Uterine Cancer Treatment Options

Uterine cancer is also called endometrial cancer. Doctors most often treat it with surgery. The surgery removes the uterus. Doctors call this a hysterectomy. For early-stage cancer, this often cures the disease by itself. Your team may add more treatment, depending on the stage. That can mean radiation, chemotherapy, hormone therapy, targeted therapy, or immunotherapy.

The main surgery is a total hysterectomy. It removes the uterus and cervix. Surgeons can do this through the vagina, through the abdomen, or with small laparoscopic tools. They usually also remove both ovaries and both fallopian tubes at the same time. Doctors call this a bilateral salpingo-oophorectomy. Surgeons often check nearby lymph nodes too. They remove some and send them to a lab. This shows whether cancer cells have spread beyond the uterus. Some cancers need a wider operation instead. This is called a radical hysterectomy. It also removes part of the vagina.

Recovering from this surgery usually takes a few weeks. Removing the ovaries brings on menopause right away, if you had not reached it already. That can cause hot flashes and other symptoms. Ask your team what to expect and how to manage them.

After surgery, a pathologist grades the cancer. Grades run from 1 to 3, based on how the cells look. Grade 1 and grade 2 tumors are usually low-risk. Grade 3 tumors are usually high-risk. So are certain cell types, such as papillary serous, clear cell, or carcinosarcoma. Grade and stage together shape what comes next.

For low-risk, early-stage cancer, surgery alone may be enough. Some people also get radiation. It can be given inside the vagina or from outside the body. The goal is to lower the chance the cancer returns. For high-risk, early-stage cancer, treatment often adds more. That can mean chemotherapy, radiation, or both, given after surgery.

For cancer that has spread widely, or come back, treatment usually starts with chemotherapy. In recent years, immunotherapy has joined that first treatment for many people. Two drugs, pembrolizumab and dostarlimab, are now combined with chemotherapy. That combination runs for about six months. After that, the immunotherapy drug continues alone. This can last one to three years.

This combination works best for one group: cancers with a change called dMMR. That stands for deficient mismatch repair. These cancers carry many small DNA errors. The errors make abnormal proteins the immune system can spot. Immunotherapy then helps the immune system attack the cancer.

The results have been strong for this group. In one large trial of dostarlimab, 61% of people with dMMR cancer had no cancer growth at two years. Only 16% of people on chemotherapy alone reached that mark. A separate trial tested pembrolizumab. There, 74% of people with dMMR cancer had no cancer growth at one year. Only 38% of people on chemotherapy alone did. People without dMMR still benefit, but less clearly. Researchers are still studying how much this combination helps them over time.

Hormone therapy is an option for some uterine cancers. It tends to fit slower-growing cancers best. It is also used for people who cannot have surgery or chemotherapy. Targeted therapy is another option in some cases. This includes the mTOR inhibitors everolimus and ridaforolimus, and the antibody bevacizumab. These drugs block specific signals that help the cancer grow. That is different from chemotherapy, which attacks all fast-growing cells.

Uterine cancer found early is often cured. Stage, grade, cell type, and how your body responds to treatment all affect the outlook. No single number can tell you what will happen in your case. Your care team is best placed to talk through what your own results mean.

Ask your team the grade and stage of your cancer. Ask whether it counts as low-risk or high-risk. Ask whether your tumor has been tested for dMMR or MSI-H. That result can open up immunotherapy. Ask what side effects to expect from each treatment, and whether a clinical trial fits your situation. Ask what symptoms — such as unusual bleeding, pain, or swelling — should prompt a call to your team between visits.

• NCI — Endometrial Cancer Treatment (PDQ®) Patient Version
• NCI Cancer Currents — Immunotherapy Approved for Advanced, Recurrent Endometrial Cancer