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Cancer of the Uterus

  • Posted: 10/25/2010

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Treatment

Surgery
Radiation Therapy
Chemotherapy
Hormone Therapy

Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:

  • Whether the tumor has invaded the muscle layer of the uterus
  • Whether the tumor has invaded tissues outside the uterus
  • Whether the tumor has spread to other parts of the body
  • The grade of the tumor
  • Your age and general health

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat uterine cancer include gynecologists, gynecologic oncologists (doctors who specialize in treating female cancers), medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on NCI’s Web site at http://www.cancer.gov/cancertopics/coping.

Also, NCI’s Cancer Information Service can answer your questions about supportive care. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI’s instant messaging service.

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of uterine cancer. See the Taking Part in Cancer Research section.

You may want to ask your doctor these questions before you begin treatment:

  • What is the grade of the tumor? What is the stage of the disease? Has the tumor invaded the muscle layer of the uterus or spread to other organs?
  • What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be a good choice for me?
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for women with uterine cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.

The surgeon usually removes the uterus, cervix, and nearby tissues. The nearby tissues may include:

  • Ovaries
  • Fallopian tubes
  • Nearby lymph nodes
  • Part of the vagina

The time it takes to heal after surgery is different for each woman. After a hysterectomy, most women go home in a couple days, but some women leave the hospital the same day. You’ll probably return to your normal activities within 4 to 8 weeks after surgery.

You may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.

It’s common to feel tired or weak for a while. You may have nausea and vomiting. Some women are constipated after surgery or lose control of their bladder. These effects are usually temporary.

If you haven’t gone through menopause yet, you’ll stop having menstrual periods after surgery, and you won’t be able to become pregnant. Also, you may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your doctor or nurse about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.

Surgery to remove lymph nodes may cause lymphedema (swelling) in one or both legs. Your health care team can tell you how to prevent or relieve lymphedema.

For some women, a hysterectomy can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.

You may want to ask your doctor these questions before having surgery:

  • What type of surgery do you recommend for me? Why?
  • Will lymph nodes and other tissues be removed? Why?
  • How will I feel after surgery? If I have pain, how can it be controlled?
  • How long will I be in the hospital?
  • When will I be able to return to normal activities?
  • What are the long-term effects of the surgery?
  • How will the surgery affect my sex life?

Radiation Therapy

Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can’t have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:

  • External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
  • Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. Usually, a treatment session lasts only a few minutes and you can go home afterward. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.

Side effects depend mainly on which type of radiation therapy is used, how much radiation is given, and which part of your body is treated. External radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, your skin in the treated area may become red, dry, and tender.

You are likely to become tired during external radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

For women who have not had surgery to remove the ovaries, external radiation aimed at the pelvic area can harm the ovaries. Menstrual periods usually stop, and women may have hot flashes and other symptoms of menopause. Menstrual periods are more likely to return for younger women.

After either type of radiation therapy, you may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait to have sex until a few weeks after radiation therapy ends.

Also, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.

Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.

You may find it helpful to read the NCI booklet Radiation Therapy and You.

You may want to ask your doctor these questions about radiation therapy:

  • Why do I need this treatment?
  • Which type of radiation therapy do you suggest for me?
  • When will the treatments begin? When will they end?
  • Will I need to stay in the hospital?
  • How will I feel during treatment?
  • How will radiation therapy affect my sex life?
  • How will we know if the radiation treatment is working?
  • Will I have any long-term side effects?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can’t be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for uterine cancer is usually given by vein (intravenous). It’s usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in an outpatient part of the hospital, at the doctor’s office, or at home. Some women may need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Other possible side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

You may wish to read the NCI booklet Chemotherapy and You.

Hormone Therapy

Some uterine tumors need hormones to grow. These tumors have hormone receptors for the hormones estrogen, progesterone, or both. If lab tests show that the tumor in your uterus has these receptors, then hormone therapy may be an option.

Hormone therapy may be used for women with advanced uterine cancer. Also, some women with Stage I uterine cancer who want to get pregnant and have children choose hormone therapy instead of surgery.

The most common drug used for hormone therapy is progesterone tablets. Possible side effects include weight gain, swelling, and breast tenderness.

You may want to ask your doctor these questions about chemotherapy or hormone therapy:

  • Why do I need this treatment?
  • Which drug or drugs will I have?
  • How do the drugs work?
  • When will treatment start? When will it end?
  • How will I feel during treatment? What are the side effects? Are there any lasting side effects? What can I do about them?

This text may be reproduced or reused freely. Please credit the National Cancer Institute as the source. Any graphics may be owned by the artist or publisher who created them, and permission may be needed for their reuse.