Cancer involves abnormal cells growing uncontrollably, invading nearby tissues, and spreading to other parts of the body through metastasis.
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The primary treatment for endometrial cancer is surgery. For the vast majority of patients, this involves a Total Hysterectomy (removal of the uterus and cervix) and Bilateral Salpingo-Oophorectomy (removal of both fallopian tubes and ovaries). Removing the ovaries is crucial because they are the source of estrogen that may be driving the cancer, and because cancer cells can sometimes spread there.
In modern gynecology, this surgery is predominantly performed via Minimally Invasive Surgery (MIS), using Laparoscopic or Robotic-assisted techniques (like the Da Vinci system). Compared to traditional open abdominal surgery (laparotomy), MIS results in significantly less blood loss, less pain, shorter hospital stays (often same-day discharge), and faster recovery. Open surgery is generally reserved for patients with very large uteruses or widespread cancer that cannot be removed through small incisions.
During the surgery, the surgeon also performs the lymph node assessment (Sentinel Lymph Node biopsy or complete dissection) and washes the abdominal cavity with fluid (peritoneal washings) to check for floating cancer cells. Although positive washings no longer strictly upstage the cancer in the new FIGO system, they still provide prognostic information.
After surgery, the pathology report guides the need for additional treatment (adjuvant therapy). For patients with cancer confined to the uterus but with intermediate risk factors (like deep invasion or higher grade), Vaginal Brachytherapy (VBT) is often recommended. VBT involves placing a cylinder inside the vagina to deliver radiation directly to the vaginal cuff (the top of the vagina where the uterus was attached). This kills any remaining microscopic cells at the surgical closure site, which is the most common site of recurrence. It has few side effects because the radiation doesn’t penetrate deep into the bladder or rectum.
For higher-risk disease (Stage III, or Stage I with aggressive histology), External Beam Radiation Therapy (EBRT) may be required. This treats the entire pelvis, including the lymph node areas. EBRT is more intensive and carries higher risks of side effects like bladder irritation or diarrhea. Intensity-Modulated Radiation Therapy (IMRT) is a modern technique that shapes radiation beams precisely to target high-risk areas while sparing healthy organs, thereby reducing toxicity.
Chemotherapy is indicated for patients with advanced-stage disease (Stage III/IV) and for those with high-risk histologies (Serous, Clear Cell, Carcinosarcoma) even at early stages. The goal is to treat systemic micrometastases that are outside the radiation field.
The global standard regimen is the combination of Carboplatin and Paclitaxel. These drugs are typically given intravenously every three weeks for six cycles. Carboplatin is an alkylating agent that damages DNA, while Paclitaxel attacks the cell’s structural skeleton (microtubules).
For patients with very advanced or recurrent disease who cannot tolerate combination therapy, single-agent therapy may be used. A “sandwich” method is sometimes employed for high-risk patients, consisting of chemotherapy cycles, followed by radiation, followed by more chemotherapy, aiming to maximize both local and distant control. Side effects like neuropathy (nerve damage) and hair loss are managed with supportive care.
The treatment landscape for advanced and recurrent endometrial cancer has been revolutionized by immunotherapy. For tumors that are Mismatch Repair Deficient (dMMR) or MSI-High, the immune checkpoint inhibitor Pembrolizumab (or Dostarlimab) has shown remarkable efficacy. These tumors have many mutations, making them “visible” to the immune system. The drug removes the “mask” the cancer uses to hide, allowing T-cells to attack. Responses can be durable, lasting for years.
For tumors that are Mismatch Repair Proficient (pMMR), which are harder to treat with immunotherapy alone, a combination of Pembrolizumab and Lenvatinib (a tyrosine kinase inhibitor) is approved. Lenvatinib blocks blood vessel growth (VEGF) and other growth pathways, making the tumor more vulnerable to the immunotherapy.
For HER2-positive serous carcinomas, the addition of Trastuzumab (a monoclonal antibody targeting HER2) to chemotherapy has been shown to improve survival. This highlights the importance of molecular profiling for every advanced case to identify these targetable vulnerabilities.
For young women with Grade 1 early-stage cancer who wish to preserve fertility, surgery can be delayed. High-dose Progestin therapy (such as Megestrol Acetate or a Levonorgestrel-releasing IUD) is used to reverse the cancer. Progesterone thins the lining and causes the cancer cells to mature or die.
Patients undergo biopsies every 3 months. If the cancer resolves, they can attempt pregnancy. Once childbearing is complete, a hysterectomy is recommended because the recurrence risk is high.
Hormonal therapy is also used palliatively for slow-growing, low-grade recurrent cancer in older women who cannot tolerate chemo. Aromatase inhibitors or Tamoxifen/Progestin combinations can suppress tumor growth for prolonged periods with minimal side effects, focusing on quality of life.
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If your ovaries are removed (oophorectomy) and you have not yet gone through menopause, you will enter surgical menopause immediately. This causes a sudden drop in estrogen, leading to hot flashes and other symptoms. If you were already postmenopausal, you will not experience a new onset of menopause symptoms, though some hormonal shifts can still occur.
The Sandwich method is a treatment protocol used for high-risk endometrial cancer. It typically involves giving three cycles of chemotherapy, followed by radiation therapy to the pelvis, followed by three more cycles of chemotherapy. This aims to attack distant cells (chemo) and local cells (radiation) comprehensively.
Yes. In fact, robotic surgery is often preferred for patients with obesity. The robotic instruments allow for precise movements in tight spaces, and the small incisions heal much better than a large open cut, significantly reducing the risk of wound infections and hernias, which are common complications in patients with higher BMI.
Lenvatinib is a potent oral drug. Common side effects include high blood pressure, fatigue, diarrhea, and loss of appetite. It can also cause soreness in the mouth and hands. Close monitoring is needed so the dose can be adjusted to keep these side effects manageable while keeping the cancer under control.
Yes, for early, low-grade disease. The IUD releases a high concentration of progestin directly into the uterine lining. This thins the endometrium and can reverse hyperplasia and early cancer. It has fewer systemic side effects than oral high-dose progesterone pills.
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