Uterine Cancer Treatments

Uterine cancer treatment typically involves a hysterectomy (surgical removal of the uterus). Your doctor may consider removal of the ovaries and surrounding lymph nodes as well. However, if you are ineligible for a hysterectomy, radiation therapy may be considered instead.

For high-risk uterine cancer, you may have radiation therapy or chemotherapy as a follow-up treatment after the hysterectomy as well. If you are not keen on going through chemotherapy, hormone therapy may be offered instead.

Your healthcare team will work with you to choose a treatment plan that fits your medical and personal needs.

If possible, surgery is the preferred treatment for uterine cancer. If you have stage 1 uterine cancer, a hysterectomy may be the only treatment required.

The most common surgery is total hysterectomy combined with bilateral salpingo-oophorectomy, which removes the uterus, the cervix and both tubes and ovaries. Note that you will no longer be able to have a child after this procedure.

Learn more: Hysterectomy

Radiation therapy uses high-energy waves similar to x-rays to kill cancer cells. It’s also commonly used to treat uterine cancer. In external beam radiation therapy (EBRT), a machine will be used to direct radiation at the tumor, passing through skin and other tissues in your body to reach it. The treatment can take 5 to 6 weeks to complete.

Chemotherapy is usually delivered by infusion, and will be slowly injected into the bloodstream through a vein. They are often prescribed in cycles, which include a few days of treatment, followed by a few days of rest. For advanced uterine cancer, a combination of carboplatin and paclitaxel is the most common chemotherapy option.

Learn more: Chemotherapy for Uterine Cancer

If you wish to have children in the future, hormone therapy may be considered. Doing just hormone therapy will allow you to keep your uterus. Preservation of the uterus should only be considered in early stage, grade I cancers. The oncologist will be able to guide you with this management. Advanced or recurring uterine cancer may occasionally be treated with hormone therapy.

Available options include progestins (e.g. Provera) and progestin-releasing intrauterine contraceptive devices (IUCDs) such as Mirena.

Learn more: Hormone Therapy for Uterine Cancer: Progestins and Other Options

Targeted therapy and immunotherapy are newer types of systemic therapy. If uterine cancer does not respond to chemotherapy, returns after treatment, or spreads beyond the uterus, these options may be considered. They are most effective when specific biomarkers of the cancer can be identified.

For instance, HER2-directed therapy with trastuzumab given in combination with carboplatin/paclitaxel is an option for treating advanced or recurrent HER2-positive uterine serous carcinoma and carcinosarcoma. Other examples include:

• Trastuzumab deruxtecan (T-DXd): HER2-directed antibody-drug conjugate that can be used in selected advanced/recurrent HER2-positive endometrial cancers after prior therapy.
• Lenvatinib: An antiangiogenic targeted agent, most notably used in combination with pembrolizumab in appropriate advanced/recurrent endometrial cancer.

For dMMR/MSI-H cancers, immune checkpoint inhibitors such as pembrolizumab may be used as immunotherapy. Although these medicines are not considered conventional “targeted therapies,” molecular testing for biomarkers such as dMMR/MSI-H plays an important role in determining whether a patient may be eligible for this type of treatment.