Endometrial cancer treatment by stage
The treatment of endometrial cancer depends on the stage and the specific pathology type of the disease at the time of diagnosis. Surgery is generally considered for this disease, and the majority of patients undergo surgery to remove the uterus and cervix
up front. In early stages, minimally invasive surgery may be the only treatment required. In later stages, more involved and extensive surgeries to remove disease outside the uterus and cervix may be required, in combination with chemotherapy and
- If you are diagnosed with stage I endometrial cancer, surgery to remove the cancerous tumor may be the only treatment necessary. During surgery, your uterus and cervix, and generally both ovaries and fallopian tubes, may be removed. A biopsy
of your lymph nodes may also be performed to check for cancer cells. Based on the pathology of surgically removed tissues and radiology results, other therapies may be suggested in addition to surgery, such as radiation therapy or chemotherapy.
Certain types of uterine cancer pathologies, such as clear cell and serous, even if diagnosed at an early stage, may require other treatment after surgery. Your doctor will carefully monitor your health for new growths (called watchful waiting).
- If you are diagnosed with stage II endometrial cancer, surgery to remove your uterus and cervix, and generally both ovaries and fallopian tubes, is the first step. Depending on your case, radiation therapy could follow your surgery to eliminate
any remaining cancer cells. Chemotherapy may be necessary if certain pathologies such as clear cell and serous are diagnosed.
- If you are diagnosed with stage III endometrial cancer, you will likely receive a combination of surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes, followed by radiation and, if necessary, chemotherapy.
- If you are diagnosed with stage IV endometrial cancer, surgery to remove your uterus, ovaries, fallopian tubes, and lymph nodes is not always required. Instead, chemotherapy, hormonal therapies, immunotherapy, and clinical trials (and sometimes
radiation therapy) will be discussed.
Our surgical team is recognized internationally as one of the best for the treatment of gynecologic cancers, and consistently ranks as one of the top in the country for surgical care. We perform over 1,500 gynecologic surgeries each year, so our patients
can be reassured they will receive the highest level of surgical care from one of the most experienced teams available.
Surgery is performed to determine the stage of cancer, and this may be adequate treatment if you have early-stage endometrial cancer. Surgery generally includes:
- Removal of the uterus and the cervix (hysterectomy)
- Removal of both of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
- Taking a small sample of your sentinel lymph nodes or tissue (biopsy) to examine for cancerous cells under a microscope
Gynecological oncologists at Dana-Farber/Brigham and Women's Cancer Center use the most advanced technology available to perform surgery with exacting precision. Our skilled surgeons regularly perform leading-edge, minimally-invasive surgeries, such as:
- Laparoscopy: A procedure performed through small incisions in the abdomen, rendering more extensive surgeries unnecessary
- Robot-assisted hysterectomy: Robot-assisted hysterectomy may be the best option for certain patients who are not candidates
for traditional surgery. Your physician can help determine if robot-assisted surgery is right for you.
Endometrial cancer in younger patients
Removing your uterus will affect your fertility and ability to have children in the future. Most endometrial patients are diagnosed later in life and are less concerned with fertility preservation. However, if you are diagnosed with an advanced stage
of endometrial cancer requiring surgery and would still like to have children, we will carefully review your treatment and surgery options before and after treatment. We will work with you to customize the best surgical approach that strives to maintain
good pregnancy outcomes later on. DF/BWCC has dedicated reproductive and fertility specialists who can discuss all fertility concerns before and after treatment, as well as options to consider, such as embryo (egg) freezing or harvesting.
Surgery takes place in the operating suites at Brigham and Women's Hospital, whose gynecologic cancer program is widely recognized as one of the best in the country. Post-surgical care and other inpatient care are provided by the DF/BWCC team either at
Brigham and Women's Hospital or at Dana-Farber's Inpatient Hospital located within Brigham and Women's Hospital.
Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and
fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are
done using a low transverse incision or a vertical incision.
After surgery, your surgical samples are carefully examined by pathology experts in the Women's and Perinatal Pathology Division. Their evaluation will be shared with all members of the gynecologic oncology program, including your treatment team, in a
weekly tumor board meeting where further treatment (if necessary) and management of your tumor will be decided.
post-operative guidelines for gynecologic surgery.
Learn about strategies and tips for
recovering from your hysterectomy.
Systemic therapies (chemotherapy, hormonal therapy, immunotherapy)
Sometimes treatment involves chemotherapy (drugs that eliminate cancer cells or stop them from dividing), hormonal therapy (a treatment that blocks the action of naturally occurring hormones), or immunotherapy (a treatment that boosts your immune system’s
ability to fight cancer). Sometimes treatment will involve clinical trials. Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Chemotherapy, hormonal therapy,
and immunotherapy are provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient centers in the country — designed
by patients, for patients.
Chemotherapy for endometrial cancer is generally reserved for stages III and IV (as needed) unless certain pathologies of uterine cancer are diagnosed, including uterine carcinosarcomas, clear cell cancers, or serous cancers. Chemotherapy drugs are usually
administered after surgery to eliminate remaining cancer cells or keep them from returning. On occasion, chemotherapy drugs will be given as supplemental treatment to radiation therapy (called "radiation sensitizing" chemotherapy) that can help make
the radiation work better.
Throughout your treatment, your medical oncologist will work closely with your team of nurses, nutritionists, and social workers to minimize the toxicities and side effects of chemotherapy, maintain your quality of life, and optimize your results. We
encourage you to be actively involved in the decision-making process when it comes to choices about chemotherapy treatment.
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to eliminate cancer cells or stop cancer growth. Radiation therapy for endometrial cancer is given by our experienced team of radiation oncologists. They
are pioneers in the field, regularly setting standards for treatment and safety nationwide. Our experts administer radiation in a dedicated-radiation suite built specifically for gynecologic patients. This suite features state-of-the-art equipment
and the latest imaging techniques to treat your endometrial cancer.
Radiation therapy may be delivered at any stage of endometrial cancer to eliminate any remaining cancer cells in the body or lymph nodes after surgery. Occasionally, radiation therapy is given in early stages or in complex cases where the cancer is spreading
throughout the body. Recurrent cases of endometrial cancer (cancer that has returned after initial treatment) are treated with radiation as a potentially curative treatment or palliative therapy to relieve symptoms and improve quality of life.
Radiation treatment for endometrial cancer could include the following:
brachytherapy or cylinder brachytherapy, radioactive material is directly implanted in or near the tumor or vagina via a tiny needle, wire, or other device. Our radiation oncologists at DF/BWCC
are among a limited few in the nation to deliver this type of radiation with image-guided techniques.
- DF/BWCC is one of the few treatment centers in the U.S. to offer image-guided brachytherapy using real-time, 3D imaging as an alternative to surgery or non-image-guided radiation for some patients with endometrial cancers. This technique offers many
benefits, including preservation of healthy tissue, prevention of unnecessary hysterectomies, and better eradication outcomes. Given our advanced radiation technologies, patients with recurring endometrial cancer or cancer deemed incurable can
now be treated with radiation — and with more success.
- 3D imaging radiation therapy called intensity-modulated radiation therapy (IMRT) uses computer images to find and target the cancerous tumor. Radiation is externally delivered and aimed at the tumor, firing thin radiation beams from different angles.
This reduces the damage to the surrounding healthy tissue.
- Our physicians developed an innovative approach for providing radiation therapy called fractionation, a series of lower-dose radiation primarily given to endometrial patients who have had their uterus removed. This process results in better outcomes,
less scar tissue, and a lower risk of vaginal toxicity.
- Radiation oncologists at DF/BWCC are currently pioneering therapies using gel spacers with great success. Radiation therapy is delivered to a targeted location while using a gel spacer, a small, removable sponge-like material injected with gel, strategically
placed inside the body to block radiation from nearby healthy tissue or surrounding organs.
Revolutionary imaging therapies
For cases of endometrial cancer that require complex imaging treatment, you will be cared for in an innovative operating and research environment developed specifically at Brigham and Women's Hospital (BWH) in 2011. Called the
Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists,
biomedical engineers, nurses, and technologists uses the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI, and OR technologies in one operating room. BWH
is one of the few hospitals in the United States to operate an AMIGO suite.
DF/BWCC offers one of the largest and most active clinical trial programs available, including clinical trials for patients with endometrial cancer. The clinical trials conducted at Dana-Farber have had a profound
impact on the type of care administered worldwide.
Clinical trials for endometrial cancer may be available at any stage of the disease. However, for some people with advanced stages of endometrial cancer, taking part in a clinical trial is the best treatment option. The genetics of endometrial cancer
are better understood than other gynecologic cancers, so there are a number of clinical trials testing therapies that target specific genetic pathways (the paths that lead to cancer on a cellular level). If you qualify for a clinical trial, your doctor
will carefully discuss all options and the best time to begin a trial (before, during, or after cancer treatment).
Clinical trials are part of the cancer research process; they are regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials have meaningful anti-cancer benefits, they can also lead
to new discoveries and improve cancer care.
Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer. Trials also include targeted therapies that attack the specific vulnerabilities in cancer cells.
Find out more about clinical trials at DF/BWCC. Detailed information about clinical trials is available from the NCI Web site. For all nationally run
clinical trials, please visit ClinicalTrials.gov.
Read about clinical trials studying new approaches to how endometrial cancer is treated.
Questions to ask your doctor about clinical trials
If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.