Treatments for endometrial carcinoma

The following are treatment options for early stage, advanced stage and recurrent endometrial carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The following are treatments for stage 1 and 2 endometrial carcinoma.

Surgery is the main treatment for early stage endometrial carcinoma.

Staging is done during surgery. The surgeon does a pelvic exam while you are under general anesthetic. Then the surgeon makes an incision, or cut, in the abdomen to examine the organs and see if the cancer has spread to them. This is called abdominal exploration (laparotomy). The surgeon may remove tissue samples and lymph nodes during surgery. The surgeon may also rinse the abdomen with saline and collect a sample (called pelvic washings). Tissue samples, lymph nodes and pelvic washings are sent to the lab and examined under a microscope to check for cancer cells. The same surgery can also be done using less invasive methods with laparoscopy or robotic surgery.

Stage 1 endometrial carcinoma is usually treated with a total hysterectomy (removal of the uterus and cervix) and bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). The surgeon may also remove lymph nodes in the pelvis and around the aorta (called lymph node dissection or lymphadenectomy). Some younger women may have the uterus removed without removing the ovaries.

Stage 2 endometrial carcinoma may be treated with a total hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection to remove lymph nodes in the pelvis and around the aorta. It may also be treated with a radical hysterectomy to remove the cervix, the uterus, some of the structures and tissues near the cervix and upper vagina. The surgeon may or may not remove lymph nodes in the pelvis and around the aorta with a radical hysterectomy.

You may be offered radiation therapy after surgery for early stage endometrial carcinoma to decrease the risk of recurrence. Sometimes it is also given before surgery for stage 2 carcinoma.

Radiation therapy can also be used as the main treatment for women who cannot have surgery because of other medical problems.

You may be given external beam radiation, brachytherapy or both..

You may be offered chemotherapy after surgery for early stage, high-grade endometrial carcinoma (such as serous adenocarcinoma or clear cell adenocarcinoma). Carcinosarcoma may also be treated with chemotherapy after surgery.

The chemotherapy drugs used to treat high-grade carcinomas include:

• cisplatin (Platinol AQ)
• carboplatin (Paraplatin, Paraplatin AQ) with paclitaxel (Taxol)

The chemotherapy drugs used to treat carcinosarcoma include ifosfamide (Ifex) alone or combined with cisplatin, carboplatin, doxorubicin (Adriamycin) or paclitaxel.

Some types of uterine cancer are treated with chemoradiation. This treatment gives chemotherapy and radiation therapy during the same time period.

Sometimes a few cycles of chemotherapy are given, then radiation, and then chemotherapy is given again. This is called sandwich therapy. It may be used for endometrial cancers such as papillary serous carcinoma and carcinosarcoma.

The following are treatments for stages 3 and 4, also called advanced-stage endometrial carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is usually the first treatment for advanced-stage endometrial carcinoma. Surgery is used to both remove and stage the cancer (called surgical staging). The type of surgery and amount of tissue that needs to be removed depends on several factors about you and the cancer, including how far it has spread within the uterus or to other organs.

Surgery for advanced-stage endometrial carcinoma is followed by another type of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Stage 3 endometrial carcinoma is usually treated with a hysterectomy (removal of the uterus). Depending on how far the cancer has spread, the surgeon will either do a total hysterectomy or radical hysterectomy. A total hysterectomy is surgery to remove the uterus and cervix. A radical hysterectomy removes more tissue than a total hysterectomy. In addition to the uterus and cervix, a radical hysterectomy may remove:

• the upper vagina
• tissues surrounding the uterus

If any other abnormal tissues are found during the surgery, you may also have a biopsy of these tissues during surgery.

A bilateral salpingo-oophorectomy (removal of the 2 fallopian tubes and ovaries) and removal of the lymph nodes in the pelvis (pelvic lymph nodes) and around the aorta (para-aortic lymph nodes) are done at the same time as the hysterectomy.

Stage 4 endometrial carcinoma is sometimes treated with surgery. In cases where cancer has spread to abdominal lymph nodes, besides the pelvic or para-aortic lymph nodes, and nowhere else, surgical debulking may be done.

In cases where cancer has spread too far to be removed by debulking, a hysterectomy may still be done to help relieve symptoms of the cancer, such as bleeding.

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy after surgery as an adjuvant therapy for advanced-stage endometrial carcinoma.

In some cases, when the tumour is too big or has spread too far to be surgically removed, radiation therapy may be used first (called neoadjuvant therapy) to try to shrink the tumour and make it possible for doctors to then remove it. Radiation therapy may also be used to manage symptoms of endometrial carcinoma if you cannot have surgery.

Brachytherapy, external radiation therapy or a combination may be used for advanced-stage endometrial carcinoma. You may have radiation therapy on its own or together with a systemic therapy.

Find out more about radiation therapy for uterine cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy may be offered for advanced-stage endometrial carcinoma that cannot be treated with surgery or radiation therapy if it’s low grade and hormone-receptor positive.

Hormone receptor–positive endometrial carcinomas have receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive), or both.

Most people who have hormone therapy for advanced-stage endometrial carcinoma will have megestrol and tamoxifen. Other hormone therapies that may be offered include:

• medroxyprogesterone (Provera) and tamoxifen
• medroxyprogesterone
• megestrol
• tamoxifen

If you are postmenopausal, you may also be offered:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

Find out more about hormone therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy after surgery (called adjuvant chemotherapy) for advanced-stage endometrial carcinoma. In cases of stage 4 cancer that can’t be removed with surgery (metastatic endometrial carcinoma), chemotherapy may be offered to help control the symptoms of metastatic cancer.

Chemotherapy drug combinations that may be used to treat advanced-stage endometrial carcinoma include:

• cisplatin (or carboplatin) and paclitaxel
• carboplatin and nab-paclitaxel
• cisplatin and doxorubicin
• carboplatin and docetaxel
• carboplatin and paclitaxel with the immunotherapy drug dostarlimab-gxly (Jemperli)
• carboplatin and paclitaxel with the immunotherapy drug durvalumab (Imfinzi)

If you can’t have a chemotherapy drug combination, you may be treated with carboplatin or doxorubicin alone.

If you have advanced-stage endometrial serous carcinoma or carcinosarcoma, you may be offered the chemotherapy drug combination carboplatin and paclitaxel along with the targeted therapy drug trastuzumab (Herceptin and biosimilars) .

Find out more about chemotherapy for uterine cancer.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy may be offered for advanced-stage endometrial carcinoma.

The type of immunotherapy drug you have depends on several aspects of the cancer including the type of endometrial carcinoma, the molecular subtype and the grade.

Pembrolizumab (Keytruda) is a drug that inhibits the PD-1 checkpoint protein. You may be offered pembrolizumab, by itself, for cancer that is the mismatch repair deficient (MMRd) molecular subtype.

For advanced-stage endometrial carcinomas that didn't respond to treatment with a platinum-based chemotherapy drug, you may be offered pembrolizumab together with the targeted therapy drug lenvatinib (Lenvima).

Dostarlimab-gxly (Jemperli) is a drug that also inhibits PD-1. You may be offered dostarlimab-gxly if the cancer is the MMRd molecular subtype. It’s usually given with the chemotherapy drug combination carboplatin and paclitaxel. If the cancer didn’t respond to a previous treatment with a platinum-based chemotherapy drug (for example, carboplatin or cisplatin), dostarlimab-gxly can be used on its own as a second-line option if the cancer is the MMRd molecular subtype.

Durvalumab (Imfinzi) is another drug that inhibits PD-1. It may be offered for advanced endometrial carcinoma that is the MMRd molecular subtype with the chemotherapy drug combination carboplatin and paclitaxel, followed by maintenance therapy with durvalumab alone.

Find out more about immunotherapy for uterine cancer.

The following are treatment options for recurrent endometrial carcinoma. Recurrent endometrial carcinoma means that the cancer has come back after it was treated. Treatments are based on where the cancer comes back and the amount of the cancer in the body.

You may be offered radiation therapy after debulking surgery if endometrial carcinoma comes back only in the pelvis (called local regional recurrence). Radiation therapy may also be offered if you have extensive pelvic disease and cannot have surgery because of other medical problems.

You may be given external beam radiation, brachytherapy or both.

You may be offered one of the following types of surgery for recurrent endometrial carcinoma.

Pelvic exenteration is used to treat a local recurrence when there is cancer in the rectum or bladder and you have already had radiation therapy.

Tumour debulking is used if you have extensive pelvic disease. This surgery helps relieve pain and symptoms caused by the tumour.

You may be offered hormonal therapy to control the growth of recurrent endometrial carcinoma or to help relieve the symptoms of distant metastases. It may be given along with radiation therapy if you can't have surgery.

The types of hormonal therapy used are the same as those given for advanced endometrial carcinoma.

You may be offered chemotherapy to control the growth of recurrent endometrial carcinoma or to help relieve the symptoms of distant metastases. The combinations of chemotherapy used include:

• cisplatin and doxorubicin, with or without paclitaxel
• carboplatin and paclitaxel
• carboplatin and docetaxel

The chemotherapy drugs used to treat recurrent high-grade endometrial carcinoma or carcinosarcoma are the same as with the other stages. Chemoradiation or sandwich therapy may be given, similar to treatments for early and advanced stage high-grade endometrial carcinoma or carcinosarcoma.

You may want to consider a type of care to make you feel better rather than treat the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

You may be asked if you want to join a clinical trial for endometrial carcinoma. Find out more about clinical trials.