The primary surgery for uterine cancer is a total hysterectomy with bilateral salpingo-oophorectomy. The uterus is removed along with both ovaries and fallopian tubes and sometimes the pelvic and para-aortic lymph nodes. Traditionally, a hysterectomy is done through an up and down incision in the abdomen. Minimally invasive techniques such as laparoscopy and robotic surgery have recently become options for this surgery.
Some uterine cancer patients may undergo a lymphadenectomy, or lymph node dissection. Lymph nodes are removed from the pelvic area and examined for the presence of cancerous cells, helping doctors determine the exact stage and grade of the cancer.
Learn about minimally invasive surgery for gynecologic cancer:
Radiation therapy may be used to treat uterine cancer after a hysterectomy or in rare situations as the primary treatment when surgery is not an option. Depending on the stage and grade of the cancer, radiation therapy may also be used at different points of treatment.
There are two types of radiation therapy and in some uterine cancer cases, both types are given.
- External beam radiation involves a series of radioactive beams precisely aimed at the tumor from outside the body. Intensity-modulated radiation therapy and proton therapy are examples of external beam radiation. Patients generally undergo daily outpatient treatments five days a week for four to six weeks, depending on the treatment plan.
- Brachytherapy involves tiny radioactive seeds that are inserted through the vagina into the uterus wherever cancer cells are located. The seeds remain in place for two to three days and then removed. Depending on your cancer, several treatments may be needed. Because brachytherapy delivers radiation to a localized area, there is little effect on nearby structures such as the bladder or rectum.
Chemotherapy may used after surgery for some uterine cancers. Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit using systemic chemotherapy. The drugs enter the bloodstream and can reach cancer cells throughout the body.
Chemotherapy is often used if the uterine cancer recurs or has spread.
The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have receptors where hormones can attach, drugs can be used to reduce the production of hormones or block them from working. Uterine cancers often grow in the presence of estrogen. This is why obesity is a risk factor for uterine cancer. Fat turns cholesterol into an estrogen, thus the more fat in the body the more estrogen that can cause uterine cancer to grow.
In hormone therapy, progesterone-like drugs known as progestins, which block the effect of estrogen, can be used to slow the growth of cancer cells.