Methods of Treatment

Most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormone therapy or chemotherapy. Another treatment option for women with uterine cancer is to take part in treatment studies (clinical trials). Such studies are designed to improve cancer treatment. (See Treatment Studies for more information.) The following sections describe types of uterine cancer treatment.

Surgery to remove the uterus (hysterectomy) and the fallopian tubes and ovaries (bilateral salpingo-oophorectomy) is the treatment recommended for most women with uterine cancer. Lymph nodes near the tumor may also be removed during surgery to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the disease can usually be cured with surgery alone.

These are some questions a woman may want to ask the doctor before having surgery:

• What kind of operation will it be?

• How will I feel after the operation?

• If I have pain, how will you help?

• How long will I have to stay in the hospital?

• Will I have any long-term effects because of this operation?

• When will I be able to resume my normal activities?

• Will follow-up visits be necessary?

In radiation therapy (also called radiotherapy), high-energy rays are used to kill cancer cells. The rays may come from a small container of radioactive material, called an implant, which is placed directly into or near the tumor site (internal radiation). It may also come from a large machine outside the body (external radiation). Some patients with uterine cancer need both internal and external radiation therapy. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area. Radiation therapy may be used in addition to surgery to treat women with certain stages of uterine cancer. Radiation may be used before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, for a small number of women who cannot have surgery, radiation treatment is sometimes used instead.

In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The patient is hospitalized during this treatment. Patients may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, there is no radioactivity in the body. External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation.

These are some questions a woman may want to ask the doctor before having radiation therapy:

• What is the goal of treatment?

• How will the radiation be given?

• When will the treatments begin? When will they end?

• How will I feel during therapy? Are there side effects?

• What can I do to take care of myself during therapy?

• How will we know if the radiation therapy is working?

• Will I be able to continue my normal activities during treatment?

Hormone therapy is the use of drugs, such as progesterone, that prevent cancer cells from getting or using the hormones they may need to grow. Hormone treatment is a systemic therapy. The drugs, which are usually taken by mouth, enter the bloodstream, travel through the body, and control cancer cells outside the uterus. Women who are unable to have surgery are sometimes treated with hormone therapy. Also, this form of treatment is often recommended for women who have metastatic or recurrent endometrial cancer.

These are some questions a woman may want to ask the doctor before having hormone therapy:

• Why do I need this treatment?

• What hormones will I be taking? What will they do?

• Will I have side effects? What can I do about them?

• How long will I be on this treatment?

Chemotherapy is the use of drugs to kill cancer cells. Anticancer drugs may be taken by mouth or given by injection into a blood vessel or a muscle. Like hormone therapy, chemotherapy is a systemic therapy; it can kill cancer cells throughout the body. Chemotherapy is being evaluated in treatment studies for patients with uterine cancer that has spread.

These are some questions a woman may want to ask the doctor before starting chemotherapy:

• What is the goal of this treatment?

• What drugs will I be taking?

• Will the drugs cause side effects? What can I do about them?

• How long will I need to take this treatment?

• How will we know if the drugs are working?

Treatment Studies

Doctors conduct treatment studies to learn about the effectiveness and side effects of new treatments. In some studies, all patients receive the new treatment. In other studies, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group. Treatment studies are also designed to compare one standard treatment with another.

Women who take part in these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science.

Doctors are studying new ways of giving radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, and new ways of combining various types of treatment. Some studies are designed to find ways to reduce the side effects of treatment and to improve the quality of women's lives.

Women who are interested in taking part in a study should talk with their doctor. They may want to read the National Cancer Institute booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know, which explains the possible benefits and risks of treatment studies.

Another way to learn about treatment studies is through PDQ, a cancer information database developed by the National Cancer Institute. PDQ contains information about cancer treatment and about treatment studies in progress throughout the country. The Cancer Information Service can provide PDQ information to patients and the public.

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