Treatment

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During surgery to remove the uterus, the surgeon will determine the stage of the cancer. The most common treatment is a total abdominal hysterectomy, in which the uterus, fallopian tubes, ovaries and lymph nodes in which the tumor commonly spreads. Other therapies—radiation, chemotherapy and hormone therapy—may also be used to treat this form of the disease.

• Hysterectomy is major surgery requiring several days in the hospital, depending on the type of surgery performed. Depending on the stage of your cancer, you may have a total hysterectomy, which involves removal of the whole uterus and cervix, or a radical hysterectomy, which involves removal of tissue surrounding the uterus in addition to the uterus and cervix.

  For several days after surgery, you may have problems emptying your bladder and having normal bowel movements. Normal activities, including sex, can be resumed in about four to six weeks.

  After a hysterectomy, you no longer have menstrual periods. If your ovaries are removed before menopause, you will immediately enter menopause, and usually experience significant menopausal symptoms, including hot flashes and vaginal dryness. Talk to your health care professional about whether you can take supplemental hormones to help reduce any symptoms.

• Radiation therapy: This involves the use of high-dose x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (called external radiation) or from implanting materials that produce radiation (radioisotopes) through thin plastic tubes into the cancerous area (called internal radiation or brachytherapy). Radiation is sometimes used after surgery depending on the extent of the cancer. If you're unable to have surgery, or the disease is too advanced for surgery, radiation may be the only treatment offered.

  During radiation therapy, you may notice a number of side effects. These include skin reactions (redness or dryness) in the area being treated, tiredness, diarrhea and frequent and uncomfortable urination. Treatment can also cause dryness, itching and burning in the vagina. Sex may be painful, and some women are advised not to have sexual relations during treatment. All symptoms should disappear once treatment ends, and most women can resume sexual activity within a few weeks.

• Chemotherapy: Chemotherapy uses drugs to kill cancer cells. The drugs are typically infused through your veins, traveling throughout your body. They're designed to kill all rapidly growing cells, both cancer cells and healthy cells. Chemotherapy is used in the treatment of endometrial cancer, particularly if it's spread beyond the endometrium, or if it is a very aggressive form of cancer. If chemotherapy is part of your treatment, you will likely be given a combination of drugs, because combination chemotherapy is often more effective than one drug alone. Chemotherapy drugs used to treat endometrial cancer may include either doxorubicin (Adriamycin), cisplatin (Platinol-AQ), paclitaxel (Taxol) or carboplatin (Paraplatin).

  Loss of appetite can be a serious problem for women receiving radiation therapy or chemotherapy. Yet nutrition is important, since it helps you withstand the side effects of treatment. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. If you have trouble eating right during your treatment, try several small meals throughout the day instead of three large meals.

  The side effects of cancer therapies vary from person to person and from one treatment to the next. Your health care professional will plan your treatment to minimize any side effects. Also remember that most side effects are temporary. Still, it's important to tell your health care professional about any reactions and side effects because he or she may be able to adjust treatments and/or prescribe other options to help you feel better.

• Hormone therapy: This form of therapy involves the use of female hormones, typically progesterone-like drugs called progestins, to slow the growth of endometrial cancer cells. The two most commonly used progestins for treating endometrial cancer are medroxyprogesterone (Provera) and megestrol acetate (Megace).

Depending on the extent of the cancer, a hysterectomy may be performed. A total abdominal hysterectomy in which the uterus, the fallopian tubes and the ovaries are removed through an incision in the abdomen, may be recommended. Lymph nodes in the pelvis may also be removed.

Note: The FDA has issued a "black box warning" for Provera, warning that prolonged use of the drug may result in significant loss of bone density, and that the loss is greater the longer the drug is administered. Other side effects of progestins include nausea, vomiting, mild shortness of breath, weakness, hot flashes, menstrual bleeding, decreased sex drive and others.

The anti-estrogen drug Tamoxifen, which is most often used to treat breast cancer, may also be used to treat advanced stage or recurrent endometrial cancer. Tamoxifen works to prevent estrogens circulating in your body from stimulating the growth of cancer cells. Side effects of Tamoxifen include blood clots, endometriosis, stroke, fertility issues and thinning of hair and nails.

Most women with endometrial cancer have their ovaries removed as part of treatment, or their ovaries destroyed with radiation, which reduces estrogen production and may slow the growth of the cancer.

Regular follow-up exams are very important for any woman who has been treated for cancer of the uterus. The health care professional will want to watch you closely for several years to be sure that the cancer has not returned. Most follow-up examinations include a regular pelvic exam and a chest x-ray.

When uterine cancer is caught early, the treatment is quite effective and chances of recurrence are small. The likelihood of recurrence goes up relative to the stage of the cancer.

If uterine cancer does recur, it's likely to happen in the first three years after the initial treatment. The best chance of a cure is if the disease reoccurs in the vagina or is seen during a pelvic exam. That's why you should have a pelvic exam every three months for the first two years after hysterectomy.

Recurrence can also occur in an organ distant from the uterus (due to cancer cells that remained after the initial treatment).

Treatment for recurrent uterine cancer depends on the amount and the location of the cancer. If it is only in the pelvis, radiation therapy alone may be enough, curing about 60 percent of recurrences found in the vagina. More extensive recurrences may require hormonal therapy or chemotherapy.

Low-grade cancers that contain progesterone receptors are more likely to respond well to hormone therapy than higher grade cancers, which respond better to chemotherapy. If you are diagnosed with recurrent uterine cancer, you may also want to consider participating in clinical trials of new treatments.