Recurrent endometrial carcinoma

Recurrent endometrial carcinoma means that the cancer has come back after it has been treated. Which treatments you’ll have is based on where the cancer comes back, the amount of cancer in the body and which kinds of treatment you had before.

Local recurrence means the cancer has come back in the same area as the original tumour or in tissues, organs or lymph nodes close to it.

Distant recurrence means the cancer has come back in other parts of the body. Distant recurrence may also be called metastatic cancer. When distant recurrence only occurs in a few sites and there is no evidence of cancer anywhere else in the body, it’s called isolated metastases. When distant recurrence occurs in many places throughout the body, it’s called disseminated disease.

You may be offered the following treatments for recurrent endometrial carcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

You may be offered surgery for recurrent endometrial carcinoma, depending on how much cancer there is and where it has spread.

In cases of locally recurrent cancer, a pelvic exenteration may also be used to remove organs and tissues not removed during previous surgeries for endometrial carcinoma such as:

• fallopian tubes
• ovaries
• lymph nodes in the pelvis (called pelvic lymph nodes) and around the aorta (called para-aortic lymph nodes)
• parts of the peritoneum
• the bladder
• the rectum
• the vagina
• the vulva

A pelvic exenteration surgery is usually only done if the cancer hasn’t responded to treatment with other therapies. It’s a type of salvage therapy.

When cancer is more widespread throughout the pelvis, tumour debulking may be done instead. This surgery helps relieve pain and symptoms caused by the tumour.

In cases of distant recurrence, surgery may be used to try to remove the cancer (called surgical resection) when it has only spread to a few sites and there is no evidence of cancer anywhere else in the body.

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

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is often given for recurrent endometrial carcinoma. The type of radiation therapy you have depends on where the cancer came back and the type of radiation therapy you previously had for endometrial carcinoma.

For a local recurrence, if you didn’t have radiation therapy or only previously had brachytherapy for endometrial carcinoma, you may be offered external radiation therapy as an adjuvant therapy after surgery for locally recurrent endometrial carcinoma. When you can’t have surgery, you’ll likely have radiation as the primary treatment.

External radiation therapy can be given alone or together with brachytherapy, or hormone therapy, or both.

If you previously had external radiation therapy for endometrial carcinoma, palliative external radiation therapy may be offered. It’s given with surgery or systemic therapy.

When cancer comes back only in the vagina, or tissues around the vagina, you may be offered brachytherapy to relieve pain and other symptoms of metastatic cancer. It can be given with hormone therapy.

For a distant recurrence that is an isolated metastasis, you may be offered external radiation therapy. External radiation therapy can be given on its own, with surgery or with systemic therapy (for example, chemotherapy, immunotherapy or targeted therapy).

In cases of disseminated metastases, external radiation therapy is sometimes given together with systemic therapy.

Find out more about radiation 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 recurrent endometrial carcinoma that is hormone receptor–positive.

Hormone receptor–positive endometrial carcinoma has receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive) or both.

You may have hormone therapy for locally recurrent endometrial carcinoma as an adjuvant therapy after surgery. If you can’t have surgery, you may be offered hormone therapy to relieve symptoms of recurrent and metastatic endometrial carcinoma.

Hormone therapy can be given by itself or with radiation therapy. Whether you have it alone or together with radiation therapy depends on which tissues or organs the cancer came back in.

The types of hormone therapy used are the same as those given for advanced-stage endometrial carcinoma.

Find out more about hormone therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy for recurrent endometrial carcinoma. It’s usually given when cancer can’t be treated with hormone therapy.

When recurrent cancer can be treated with surgery, chemotherapy may be offered as adjuvant therapy after surgery. If recurrent cancer can’t be treated with surgery, you may be offered chemotherapy to relieve the symptoms of metastatic cancer.

You can have chemotherapy by itself or with radiation therapy. Whether you have it alone or together with radiation therapy depends on which tissues or organs the cancer came back in. Chemotherapy drug combinations that may be used to treat recurrent endometrial carcinoma include:

• cisplatin (or carboplatin) and paclitaxel
• carboplatin and nab-paclitaxel
• cisplatin and doxorubicin
• carboplatin and docetaxel
• paclitaxel, ifosfamide and mesna
• 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 a single drug such as:

• cisplatin
• carboplatin
• doxorubicin
• paclitaxel

If you have recurrent 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) . You may also be offered the chemotherapy drug combination ifosfamide and paclitaxel for carcinosarcoma.

For recurrent endometrial small cell carcinoma, the chemotherapy drug combination cyclophosphamide, doxorubicin and vincristine can also be offered.

Find out more about chemotherapy for uterine cancer.

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy may be offered for recurrent endometrial carcinoma that can’t be treated with surgery or radiation therapy.

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 if cancer is the mismatch repair deficient (MMRd) molecular subtype. It's usually given on its own.

For recurrent endometrial carcinomas that are not the MMRd molecular subtype and 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.

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 recurrent endometrial carcinoma.

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

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.