6 Treatment Options for Uterine Cancer

No doctor can tell you how to treat uterine cancer without gathering additional details. A variety of factors play into a person's treatment plan. But rest assured that a number of therapeutic options are available.

We asked medical experts about the most common uterine cancer treatments and how, exactly, they work to combat the disease.

How is uterine cancer treated?

There are a couple of ways to think about how treatment for uterine cancer is determined and delivered.

Your care team

Uterine cancer treatment is "multidisciplinary," says Alison Schram, MD, attending physician in the early drug development and gynecologic medical oncology services at Memorial Sloan Kettering Cancer Center. That means there are typically a lot of different care providers involved in the treatment process, she tells Health.

A person's specific care team depends on the stage of their uterine cancer (meaning, how far the cancer has spread in the body), she explains. Doctors that might be involved in the process include medical oncologists who administer chemotherapy; radiation oncologists who give radiation; and gynecologic surgeons who perform surgery to remove the cancer. Gynecologic surgeons may also administer chemotherapy in place of a medical oncologist.

Your individual treatment plan

When determining a patient's specific treatment plan for uterine cancer, doctors take three things into consideration: the stage of the cancer, the grade (meaning, how aggressive and abnormal the cells look under the microscope), and the histology, or the type of cancer cell, explains Dr. Schram.

As patients discuss uterine cancer treatment options with their doctor, it's important that they understand the goal of the treatment, adds Pamela Soliman, MD, professor and deputy chair of Gynecologic Oncology and Reproductive Medicine at the University of Texas MD Anderson Cancer Center. In some cases, the goal is to cure the cancer; in others, it's to prolong a patient's life or ease their symptoms.

Understanding the goal of uterine cancer treatments is important because it helps patients have realistic expectations, Dr. Soliman tells Health. When discussing uterine cancer treatments with your doctor, be sure to ask about the goal of different options.

What are the treatment options for uterine cancer?

The type of treatment you receive depends on a number of factors. These include the stage and grade of your cancer, says the National Cancer Institute. Here are the main treatment options:

Surgery

In most cases, a hysterectomy (surgery to remove the uterus) is the first treatment given for uterine cancer. Oftentimes, surgeons will remove the uterus as well as the ovaries and either take tissue samples from lymph nodes (a process known as a "biopsy") or remove some of the lymph nodes entirely, says Dr. Schram.

The surgery serves two purposes, Dr. Soliman explains. One is to physically remove the cancer. The other is to "stage" the cancer, or see how far it has spread in the body and understand exactly what type of cancer it is. Staging helps doctors determine if additional treatment is needed after surgery.

In a small number of cases, surgery is performed if the cancer returns to one specific spot. The goal in that setting isn't to cure the cancer, but instead to alleviate symptoms, says Dr. Schram.

Hormone therapy

For some uterine cancer patients, surgery isn't the best option. This includes patients who are diagnosed with low-risk uterine cancer at a young age and still want the option to have children (and thus don't want their uteruses removed), as well as those who are at high-risk of complications from surgery, Dr. Soliman explains. In such cases, hormonal therapy is typically considered instead. Hormone therapy is also considered as a treatment option in patients whose uterine cancer has come back, Dr. Soliman adds.

Hormone-blocking drugs can slow the growth of cancer in patients who have tumors with receptors to the hormones estrogen and progesterone, says NYU Langone Health. Progestins, which are synthetic versions of the hormone progesterone, are the main hormone treatment for endometrial cancer, says the American Cancer Society (ACS).

Chemotherapy

Chemotherapy (chemo) is a type of drug that kills cancerous cells. It's usually administered as a combination of two or more drugs.Oftentimes, chemo is given as an additional therapy after surgery if the findings from surgery reveal that the person is at high risk for the cancer returning, says Dr. Soliman.

In a small number of cases, doctors will give chemotherapy before surgery in order to shrink the cancer and make it easier to remove, says Dr. Schram. Other times, doctors will give chemo to patients whose cancer has spread far enough in their bodies that surgery is no longer a feasible option for removing it all, says Dr. Soliman.

Depending on how far the cancer has spread in the body, chemo may be given with radiation, or a more aggressive chemo regimen may be given by itself. Chemo is also typically given to women whose uterine cancer comes back after their initial treatment, says Dr. Schram.

Radiation

Radiation therapy is a type of treatment that uses beams of energy to kill cancer cells, per the Mayo Clinic.

There are two major kinds of therapy for treating uterine cancer, says Dr. Schram. Intravaginal radiation therapy delivers radiation to the vaginal cuff area (top of the vagina). This form of radiation is used when doctors believe there is a high chance that the cancer could return, specifically in the vaginal cuff area. Extended beam radiation therapy (EBRT), also known as pelvic radiation, delivers radiation to a wider area and is used when doctors believe there is a high chance the cancer could come back to areas outside the vaginal cuff.

Typically, radiation is given after surgery as a form of therapy for both stage 1 uterine cancer (when the cancer is contained to just the uterus) and stage 2 cancer (when the cancer has spread to the area by the cervix).

Sometimes, radiation is used as the first form of treatment for patients who have a higher-risk type of uterine cancer but for whom surgery is not an option, says Dr. Soliman. In some cases, radiation is given if the cancer comes back to one specific spot. The goal in that situation would be to alleviate symptoms, not to cure the cancer, says Dr. Schram.

Immunotherapy and targeted therapy

Immunotherapy is a type of cancer treatment that helps your immune system fight cancer, according to National Cancer Institute (NCI). Targeted therapy, per the NCI, is "a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread."

In July 2021, the US Food and Drug Administration approved a combination of Keytruda (pembrolizumab), which is an immunotherapy, and Lenvima (lenvatinib), a targeted therapy, as a treatment for patients with certain types of advanced endometrial cancers.

Both pembrolizumab and lenvatinib independently work in a small percentage of patients with endometrial cancer, but when given together, they produce a "synergistic" effect, explains Dr. Schram. For patients whose cancer has metastasized (spread from the uterus to distant parts of the body) or whose cancer has come back, the combination of these two therapies plus chemo is typically given as first-line treatment, says Dr. Schram.

Other targeted therapies, such as trastuzumab and bevacizumab, are sometimes used to treat certain types of uterine cancer as well, the American Society of Clinical Oncology points out.

Clinical trials

Through clinical trials, doctors study new ways to treat uterine cancer and improve the quality of life for patients.

Dr. Soliman encourages patients with recurrent uterine cancer to consider enrolling in a clinical trial. "There's definitely a need for more effective treatments in patients with uterine cancer," she explains.