Treatment for uterine cancer

Tuesday 1 April, 2014

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On this page: SurgeryRadiotherapy | Hormone treatment | Chemotherapy | Palliative treatment | Key points


Your doctor will advise you on the best treatment for the cancer. Treatment will depend on the results of your tests, where the cancer is, whether it has spread, your age and your general health.

Cancer of the uterus is often diagnosed early, before it has spread, and can be treated surgically. For many women, surgery will be the only treatment they need. If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or chemotherapy may also be used.

Surgery

Hysterectomy and bilateral salpingo oophorectomy

Cancer of the uterus is usually treated by removing the uterus and cervix. This operation is called a total hysterectomy. In most cases, the fallopian tubes and both ovaries will also be removed at the same time. This is called a bilateral salpingo-oophorectomy.

The ovaries are usually removed during surgery as they produce oestrogen, a hormone that may cause the cancer to grow. Removing them reduces the risk of the cancer coming back (recurrence).

The hysterectomy will help the doctors confirm the type of uterine cancer you have and if it has spread (metastasised). It may be performed through a cut in the abdomen (laparotomy) or using laparoscopic (keyhole) surgery.

You will be given a general anaesthetic. If you are having a laparotomy, a cut is made from the pubic area to the bellybutton. Sometimes a cut is made along the pubic line instead. Once the abdomen is open, the surgeon washes out the area with fluid. The uterus, fallopian tubes and ovaries are then removed. If the cancer has spread to the cervix, the surgeon may also remove a small part of the upper vagina and the ligaments supporting the cervix.

The lymph nodes in your pelvis may also be removed, depending on the size and type of cancer. This procedure is called a lymphadenectomy. Your gynaecological oncologist will discuss this with you before the operation.

All of the tissue and fluids that are removed are sent to a pathologist to be examined for cancer cells.

If the operation is performed as a laparoscopic procedure (keyhole surgery), the surgeon will make small cuts in the abdomen and use a thin telescope (laparoscope) to see inside the abdomen. The uterus and other organs are removed through the vagina or the abdominal incision. This is called a total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy.

Robotic hysterectomy

A robotic hysterectomy is a form of keyhole surgery. The instruments used in the operation are controlled by robotic arms guided by the surgeon, who sits next to the operating table. Because it is keyhole surgery, you won’t be left with a large scar and the time it takes you to recover will usually be shorter than if a cut is made in your abdomen. 

A diagram of a hysterectomy and bilateral salpingo-oophorectomy
After the operation

When you wake up from the operation, you will have an intravenous drip in your arm to give you fluid and medication. There may also be a tube in your abdomen to drain away fluid from the operation site, and a tube in your bladder to collect urine. These will usually be removed the day after the operation.

As with all major operations, you will have some discomfort or pain. You will be given pain relief medication through a drip or via an injection into your spine. The spinal injection is called an epidural. If you still have pain, your doctor or nurse can change your medication to one that is more effective.

A few days after the operation, your doctor will have all the test results and will discuss with you if further treatment is necessary. This will depend on the type of cancer, the stage and grade of the disease, and the amount of any remaining cancer. If the cancer is at a very early stage, you may not need additional treatment.

Side effects

After surgery, some women experience side effects. These may include one or all of the following:

Menopause

If you have had a bilateral salpingo-oophorectomy and were not menopausal before the operation, the removal of your ovaries will cause menopause. If you have not been through menopause and are concerned about how the surgery will affect your fertility, see infertility

Internal scar tissue (adhesions)

Tissues in the body may stick together, which can sometimes be painful. Rarely, adhesions to the bowel or bladder may need to be treated with further surgery.

Impact on sexuality

The physical and emotional changes you experience after surgery may affect how you feel about sex and how you respond sexually. See more information about sexuality and intimacy or call 13 11 20.

Lymphoedema

If you have a lymphadenectomy, you may develop lymphoedema. This is a swelling in part of the body due to a blockage of the lymph vessels. Removing lymph nodes from the pelvis prevents lymph fluid from draining, which causes it to build up and the legs to swell.

Women who have had a lymphadenectomy followed by radiotherapy are more at risk of lymphoedema. Symptoms appear gradually, sometimes years after a lymphadenectomy. See symptoms and tips on dealing with lymphoedema.

Lymphadenectomy

Your doctor may suggest removing some lymph nodes from your pelvic region. This is called a pelvic lymphadenectomy or lymph node dissection. Removing lymph nodes will help your doctor to find out whether the cancer has spread. The lymph nodes will be examined under a microscope to see if they contain cancer. 

Taking care of yourself at home

Most women who have a hysterectomy will feel better within six weeks, but your recovery time will depend on factors like your age, general health and the type of surgery you had. If you need home nursing care, ask hospital staff about services in your area.

Rest

When you get home from hospital, you will need to take things easy for the first week. Ask family or friends to help you with chores so you can rest.

Lifting

You should avoid heavy lifting for about a month, although this will depend on the method of the surgery.

Driving

You will most likely need to avoid driving for a few weeks after the surgery. Check with your car insurer for any exclusions regarding major surgery and driving. 

Sex

Sexual intercourse should be avoided for 4–6 weeks after surgery. Ask your doctor when you can resume sexual intercourse, and explore other ways you and your partner can be intimate, such as massage.

Exercise

Your health care team will probably encourage you to walk the day after the surgery. Start with a short walk and go a little further each day. Speak to your doctor if you would like to try more vigorous exercise.

Radiotherapy

Radiotherapy uses x-rays to kill or injure cancer cells so they cannot multiply. The radiation can be targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.

Radiotherapy is commonly used as an additional treatment to reduce the chance of the disease coming back. This is called adjuvant therapy. There are two ways radiotherapy is given:

  1. From inside the body (internal, known as brachytherapy): radioactive material is put in thin tubes and placed near the cancer.
  2. From outside the body (external): a machine directs radiation at the cancer and surrounding tissue.

Radiotherapy may be recommended as the main treatment if you are not well enough for a major operation.

Which radiotherapy treatment will I have?

The type of radiotherapy offered depends mostly on the type of cancer and its extent, your general health and your age. But it can also depend on where you live and what services are available. For example, high-dose-rate brachytherapy may require several appointments. This can be difficult if you live in a regional or remote area as you may have to travel long distances for treatment. 

Brachytherapy (internal radiotherapy)

In brachytherapy, the radiation source is placed inside the body on or near the cancer. A cylinder is inserted into the vagina and is connected to a machine using plastic or metal tubes. These tubes move the radiation from the machine into your body. Internal radiotherapy can be done in two ways:

High-dose-rate treatment

You will usually have 4–5 treatment sessions as an outpatient. Each high-dose brachytherapy session will last from five to 10 minutes, but it takes much longer to set up the equipment.

Low-dose-rate treatment

Not as common as high-dose treatment, as it is gradually being replaced by newer, high-doserate machines. You may have low-dose-rate treatment in hospital continuously for up to 36 hours. Because the implant used in low-dose brachytherapy is radioactive, you will be cared for alone or in a room away from the main ward. Visitors may be limited while the implant is in place.

Sometimes brachytherapy is used to treat uterine cancer that has come back. This type of brachytherapy often involves putting needles into the cancer cells. You will be given an anaesthetic for this procedure.

You will need to stay in hospital while you have the treatment, as the needles will have to remain in place until the full course of treatment is finished. This type of brachytherapy can be delivered as either high-dose-rate or low-dose-rate treatment. 

External radiotherapy

In external radiotherapy, x-rays from a large machine are directed at the part of the body needing treatment. For cancer of the uterus, the lower abdominal area and pelvis are treated, but if the cancer has spread (metastasised), other areas may also be treated.

You will probably have external radiotherapy treatment from Monday to Friday for 4–6 weeks. Weekend rest breaks allow the normal cells to recover. You usually receive this treatment as an outpatient (at a radiotherapy centre) and you will not need to stay in hospital.

The actual treatment takes only a few minutes each time, but a lot of planning is required to make sure the treatment is right for you. This may involve a number of visits to your doctor to have more tests (e.g. blood tests) and undergo special planning scans such as a PET scan.

It’s very important that you attend all of your scheduled sessions to ensure you receive enough radiation to kill the cancer cells or relieve symptoms. 

The machine used for external radiotherapy is large and kept in an isolated room. This can be confronting or frightening, especially when you have treatment for the first time. You may find you feel more at ease with each session you attend. 

Side effects

Radiotherapy can cause short- and long-term side effects. This is because radiotherapy can damage both healthy cells and cancer cells. Most side effects are temporary and steps can often be taken to prevent or reduce them. The most common side effects occur during or soon after treatment.

Different women may have different side effects even if the dose and frequency of the radiotherapy are the same. Before your treatment starts, talk to your radiation oncologist about possible side effects.

You may experience some of the following side effects:

Lethargy and loss of appetite

Radiotherapy can make you feel tired and you may lose your appetite.

Skin problems

Radiotherapy may make your skin dry and itchy in the treatment area.

Hair loss

Radiotherapy to your abdomen and pelvis can cause you to lose your pubic hair. This may be permanent.

Reduced vaginal size

Radiotherapy to the pelvic area can affect the vagina, which will become tender during treatment and for a few weeks afterwards. In the long term, radiotherapy can make the vagina drier, and can lead to the vagina becoming shorter, narrower and less flexible. This may make vaginal examinations painful and sexual intercourse uncomfortable or difficult. 

Your doctor may recommend the use of a vaginal dilator. For more information on vaginal dilators, see vaginal narrowing.

Diarrhoea

Having radiotherapy to your lower abdomen or pelvis may irritate the bowel and cause diarrhoea. Symptoms include loose and watery stools, abdominal cramps and frequent bowel movements. For some ways to reduce diarrhoea, see bowel problems and consult your doctor.

Cystitis

Radiotherapy to the pelvic area can cause a burning sensation when passing urine (cystitis).

Menopause

Radiotherapy to the pelvic region may also cause your periods to stop (menopause). See more information on menopause.

When you’re having radiotherapy, try to rest as much as possible. Drinking lots of water and eating small, frequent meals will also help. Ask your doctor or nurse about ways to manage the side effects of radiotherapy.

For more information call 13 11 20 or see the radiotherapy section.

Waiting at the hospital for radiotherapy to begin may make you feel anxious. Take activities to help distract you or to help pass the time. 

Hormone treatment

Hormones are substances that are produced naturally in the body. They help control the growth and activity of cells. Some cancers of the uterus depend on hormones (like oestrogen) to grow. Hormone treatment works by helping the body to produce smaller amounts of the hormones that the cancer needs to grow.

Hormone treatment can be given if the cancer has spread or if the cancer has come back (recurred). It is also sometimes offered in the first instance if surgery is not an option. The main hormone treatment for women with uterine cancer is progesterone.

Progesterone

Progesterone occurs naturally in women, and it can also be produced artificially to help shrink some cancers and control symptoms. Progesterone is available in tablet form or is given as an injection by your GP or nurse. The most common types of progesterone are medroxyprogesterone (Provera®) and megestrol (Megace®). Progesterone may also be given in a device (called a Mirena®) that is fitted into the uterus.

The common side effects of progesterone treatment include:

  • breast tenderness
  • tiredness
  • nausea
  • fluid retention.

In high doses, progesterone may increase appetite and cause weight gain. 

Julie’s story

"At 62, I received a reminder to have a Pap smear and filed it with all my important documents, thinking I’d get to it eventually.

"After having a Pap smear a few months later, I got home one day to a message from the surgery saying the doctor wanted to see me. It was the Thursday before Easter and that long weekend I had myself dead and buried 10 times over.

"The doctor told me there was an anomaly on my Pap smear and referred me to a gynaecologist. Within a few weeks, I had a hysteroscopy and biopsy.

"Two weeks later, I was told I had cancer of the uterus. I had a total hysterectomy and some of my lymph nodes were removed as well. Fortunately, the cancer hadn’t spread, but because it was grade 3 the doctor recommended I have chemotherapy and radiation.

"The main side effect of the chemotherapy was abdominal pain and pain in my legs and feet, and feeling very weak. I went from being an active woman to someone who was using a walker to get around. I’m a very positive and happy person, so that was pretty confronting.

"I’m one of the lucky ones. It’s very rare for cancer of the uterus to be picked up on a Pap smear. I'd had symptoms, such as nausea and abdominal pain, but I thought they were related to other health conditions I had.

"As my body’s healing and getting stronger, psychologically I’m getting stronger, too. I had planned to work beyond 65, but now I’m thinking I’ll retire sooner. I have different priorities now. I’ve been given a second chance."

Tell your cancer story.

Chemotherapy

Chemotherapy is the use of cytotoxic drugs that kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells.

Chemotherapy may be used:

  • for certain types of uterine cancer
  • when cancer comes back after surgery or radiotherapy to try to control the cancer and to relieve symptoms
  • if the cancer does not respond to hormone treatment
  • if the cancer has spread beyond the pelvis when the cancer is first diagnosed
  • in conjunction with radiotherapy.

Chemotherapy is usually given by injecting the drugs into a vein (intravenously). You may be treated as an outpatient or you may need to stay in hospital overnight. You will have a number of treatments, sometimes up to six, every 3–4 weeks over several months. Your doctor will talk to you about how long your treatment will last. 

Side effects

The side effects of chemotherapy vary greatly for each woman and depend on the drugs you receive, how often you have the treatment, and your general fitness and health. Side effects may include feeling sick (nausea), vomiting, feeling tired, and some thinning and loss of body and head hair. Most side effects are temporary and steps can often be taken to prevent or reduce their severity. 

For more information about chemotherapy and tips for managing side effects, ask your doctor or nurse, call Cancer Council 13 11 20 or see the chemotherapy section.

If you have private health insurance, check with your provider whether you are entitled to a rebate on a wig for hair loss associated with chemotherapy. 

Palliative treatment

Palliative treatment helps to improve people’s quality of life by alleviating symptoms of cancer without trying to cure the disease. It is particularly important for people with advanced cancer. However, it is not just for end-of-life care and can be used at different stages of cancer.

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication such as hormone treatment (see above).

Call 13 11 20 for more information about palliative care and advanced cancer.

Key points

  • The main treatment for cancer of the uterus is surgery to remove the uterus and cervix. This operation is called a hysterectomy.
  • In most cases, the fallopian tubes and both ovaries will also be removed at the same time. This is called a bilateral salpingo-oophorectomy.
  • You will be given pain relief during and after the operation as there will be some pain or discomfort.
  • Recovery times vary depending on the type of surgery you have.
  • You will need to take things easy when you first get home from hospital. Ask family or friends to help with chores so you can rest.
  • You will probably need to avoid driving for a few weeks after surgery. Check whether your car insurance policy has any exclusions from driving after major surgery.
  • Avoid heavy lifting for a few weeks after surgery.
  • Sexual intercourse should be avoided for about 4–6 weeks to give your wounds time to heal.
  • If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or chemotherapy may also be used.
  • Radiotherapy may be offered if you are not well enough for a major operation. It can also be used as an additional treatment.
  • Hormone therapy targets cancer that depends on hormones (e.g. oestrogen) to grow. The treatment works by helping the body to produce smaller amounts of these hormones. 

Reviewed by: Dr Sam Saidi, Senior Staff Specialist, Department of Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Sharon Ellis, Consumer; Anne Finch, Accredited Practising Dietitian, Campaign Project Officer, Cancer Council WA; Harrison Hills, Accredited Practising Dietitian, Nutrition and Physical Activity Project Officer, Cancer Council WA; Suparna Karpe, Clinical Psychologist, Department of Gynaecological Oncology, Westmead Hospital, NSW; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Rosalind Robertson, Senior Psychologist, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, Gynaecological Cancer Research Nurse, QIMR Berghofer Medical Research Institute, SA; Kylie Tilbury, Acting Gynaecology, Brain and CNS Cancer Nurse Care Coordinator, The Canberra Hospital, ACT.

Updated: 01 Apr, 2014