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 stage 3 and 4 endometrial cancer. Treatments offered for stage 4 endometrial carcinoma are to control the disease and relieve the symptoms it is causing.

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.

Surgery is the main treatment for stage 3 endometrial carcinoma. The type of surgery is a total hysterectomy or a radical hysterectomy and removal of lymph nodes in the pelvis and around the aorta. The surgeon may also remove the omentum and biopsy any abnormal tissues inside the abdomen at the time of surgery.

Tumour debulking means removing as much of the tumour as possible. It may be offered for stage 4 endometrial carcinoma when the cancer has spread throughout the pelvis (called extensive pelvic disease) or upper abdomen. Tumour debulking is done to help relieve pain and symptoms caused by the tumour.

You may be offered radiation therapy for advanced stage endometrial carcinoma. You may be given external beam radiation, brachytherapy or both. Radiation therapy may be given:

• if you cannot have surgery because of other medical problems
• after surgery to treat extensive pelvic disease
• to manage symptoms such as controlling heavy vaginal bleeding
• before surgery in certain cases

You may be offered hormonal therapy for stage 3 endometrial carcinoma if you can't have surgery or radiation therapy. Hormonal therapy may also be used to help relieve the symptoms of distant metastases in stage 4 endometrial carcinoma.

The main types of hormonal therapy used are megestrol (Megace, Apo-megestrol, Nu-megestrol, Lin-megestrol) and medroxyprogesterone (Provera). Other hormonal therapies used to treat endometrial carcinoma include:

• anastrozole (Arimidex)
• letrozole (Femara)
• exemestane (Aromasin)
• tamoxifen (Nolvadex, Tamofen)
• goserelin (Zoladex)
• leuprolide (Lupron, Lupron Depot, Eligard)

You may be offered chemotherapy after surgery for stage 3, high-grade endometrial carcinoma such as serous adenocarcinoma or clear cell adenocarcinoma. Advanced stage carcinosarcoma may also be treated with chemotherapy after surgery. The chemotherapy drugs used to treat stage 3, high-grade endometrial carcinoma or carcinosarcoma are the same ones used to treat earlier stages. Chemoradiation or sandwich therapy may be given, similar to treatment for early stage, high-grade endometrial carcinoma or carcinosarcoma.

You may be offered chemotherapy for stage 4 endometrial carcinoma to help relieve the symptoms of distant metastases. The combinations of chemotherapy used include:

• cisplatin and doxorubicin (Adriamycin), with or without paclitaxel
• carboplatin and paclitaxel
• carboplatin and docetaxel (Taxotere)

Pembrolizumab (Keytruda) is an immunotherapy drug that helps strengthen or restore the immune system's ability to find and destroy cancer cells. Lenvatinib (Lenvima) is a targeted therapy drug that targets specific molecules (for example, proteins) inside cancer cells or on their surface.

You may be offered pembrolizumab combined with lenvatinib for advanced endometrial carcinoma that:

• is not microsatellite instability high (MSI-H) or mismatch repair deficient (dMMR)
• does not respond to treatment with platinum-based chemotherapy
• can't be treated with surgery or radiation therapy

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.