chemotherapy uses drugs to destroy cancer cells or slow their growth, and may involve a number of treatments (‘cycles’) over several months.
If you have not had a hysterectomy or have not been through menopause, you should avoid getting pregnant during your chemotherapy because it can harm your unborn baby. If you become pregnant during treatment, talk to your doctor urgently.
Hormones are produced by glands in the body and circulate in the bloodstream. Some cancers of the uterus depend on hormones (such as oestrogen) for their growth. Hormone therapy uses tablets with hormones in them that can stop the cancer cells from growing.
Effects of treatment on fertility
Endometrial cancer more commonly affects older women who have completed their family and passed through menopause. However, younger women can also be diagnosed with endometrial cancer, and the cancer and its treatment may affect your ability to have children in the future.
Usual recommended treatment for endometrial cancer is to surgically remove the uterus, including the cervix, and usually the fallopian tubes and ovaries. If your uterus has been removed, you will not be able to become pregnant.
However, some options may allow you to have children (called fertility-sparing options).
If you are diagnosed with a low-risk type of endometrial cancer at an early stage, when the cancer has not spread to the muscle of the uterus, it may be possible to treat the cancer with hormone therapy. This means that your uterus and ovaries will not be removed during surgery. You may be given hormones (progesterone) for 4–6 months and monitored closely by a specialist gynaecological cancer team. If the cancer regresses during this time, you may be able to become pregnant.
Younger women who have their uterus removed during surgery may be able to keep their ovaries, which are usually transposed (moved out of the pelvis) so that they will not be affected by any post-operative radiation treatment. If you still have your ovaries after surgery, you will still produce your own eggs. This means that, in the future, you could choose to have a baby through surrogacy (where your own eggs are fertilised with sperm and the embryo is implanted in another woman to carry the baby for you).
If your uterus, ovaries and fallopian tubes have been removed, you can still consider surrogacy using a donor’s eggs, or adoption, as a way to have children.
Your doctor will discuss possible fertility-sparing options with you. You can also talk to an expert fertility counsellor, in consultation with your gynaecological oncologist, to help you make a decision if you are feeling stressed or anxious about your diagnosis and treatment.
Recurrent or advanced endometrial cance
Recurrent endometrial cancer is cancer that has recurred (come back) after it has been treated. It grows back from the cells of the original primary cancer that have not responded to treatment. Secondary cancer, or metastasis, is cancer that has spread from the original site to another part of the body. Endometrial cancer may come back in the pelvis, in lymph nodes in the abdomen and pelvis, or in other parts of the body.
There are a number of treatment options for recurrent endometrial cancer that can relieve symptoms and improve your quality of life. These include: