Advanced-stage endometrial carcinoma

The following are treatments for stages 3 and 4, also called advanced-stage endometrial carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is usually the first treatment for advanced-stage endometrial carcinoma. Surgery is used to both remove and stage the cancer (called surgical staging). The type of surgery and amount of tissue that needs to be removed depends on several factors about you and the cancer, including how far it has spread within the uterus or to other organs.

Surgery for advanced-stage endometrial carcinoma is followed by another type of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Stage 3 endometrial carcinoma is usually treated with a hysterectomy (removal of the uterus). Depending on how far the cancer has spread, the surgeon will either do a total hysterectomy or radical hysterectomy. A total hysterectomy is surgery to remove the uterus and cervix. A radical hysterectomy removes more tissue than a total hysterectomy. In addition to the uterus and cervix, a radical hysterectomy may remove:

• the upper vagina
• tissues surrounding the uterus

If any other abnormal tissues are found during the surgery, you may also have a biopsy of these tissues during surgery.

A bilateral salpingo-oophorectomy (removal of the 2 fallopian tubes and ovaries) and removal of the lymph nodes in the pelvis (pelvic lymph nodes) and around the aorta (para-aortic lymph nodes) are done at the same time as the hysterectomy.

Stage 4 endometrial carcinoma is sometimes treated with surgery. In cases where cancer has spread to abdominal lymph nodes, besides the pelvic or para-aortic lymph nodes, and nowhere else, surgical debulking may be done.

In cases where cancer has spread too far to be removed by debulking, a hysterectomy may still be done to help relieve symptoms of the cancer, such as bleeding.

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy after surgery as an adjuvant therapy for advanced-stage endometrial carcinoma.

In some cases, when the tumour is too big or has spread too far to be surgically removed, radiation therapy may be used first (called neoadjuvant therapy) to try to shrink the tumour and make it possible for doctors to then remove it. Radiation therapy may also be used to manage symptoms of endometrial carcinoma if you cannot have surgery.

Brachytherapy, external radiation therapy or a combination may be used for advanced-stage endometrial carcinoma. You may have radiation therapy on its own or together with a systemic therapy.

Find out more about radiation therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy after surgery (called adjuvant chemotherapy) for advanced-stage endometrial carcinoma. In cases of stage 4 cancer that can’t be removed with surgery (metastatic endometrial carcinoma), chemotherapy may be offered to help control the symptoms of metastatic cancer.

Chemotherapy drug combinations that may be used to treat advanced-stage endometrial carcinoma include:

• cisplatin (or carboplatin) and paclitaxel
• carboplatin and nab-paclitaxel
• cisplatin and doxorubicin
• carboplatin and docetaxel
• carboplatin and paclitaxel with the immunotherapy drug dostarlimab-gxly (Jemperli)
• carboplatin and paclitaxel with the immunotherapy drug durvalumab (Imfinzi)

If you can’t have a chemotherapy drug combination, you may be treated with carboplatin or doxorubicin alone.

If you have advanced-stage endometrial serous carcinoma or carcinosarcoma, you may be offered the chemotherapy drug combination carboplatin and paclitaxel along with the targeted therapy drug trastuzumab (Herceptin and biosimilars) .

Find out more about chemotherapy for uterine cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy may be offered for advanced-stage endometrial carcinoma that cannot be treated with surgery or radiation therapy if it’s low grade and hormone-receptor positive.

Hormone receptor–positive endometrial carcinomas have receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive), or both.

Most people who have hormone therapy for advanced-stage endometrial carcinoma will have megestrol and tamoxifen. Other hormone therapies that may be offered include:

• medroxyprogesterone (Provera) and tamoxifen
• medroxyprogesterone
• megestrol
• tamoxifen

If you are postmenopausal, you may also be offered:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

Find out more about hormone therapy for uterine cancer.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy may be offered for advanced-stage endometrial carcinoma.

The type of immunotherapy drug you have depends on several aspects of the cancer including the type of endometrial carcinoma, the molecular subtype and the grade.

Pembrolizumab (Keytruda) is a drug that inhibits the PD-1 checkpoint protein. You may be offered pembrolizumab, by itself, for cancer that is the mismatch repair deficient (MMRd) molecular subtype.

For advanced-stage endometrial carcinomas that didn't respond to treatment with a platinum-based chemotherapy drug, you may be offered pembrolizumab together with the targeted therapy drug lenvatinib (Lenvima).

Dostarlimab-gxly (Jemperli) is a drug that also inhibits PD-1. You may be offered dostarlimab-gxly if the cancer is the MMRd molecular subtype. It’s usually given with the chemotherapy drug combination carboplatin and paclitaxel. If the cancer didn’t respond to a previous treatment with a platinum-based chemotherapy drug (for example, carboplatin or cisplatin), dostarlimab-gxly can be used on its own as a second-line option if the cancer is the MMRd molecular subtype.

Durvalumab (Imfinzi) is another drug that inhibits PD-1. It may be offered for advanced endometrial carcinoma that is the MMRd molecular subtype with the chemotherapy drug combination carboplatin and paclitaxel, followed by maintenance therapy with durvalumab alone.

Find out more about immunotherapy for uterine cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Some people may be offered targeted therapy as a treatment for advanced-stage endometrial carcinoma.

Trastuzumab (Herceptin and biosimilars) is a drug that inhibits human epidermal growth factor receptor 2 (HER2). You may be offered trastuzumab, along with the chemotherapy drug combination of paclitaxel and cisplatin or carboplatin as palliative therapy to help relieve pain or control the symptoms of metastatic cancer.

Lenvatinib (Lenvima) is a drug that inhibits VEGF receptors. It may be offered for advanced-stage endometrial carcinoma that recurs after treatment with a platinum-based chemotherapy drug. Lenvatinib is typically given with the immunotherapy drug pembrolizumab.

Find out more about targeted therapy for uterine cancer.

Talk to your doctor about clinical trials open to people with endometrial carcinoma in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.