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Treatment Options for Endometrial Cancer

August 2022 Part 1 of 2 – Endometrial Cancer Special Issue Series

Ms. Atkinson is a gynecology/oncology nurse navigator at the Novant Health Derrick L. Davis Cancer Institute in Winston-Salem, NC.

Many times, endometrial cancer is diagnosed early and may only require surgery to completely remove the cancer, which is good news when you’re facing a cancer diagnosis. But if this is not your story, don’t despair, there is good and hopeful news for you, too. There are more effective treatment options available to you today than ever before. I will outline several of these treatments in this article.

When recommending a treatment course, your doctor will consider several factors; 3 of the most important factors are the stage, grade, and histologic type of the cancer:

  • Stage is a measurement of how far the cancer has spread in the body
  • Grade is a measurement of how aggressive the cancer is
  • Histologic type defines the precise type of cancer. For example, endometrioid is the most common type of endometrial cancer. Other types include papillary serous, clear-cell, and uterine sarcoma.

Stage I Endometrial Cancer

In stage I endometrial cancer, the cancer has not spread beyond the uterus. Some women with stage I cancer may only require surgery. In this case, your doctor will schedule follow-up appointments postsurgery to check for a recurrence or a return of the cancer. This may include physical exams, blood tests, and imaging tests. However, in some stage I cases, the doctor may recommend further treatment. The most common postsurgery treatments for stage I endometrial cancer are vaginal brachytherapy and external beam radiation therapy (also called EBRT or simply “radiation”). If the cancer is determined to be a high grade or more aggressive, chemotherapy may also be prescribed.

Stage II: Surgery plus Treatment

In stage II endometrial cancer, the cancer has spread to the cervix. Much like stage I, after surgery your doctor may recommend some combination of EBRT, vaginal brachytherapy, or chemotherapy. In cases where the tumor is small and slow growing, your doctor may prescribe a hormone therapy.

Hormone therapy is also called “endocrine therapy” and should not be confused with hormone replacement therapy or chemotherapy. Hormone therapies are treatments that manipulate the effect of hormones in some way to interrupt the growth of cancer cells.

Options for Stage III and IV Endometrial Cancer

In stage III endometrial cancer, the cancer has spread to other areas of the body, such as the fallopian tubes, the surface of the uterus, or the lymph nodes. Surgery may be an option.

In stage IV endometrial cancer, the cancer has spread to lymph nodes and organs outside the pelvis. Surgery may still be an option depending on how far the cancer has spread. In some cases, chemotherapy may be recommended before surgery in hope of shrinking the tumor. Whether you undergo surgery or not, your doctor may prescribe either chemotherapy or hormone therapy possibly followed by EBRT and/or vaginal brachytherapy.

Treatments for Endometrial Cancer
External Beam Radiation TherapyA procedure that aims high-energy waves (radiation), much like x-rays, directly at the cancer site.
ChemotherapyDrugs that work by stopping or slowing the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Hormone TherapyA method of treating cancer that blocks or removes hormones in the body. Typically used to treat slow-growing, less-aggressive cancer.
Vaginal BrachytherapyA type of radiation therapy in which radioactive material sealed in seeds, wires, or catheters is placed directly into the vagina to kill cancer cells in that area.
Targeted TherapyA type of cancer treatment designed to “target” specific properties of cancer cells, such as proteins or genetic mutations.
ImmunotherapyA type of cancer treatment that uses the body’s immune system to help fight cancer.

What About Recurrence?

If the cancer comes back after treatment, your doctor will consider many factors before prescribing treatment, such as the location of the recurrence and previously used treatments. If the cancer returns to the pelvic area, also called a “local recurrence,” you may be prescribed EBRT (if you have not previously received EBRT), exploratory surgery, chemotherapy, hormone therapy, or vaginal brachytherapy.

If the cancer returns to other areas of the body outside of the pelvic area, also called a “distant recurrence,” your doctor may prescribe surgery, EBRT or other types of radiation, chemotherapy, hormone therapy, immunotherapy, and/or targeted therapy.

Target Therapy and Immunotherapy

Most recently, targeted therapies and immunotherapies were approved by the US Food and Drug Administration for women with recurrent endometrial cancer. These approvals are good news for women with endometrial cancer and mark the first new treatment options for recurrent endometrial cancer in years. To determine if you are a candidate for these treatments, your doctor will order tests on the cancer cells to check for the presence of certain properties, also called “biomarkers.” If certain biomarkers are present, targeted therapy or immunotherapy may be an option.

YOUR Treatment

It is my sincere hope that you learn everything you can about your treatment options so you can confidently make decisions with your treatment team about your best course of action. If you ever have questions about the disease, the prescribed treatments, or side effects from those treatments, never hesitate to contact your nurse navigator. They are there to help guide and support you.

I am very happy to report the good news of recently approved new treatment options for women with endometrial cancer, but more so, I hope you receive good news from your doctor of a successful treatment.

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