Treatment for uterine cancer

Wednesday 1 March, 2017

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On this page: Surgery | Radiotherapy | Hormone treatment | Chemotherapy | Palliative treatment | Key points


The treatment recommended by your doctor will depend on the results of your tests, the type of cancer, 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

Cancer of the uterus is usually treated by an operation to remove the uterus and cervix (a total hysterectomy), along with both fallopian tubes and ovaries (a bilateral salpingo-oophorectomy). The ovaries are usually removed as they produce oestrogen, a hormone that may cause the cancer to grow. Removing them reduces the risk of the cancer coming back.

The surgery will be performed under a general anaesthetic. The type of hysterectomy offered to you will depend on a number of factors, including your age and build, the size of your uterus, the size of the tumour, and the surgeon's specialty and experience. Your surgeon will talk to you about the risks and complications of your procedure.

If you are pre-menopausal, the removal of the ovaries will bring on menopause. If your ovaries appear normal and you don't have any risk factors, you may be able to keep your ovaries. Talk to your doctor about your particular situation.

How the surgery is done

Laparotomy

The surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the 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.

Laparoscopic hysterectomy

This is sometimes called keyhole surgery. The surgeon will make 3–4 small cuts in the abdomen and use a thin telescope (laparoscope) to see inside the abdomen. The uterus and other organs are usually removed through the vagina. A robotic hysterectomy is a specialised form of laparoscopic hysterectomy where the surgical instruments are controlled by robotic arms guided by the surgeon, who sits next to the operating table.

The lymph nodes in your pelvis may also be removed, depending on the size and type of cancer. This procedure is called a lymphadenectomy or lymph node sampling. In certain cases, further biopsies or tissue might be taken depending on the type of tumour that you have. Your gynaecological oncologist will discuss this with you before the operation.

All tissue and fluids removed are examined for cancer cells by a pathologist. The results will help confirm the type of uterine cancer you have, if it has spread (metastasised), and its stage.

A diagram of a hysterectomy and bilateral salpingo-oophorectomy

Most women with uterine cancer will have this operation. However, your case may be different. Talk to your doctor. Before the operation Fallopian tubes Uterus (womb) Ovary Cervix (neck of the uterus) After the operation The dotted outline shows the organs removed during surgery. Ovary Vagina (birth canal)

After the operation

When you wake up after the operation, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be transferred to the ward where you will stay for around one to four days until you can go home. Your length of stay will depend on the type of surgery (laparoscopy or laparotomy) you have had.

You will have an intravenous drip in your arm to give you medicines and fluid. There may also be a tube in your abdomen to drain the operation site and a tube in your bladder (catheter) 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. For the first day or two, you may be given pain medicine through a drip or via a local anaesthetic injection into the abdomen (a TAP block) or spine (an epidural). Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe.

You can also expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your doctor will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.

You will have to wear compression stockings for a couple of weeks to help the blood in your legs to circulate. You will also be given a daily injection of a blood thinner to reduce the risk of blood clots. Depending on your risk of clotting, you may be taught to give this injection to yourself, so you can continue it for a few weeks at home.

Your doctor will have all the test results about a week after the operation. Whether further treatment is necessary will depend on the type, 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, such as:

Menopause

If you 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 surgery will affect your fertility, see information about infertility.

Vaginal vault prolapse

After a hysterectomy, the top of the vagina can drop towards the vaginal opening because the structures that support the top of the vagina have weakened. Talk to the hospital physiotherapist about pelvic floor exercises that can help strengthen the pelvic floor muscles to try to avoid a prolapse. They can usually be commenced one to two weeks after surgery.

Internal scar tissue (adhesions)

Tissues in the abdomen may stick together, which can sometimes be painful or cause bowel problems such as constipation. 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. Call Cancer Council 13 11 20 or see Sexuality, Intimacy and Cancer.

Lymphoedema

If you have a lymphadenectomy (see below), you may develop lymphoedema. Removing lymph nodes from the pelvis may prevent lymph fluid from draining, causing swelling in the legs. The risk of lymphoedema following most operations for cancer of the uterus in Australia is low. The risk is higher in women who had a lymphadenectomy followed by radiotherapy. Symptoms appear gradually, sometimes years after the treatment. See information about symptoms and tips on dealing with lymphoedema.

Lymphadenectomy

Lymph nodes are an important part of the lymphatic system. Cancer cells can travel from the uterus through the lymphatic system to other parts of the body. As they pass through the lymph nodes, some cancer cells are destroyed, some move through to grow in another part of the body, and some get stuck, forming tumours (known as lymph node spread).

There are large groups of lymph nodes in the pelvis. Your doctor may suggest removing some pelvic lymph nodes to find out whether the cancer has spread. This procedure is called a pelvic lymphadenectomy, lymph node dissection or lymph node sampling. The lymph nodes will be examined to see if they contain cancer. As the risk of cancer spreading to the lymph nodes is low for early stage endometrial cancers, this procedure will usually only be offered for more advanced or higher grade tumours.

Christine's story

"At 50 I was having some heavy bleeding during my periods, so my GP sent me for an ultrasound. As the ultrasound technician told me that everything looked okay, I put the heavy bleeding down to the menopause and didn't go back to my GP to check on the results. It wasn't until a year later when I saw my GP again that she told me that the ultrasound had shown I had fibroids and referred me to a gynaecologist.

"The gynaecologist performed a dilation and curettage for the fibroids and to help with the heavy bleeding. As a matter of course the tissue was sent for testing, and four days later I was told I had uterine cancer and booked in to see an oncologist.

"The oncologist recommended a hysterectomy. I chose to have robotic surgery to remove the uterus, cervix and ovaries, as well as some nearby lymph glands. After the surgery, my oncologist informed me that the cancer hadn't spread, but it was very aggressive and well advanced into the walls of the uterus. He recommended that I have radiotherapy to reduce the risk of a recurrence.

"With the support of my family and workplace, I was able to schedule the appointments before work. I found the sessions easier than I expected, although I got very tired at the time. I have also been left with some scar tissue around the bowel, which means I have to be careful with what I eat.

"I've just passed the five year mark and have had my final appointment with my oncologist – this has been a big relief. In the last year I've become involved as a volunteer providing telephone peer support with Cancer Connect. I didn't connect with any services when I was diagnosed, and I now realise how helpful it would have been to speak to people in similar situations."

Tell your cancer story.

Taking care of yourself at home after a hysterectomy

Your recovery time will depend on your age, general health and the type of surgery that you had. Most women feel better within 1–2 weeks and should be able to fully return to normal activities after 4–8 weeks. The overwhelming majority of women do not need specific help to recover but if you think you will 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

Avoid heavy lifting (more than 3–4 kilograms) for about a month, although this will depend on the method of the surgery.

Work

Depending on the nature of your work, you will probably need 4–6 weeks leave from work.

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.

Bowel problems

You may have constipation following the surgery and may need to take laxatives to avoid straining when passing a bowel motion.

Nutrition

Focus on eating a balanced diet (including proteins such as lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds, and legumes/beans), to help your body recover from surgery.

Sex

Sexual intercourse should be avoided for 4–8 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. Exercise has been shown to help people manage some of the common side effects of treatment, speed up a return to usual activities, and improve overall quality of life. 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.

Bathing

Take showers instead of baths for 4–6 weeks after surgery.

Radiotherapy

Radiotherapy (also known as radiation therapy) uses x-rays to kill or damage cancer cells so they cannot multiply. The radiation is targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.

Radiotherapy for cancer of the uterus is commonly used as an additional treatment after surgery to reduce the chance of the disease coming back. This is called adjuvant therapy. Alternatively, radiotherapy may be recommended as the main treatment if you are not well enough for a major operation.

There are two main ways of delivering radiotherapy: internally or externally (see below). Some women are treated with both types of radiotherapy. Your radiation oncologist will recommend the course of treatment most suitable for you.

Internal radiotherapy (vaginal brachytherapy)

Internal radiotherapy is a way of delivering targeted radiotherapy directly to the tumour from inside your body. For cancer of the uterus, a cylinder containing radioactive material is inserted into the vagina. This cylinder is connected to a machine using plastic or metal tubes. These tubes move the radiation from the machine into your body.

You will usually have 4–5 treatment sessions, 2–3 times a week, as an outpatient. Each session will last from 5–10 minutes, but it takes much longer to set up the equipment. The applicator is taken out after each dose of radiation is delivered.

Which radiotherapy treatment will I have?

The type of radiotherapy offered depends mostly on the type of cancer, how far it has spread, your general health and your age. But it can also depend on where you live and what services are available. For more information on radiotherapy treatments, call Cancer Council 13 11 20 or see Understanding Radiotherapy.

External radiotherapy (external beam radiotherapy)

External radiotherapy directs the treatment at the cancer and surrounding tissue from outside the body. 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 lie on a treatment table under a machine called a linear accelerator, which delivers high energy x-rays.

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.

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.

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.

Side effects

Radiotherapy can cause both temporary and long-term side effects. This is because radiotherapy can damage healthy cells as well as cancer cells. The most common side effects occur during or soon after treatment. Most are temporary and steps can often be taken to prevent or reduce them. When you're having radiotherapy, try to rest as much as possible. Drinking lots of water and eating small, frequent meals will also help.

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. See some tips on managing fatigue.

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 cause vaginal scarring. This can lead to the vagina becoming shorter, narrower and less flexible (vaginal stenosis). This may make vaginal examinations painful and sexual intercourse difficult or uncomfortable. Your doctor may recommend the use of a vaginal dilator.

Menopause

See more information about menopause.

Cystitis

Radiotherapy to the pelvic area can cause a burning sensation when passing urine (cystitis). See some suggestions on dealing with cystitis.

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. See some ways to reduce diarrhoea and consult your doctor or dietitian.

Brachytherapy and external radiotherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions are over and when you are at home.

Hormone treatment

Hormones such as oestrogen and progesterone 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 can be given if the cancer has spread or if the cancer has come back (recurred), particularly if it is a low grade cancer. It is also sometimes offered in the first instance if surgery is not an option, for example, for young women who still want to have children. The main hormone treatment for women with oestrogen-dependent uterine cancer is progesterone.

Progesterone

Progesterone occurs naturally in women and can also be produced in a laboratory. High doses of progesterone can help shrink some cancers and control symptoms. Progesterone is available in tablet form (commonly either medroxyprogesterone or megestrol); as an injection given by your GP or nurse; or through a hormone-releasing intrauterine device (IUD) called a Mirena, which is fitted into the uterus by your doctor (if you have not had a hysterectomy). Talk to your doctor about the risks and benefits of the different methods.

Side effects

The common side effects of progesterone treatment include breast tenderness, headaches, tiredness, nausea, menstrual changes, and bloating. In high doses, progesterone may increase appetite and cause weight gain. If you have an IUD, it may move out of place and need to be refitted by your doctor.

Chemotherapy

Chemotherapy uses drugs to 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 for uterine cancer may be used:

  • for certain types
  • 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, very infrequently, 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, see Understanding Chemotherapy or call Cancer Council 13 11 20.

Palliative treatment

Palliative treatment helps to improve people's quality of life by alleviating symptoms of cancer without trying to cure the disease, and is best thought of as supportive care.

Many people think that palliative treatment is for people at the end of their life: however it may be beneficial for people at any stage of advanced uterine cancer. It is about living as long as possible in the most satisfying way you can.

As well as slowing the spread of cancer, palliative treatment can relieve any pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other medicines such as hormone treatment.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers.

See more information about Understanding Palliative Care or Living with Advanced Cancer or call Cancer Council 13 11 20.

Key points

  • The main treatment for cancer of the uterus is surgery to remove 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.
  • 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 recover.
  • 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 4–8 weeks to give your wounds time to heal.
  • Radiotherapy may be offered as the main treatment if you are not well enough for a major operation. It can also be used as an additional treatment after surgery.
  • Hormone therapy targets cancers of the uterus that depend on oestrogen to grow. The main hormone treatment for women with uterine cancer is progesterone.
  • Chemotherapy may be used if the cancer has spread beyond the uterus, or if the cancer comes back after surgery or radiotherapy.

Reviewed by: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology Group, Chris O’Brien Lifehouse, NSW; Lauren Atkins, Accredited Practising Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Scott Carruthers, Radiation Oncologist, Royal Adelaide Hospital, SA; Prof Michael Friedlander, Medical Oncologist, Royal Hospital for Women Sydney, NSW; Roslyn McAullay, Social Worker, Women and Newborn Health Service, King Edward Memorial Hospital, WA; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, NSW; Christine O’Bryan, Consumer; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Department of Physiotherapy, King Edward Memorial Hospital for Women, WA.

Updated: 01 Mar, 2017