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Uterine Cancer Profiler Main
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The stage and grade of endometrial cancer's development are the important factors in selecting a treatment. The decision depends on both the degree to which the cancer has penetrated the wall of the uterus and the extent to which it has spread beyond it. Younger women with a precancerous 0 stage hyperplasia (see the box on Stages of Endometrial Cancer) who wants to keep their ability to have children, may undergo a D&C combined with progestin treatment. Older women with hyperplasia, who are not concerned about having children, may be advised to have a hysterectomy or removal of the uterus, ovaries and fallopian tubes. Early or advanced stages of uterine cancer are commonly treated with surgery, radiation and sometimes chemotherapy. More extensive surgery is needed to remove various lymph nodes if the disease has spread or was not diagnosed until an advanced stage. Radiation therapy starts after surgery and may be given both internally and externally. Radiation can successfully treat cancer in the peritoneum (the covering of the pelvic organs) or in the ovaries or vagina. It can be combined with hormones and chemotherapy to reach the areas to which the cancer has spread. Chemotherapy is used primarily as palliative therapy, with the goal of shrinking the cancer to help prolong survival and improve quality of life. It does not cure the cancer, and is used in more advanced stages of uterine cancer. Hysterectomy Surgery is usually the first treatment for uterine cancer. A hysterectomy aims to remove all cancerous tissue without spreading cancer cells to other tissues and organs. During the operation, the surgeon removes the uterus usually through an incision in the lower abdomen, but in some cases it can be removed through the top of the vagina (vaginal hysterectomy). Samples of tissue and fluid from the entire pelvic area and any suspicious tissues are analyzed for cancer. Ovaries and fallopian tubes also may be removed to block the production of estrogen, which could stimulate cancer growth. Lymph nodes may also be removed. If all these structures are removed, the surgery is called a "total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO).  Side Effects of Hysterectomy 
Hysterectomy carries significant consequences. When the uterus is removed, a woman no longer menstruates. If the ovaries are left intact, they continue to produce hormones until natural menopause occurs. But if they are removed during hysterectomy, menopausal symptoms such as hot flashes, vaginal dryness, and night sweats will begin. Hormone replacement therapy can prevent or minimize these symptoms. Although sexual function should not be impaired some women describe changes in sexual sensation following a hysterectomy. In some cases, the vagina is slightly shortened.
For many women, a hysterectomy is an emotional issue. Regardless of whether a woman still wants to have children, removal of the uterus can affect her identity as a woman. The effects of a hysterectomy accompanied by removal of the ovaries also may include depression and increased risk of coronary heart disease and osteoporosis.
Recovery from hysterectomy may take between four and six weeks, although some women feel fatigued for longer periods. Hospitalization normally requires three days. Getting out of bed and walking may be a little difficult the day after surgery, but it is important to do so. Vaginal bleeding and discharge for several days is not unusual.
Other possible temporary complications and side effects that may occur with any major surgery are wound infection, post-operative pain, difficulty emptying the bladder or having a normal bowel movement. Depending on the particular patient and the stage of cancer, the physician may prescribe estrogen replacement therapy within weeks or months with progestins to balance the estrogen. Follow-up visits to the doctor may be necessary every three to four months.
It's important to discuss the risks and benefits of the procedure, as well as the long-term consequences, with your doctor.
Radiation Therapy The need to avoid vital organs while removing cancerous tissue limits the extent of any surgery. Radiation is used in treatment of more advanced cancer that has spread beyond the uterus. However, it may also be used in early stages to destroy cancerous cells that are difficult for the surgeon to remove, and has even been used alone in some early-stage patients. Success rates, however, are not as high as surgery. Radiation therapy, which destroys the ability of cells to grow and divide, is most commonly used in combination with surgery, especially for cancers that have grown beyond the uterus. Radiation can be done before or after surgery. Two forms of radiation therapy are employed: brachytherapy (internal radiation), in which radioactive implants are placed directly in the cancerous site, and external radiation, in which a machine directs radiation to the diseased tissue. Brachytherapy destroys less of the healthy tissue around the cancer and causes fewer side effects than external radiation. Radioactive implants are inserted through the vagina, into the area of the cervix and uterus. External radiation can be administered on an outpatient basis and is usually given five days a week for five to six weeks. Internal radiation usually requires a short hospital stay; the implant is left in place for two to three days. In some instances, external radiation therapy is combined with brachytherapy. Side Effects of Radiation Therapy Radiation therapy affects the normal tissues next to the tumor. While the side effects are uncomfortable, they are usually temporary and are controlled with medications. Common side effects include diarrhea, bladder irritation, vaginal irritation, skin reactions and fatigue. In a few patients, urinary and rectal inflammation and fistulas (abnormal passages between organs) may show up months and even years after radiation. Chemotherapy 
Chemotherapy is sometimes used in conjunction with radiation therapy or surgery to improve the management of locally advanced uterine cancer. Chemotherapy is used to reach areas where the cancer is not accessible through surgery and radiation is unable to control. Chemotherapy drugs usually work by interfering with cell division. If a cancer cell can't divide and multiply, it can't grow. Chemotherapy is referred to as "systemic" therapy as the drug(s) travel throughout the body to destroy normal and cancerous cells. Most chemotherapy is given intravenously (IV), but some may be taken by mouth. Intravenous chemotherapy is typically administered in the doctor's office or outpatient clinic. Doxorubicin, cyclophosphamide, cisplatin, carboplatin, 5-FU and paclitaxel are commonly used chemotherapy medications.
Chemotherapy side effects Chemotherapy affects any rapidly dividing cells but can't tell the difference between cancer cells, and normal cells that continuously divide. These tissues include hair follicles and cells lining the inside of the mouth, stomach, and intestines. This is why patients undergoing chemotherapy often have hair loss, mouth sores, nausea, and vomiting. Chemotherapy also temporarily damages the bone marrow where blood and immune system cells are made, making patients more susceptible to infection, bruising, bleeding, and anemia. They may also be quite fatigued, and feel numbness, tingling or burning in their hands and feet. Kidney damage may occur with cisplatin. The side effects listed above are only some of the most common ones. Fortunately, most of these side effects usually resolve and go away once the chemotherapy is completed. Hormonal Treatments Progestational hormones can be used to treat more advanced endometrial cancer and occasionally for the woman with an early stage cancer who wants to preserve her fertility and avoid surgery. Progesterone (or progestin) balances or reduces any estrogen buildup that promotes tumor growth. There are several different progestational hormone drugs available. One called Depo-Provera is given by injection; others can be taken orally. Hormone therapy side effects Hormone therapy with progesterone has few side effects. The medication is generally well tolerated by most women. Mild fluid retention, improved appetite, and weight gain are the most common side effects. Because the impact of these side effects can vary from patient to patient, the physician and patient must work together to monitor the side effects and how they affect the patient's quality of life. Summary of Side Effects If the cancer reaches a late stage, with cancerous growths in many areas of the body, the side effects of treatment added to the effects of the disease, can be difficult to cope with. However, doctors now have a number of strategies that help make therapy much more comfortable:
Any woman suffering from endometrial cancer and the effects of treatment needs a great deal of emotional and medical support. For sources of emotional and social assistance, see the Support And Links For More Information on the About Uterine Cancer page. For relief of physical pain and discomfort, the doctor can draw on a wide variety of medications and therapeutic techniques.
 This content is reviewed regularly. Last Updated 6/6/2007
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