Treatment Choices for Endometrial Cancer, by Stage
The stage (extent) of endometrial cancer is the most important factor in choosing treatment. But other factors can also affect your treatment options, including the type of cancer, your age and overall health, and whether you want to be able to have children. Tests done on the cancer cells are also used to find out if certain treatments, like hormone and targeted therapy, might work.
Surgery is the first treatment for almost all women with endometrial cancer. The operation includes removing the uterus, fallopian tubes, and ovaries. (This is called a total hysterectomy bilateral salpingo-oophorectomy or TH/BSO). Lymph nodes from the pelvis and around the aorta may also be removed (a pelvic and para-aortic lymph node dissection [LND] or sampling) and tested for cancer spread. Pelvic washings may be done, too. The tissues removed at surgery are tested to see how far the cancer has spread (the stage). Depending on the stage of the cancer, other treatments, such as radiation and/or chemotherapy may be recommended.
For some women who still want to be able to get pregnant, surgery may be put off for a time and other treatments tried instead.
If a woman isn't well enough to have surgery, other treatments, like radiation, will be used.
Stage I cancers
Stage I is only in the uterus. It has not spread to lymph nodes or distant sites.
Stage I endometrioid cancers
Standard treatment includes surgery to remove and stage the cancer (see above). Sometimes this is the only treatment needed. The patient is then closely watched for signs that the cancer has come back (recurred).
For women with higher grade tumors, radiation will likely be recommended after surgery. Vaginal brachytherapy (VB), pelvic radiation, or both can be used.
Some younger women with early endometrial cancer may have their uterus removed without removing the ovaries. This prevents menopause and the issues that can come with it. This also increases the chance that the cancer will come back, but it doesn’t make it more likely that you will die from the cancer. This may be something that you want to discuss with your doctor.
Women who cannot have surgery because of other medical problems or who are frail due to age are often treated with just radiation (external radiation and/or vaginal brachytherapy).
Fertility-sparing treatment for stage IA grade 1 endometrioid cancers: For young women who still want to have children, surgery may be postponed while progestin therapy is used to treat the cancer. Progestin treatment can cause the cancer to shrink or even go away for some time, giving the woman a chance to get pregnant. Still, this is experimental and can be risky if the patient isn't watched closely. An endometrial biopsy or a D&C should be done every 3 to 6 months. If there's still no cancer after 6 months, the woman can try to become pregnant. She will continue to be checked for cancer every 6 months. Because the cancer often comes back
The stage (extent) of endometrial cancer is the most important factor in choosing treatment. But other factors can also affect your treatment options, including the type of cancer, your age and overall health, and whether you want to be able to have children. Tests done on the cancer cells are also used to find out if certain treatments, like hormone and targeted therapy, might work.
Surgery is the first treatment for almost all women with endometrial cancer. The operation includes removing the uterus, fallopian tubes, and ovaries. (This is called a total hysterectomy bilateral salpingo-oophorectomy or TH/BSO). Lymph nodes from the pelvis and around the aorta may also be removed (a pelvic and para-aortic lymph node dissection [LND] or sampling) and tested for cancer spread. Pelvic washings may be done, too. The tissues removed at surgery are tested to see how far the cancer has spread (the stage). Depending on the stage of the cancer, other treatments, such as radiation and/or chemotherapy may be recommended.
For some women who still want to be able to get pregnant, surgery may be put off for a time and other treatments tried instead.
If a woman isn't well enough to have surgery, other treatments, like radiation, will be used.
Stage I cancers
Stage I is only in the uterus. It has not spread to lymph nodes or distant sites.
Stage I endometrioid cancers
Standard treatment includes surgery to remove and stage the cancer (see above). Sometimes this is the only treatment needed. The patient is then closely watched for signs that the cancer has come back (recurred).
For women with higher grade tumors, radiation will likely be recommended after surgery. Vaginal brachytherapy (VB), pelvic radiation, or both can be used.
Some younger women with early endometrial cancer may have their uterus removed without removing the ovaries. This prevents menopause and the issues that can come with it. This also increases the chance that the cancer will come back, but it doesn’t make it more likely that you will die from the cancer. This may be something that you want to discuss with your doctor.
Women who cannot have surgery because of other medical problems or who are frail due to age are often treated with just radiation (external radiation and/or vaginal brachytherapy).
Fertility-sparing treatment for stage IA grade 1 endometrioid cancers: For young women who still want to have children, surgery may be postponed while progestin therapy is used to treat the cancer. Progestin treatment can cause the cancer to shrink or even go away for some time, giving the woman a chance to get pregnant. Still, this is experimental and can be risky if the patient isn't watched closely. An endometrial biopsy or a D&C should be done every 3 to 6 months. If there's still no cancer after 6 months, the woman can try to become pregnant. She will continue to be checked for cancer every 6 months. Because the cancer often comes back
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