Treatments for early-stage endometrial carcinoma

The following are treatment options for stages 1 and 2, also called early-stage endometrial carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the main treatment for early-stage endometrial carcinoma. Surgery is used to both remove the cancer and to determine what stage the cancer is (called surgical staging). The type of surgery and amount of tissue that needs to be removed depends on the cancer type and several factors about you, including your age and where the cancer is in the uterus.

Most people with early-stage endometrial carcinoma will have a total hysterectomy (removal of the uterus and cervix) and a bilateral salpingo-oophorectomy (removal of the 2 fallopian tubes and ovaries).

The surgeon may also remove lymph nodes in the pelvis (called pelvic lymph nodes) and around the aorta (called para-aortic lymph nodes) in early-stage endometrial carcinomas if they:

• are high grade
• are an aggressive type of cancer
• have grown more than halfway into the myometrium (muscle layer of the uterus wall)

Sometimes, doctors will offer young or premenopausal people with low-grade, stage 1A endometrial carcinoma surgery that doesn’t remove the ovaries to prevent the onset of menopause. This may increase the risk of cancer recurrence in the ovaries but avoids side effects of menopause such as loss of bone density.

Surgery for early-stage endometrial carcinoma is sometimes followed by other types of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Find out more about surgery for uterine cancer.

Fertility-sparing treatments use non-surgical treatments to try to treat uterine cancer so that people who wish to have children can still try to conceive (get pregnant).

A hysterectomy and bilateral salpingo-oophorectomy are often done once the person decides not to have any more children, or if other treatments are unable to control the cancer.

Find out more about fertility preservation 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 early-stage endometrial carcinoma if:

• it's a high-risk stage 1 cancer
• it's a stage 2 cancer

Radiation therapy can also be used to treat early-stage endometrial carcinoma if you can't have surgery.

Brachytherapy, external radiation therapy or a combination may be used. Which type of radiation therapy you have depends on aspects of your cancer such as the type of endometrial carcinoma, the molecular subtype and the grade.

Find out more about radiation therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. It’s sometimes offered after surgery as an adjuvant therapy for early-stage endometrial carcinoma to decrease the risk of the cancer recurring.

Whether you have adjuvant chemotherapy depends on several aspects of the cancer including the type of endometrial carcinoma, the molecular subtype and the grade. The most common chemotherapy drug combination used for early-stage endometrial carcinoma is carboplatin and paclitaxel. Other combinations that may be used include:

• cisplatin and paclitaxel
• cisplatin (or carboplatin) and doxorubicin
• carboplatin and nab-paclitaxel

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

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. You may be offered hormone therapy as a fertility-sparing treatment for early-stage endometrial carcinoma.

People who have hormone therapy for early-stage endometrial carcinoma most commonly have a levonorgestrel intrauterine device (Mirena, Kyleena), sometimes called a hormonal IUD. Other hormone therapy drugs that can be used include:

• megestrol
• medroxyprogesterone (Provera)

Find out more about hormone therapy and fertility preservation 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. Targeted therapy is sometimes offered as adjuvant therapy for early-stage endometrial carcinoma.

Bevacizumab (Avastin and biosimilars) is a drug that inhibits vascular endothelial growth factor (VEGF). It may be offered for early-stage endometrial carcinoma that is the mismatch repair deficient (MMRd) molecular subtype. Bevacizumab is usually given with the chemotherapy drug combinations paclitaxel and carboplatin or paclitaxel and cisplatin.

Find out more about targeted therapy for uterine cancer.