HEALTH CONDITION

Treatment

Surgery is often the main treatment for womb cancer. The best treatment will depend on your individual circumstances.

Your cancer care team

People with cancer should be cared for by a team of specialists.

The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, a pathologist, a radiographer and a specialist nurse.

Other members may include a dietitian, a physiotherapist and an occupational therapist. You may also have access to clinical psychology support.

When deciding which treatment is best for you, your healthcare professionals will consider:

  • the type and size of the cancer
  • what grade it is
  • your general health
  • whether the cancer has spread to other parts of your body
  • whether fertility is a matter of concern – this is rare because of the age that womb cancer usually occurs

They will discuss and recommend the best treatment for you based on these considerations. The final decision on which type of treatment you have, if any, is always yours.

Before going to hospital to discuss your treatment options, it can be useful to write a list of questions you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

The stages of womb cancer and the main treatment options are outlined below.

Stages of womb cancer

Doctors will use the results of your tests to identify the "stage" of your cancer (how far the cancer has spread). The stage will determine which types of treatments will be necessary.

Your chances of surviving womb cancer depend on the stage at which it's diagnosed.

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Treatment overview

The main treatment for womb cancer is to remove the womb (hysterectomy) together with the ovaries and fallopian tubes.

This is sometimes followed by radiotherapy or chemotherapy to try to kill any possible remaining cancer cells, depending on the stage and grade of the cancer.

Treatment for women who have not been through the menopause

Having a hysterectomy means you will no longer be able to get pregnant. Younger women who have not already reached the menopause may not want to have their womb and ovaries removed if they wish to have children.

In this case, it may be possible, under very specific circumstances, to treat the cancer using hormone therapy.

Treating advanced cancer

Advanced womb cancer requires a different course of treatment, usually depending more on chemotherapy.

Advanced cancer may not be curable, but the treatment aims to achieve a remission, where the cancer shrinks, making you feel normal and able to enjoy life to the full.

Even if there's no chance of a cure, surgery may be carried out to remove as much of the cancer as possible.

Radiotherapy, chemotherapy or hormone therapy can reduce symptoms such as pain by shrinking the cancer or slowing its growth.

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Surgery

Surgery for stage 1 womb cancer

If you have stage 1 cancer, you'll probably have a hysterectomy. This involves removing the womb, as well as both ovaries and the fallopian tubes, in a procedure called a bilateral salpingo-oophorectomy (BSO).

The surgeon may also take samples from the lymph nodes in the pelvis and abdomen, and other nearby tissue. These will be sent to the laboratory to see whether the cancer has spread.

Hysterectomy may be performed as keyhole surgery using a telescope (laparoscopic hysterectomy) or with a large cut across your tummy (abdominal hysterectomy). Laparoscopic hysterectomy has the benefit of minimal scarring and quicker recovery.

You'll probably be ready to go home 1 to 3 days after your operation, depending on the type of surgery. But it can take many weeks to recover fully.

After your operation, you'll be encouraged to start moving about as soon as possible. This is very important.

Even if you have to stay in bed, you'll need to keep doing regular leg movements to help your circulation and prevent blood clots. You'll be shown exercises by the nurses or physiotherapist to help prevent complications.

When you go home, you'll need to exercise gently to build up your strength and fitness. Discuss with your doctor or physiotherapist which types of exercise would be suitable for you.

Surgery for stage 2 or 3 womb cancer

If you have stage 2 or 3 womb cancer and the cancer has spread to the cervix or nearby lymph nodes in the pelvis, you may have a radical or total hysterectomy.

This involves the additional removal of the cervix and the top of your vagina, as well as the removal of the pelvic lymph nodes. You may also need radiotherapy or chemotherapy after surgery to reduce the risk of the cancer returning.

Surgery for advanced cancer (stage 4)

If you have advanced womb cancer, you may have surgery to remove as much of the cancer as possible. This is called debulking surgery.

This won't cure the cancer, but it may ease some of the symptoms. Your doctor will discuss whether debulking surgery is suitable for you.

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Radiotherapy

A course of radiotherapy will be recommended if your treatment team thinks there's a significant risk the cancer could return in the pelvis.

Radiotherapy may also be used to slow the spread of cancer when a surgical cure is not possible.

There are two types of radiotherapy used to treat womb cancer:

  • internal radiotherapy (also called brachytherapy) – where a plastic tube is inserted inside the womb and radiation treatment is passed down the tube into the womb
  • external radiotherapy – where a machine is used to deliver pulses of radiation to your pelvis

A course of external radiotherapy is usually given to you as an outpatient for 5 days a week, with a break at the weekend. The treatment takes a few minutes. The whole course of radiotherapy may last approximately 4 weeks, depending on the stage and position of the womb cancer.

Some women have brachytherapy as well as external radiotherapy. During brachytherapy, the device that delivers radiation is placed in your vagina.

There are different types of brachytherapy, involving either low, medium or high dose rates. With low-dose-rate methods, the radiation is delivered more slowly, so the device has to stay inside you for longer. You'll have to stay in hospital while you have the treatment. Your doctor will discuss this with you.

Radiotherapy has some side effects. Skin in the treated area can become red and sore, and hair loss may occur. Radiotherapy to the pelvic area can affect the bowel and cause sickness and diarrhoea.

As your course of treatment progresses, you're likely to get very tired. Most of these side effects will go away when your treatment finishes, although around 5% of women experience long-term treatment effects, such as diarrhoea and bleeding from the bottom.

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Chemotherapy

If you have stage 3 or 4 womb cancer, you may be given a course of chemotherapy.

Chemotherapy can be used after surgery to try to prevent the return of the cancer. In cases of advanced cancer, it may be used to slow the spread of the cancer and relieve symptoms.

Chemotherapy is usually given as an injection into the vein (intravenously). You'll usually be able to go home the same day you have chemotherapy, but sometimes you may need a short stay in hospital.

Chemotherapy is usually given in cycles, with a period of treatment followed by a period of rest to allow the body to recover.

Side effects of chemotherapy can include:

There is also an increased risk of an infection developing in your bloodstream (sepsis), as your body's ability to fight infection is reduced by chemotherapy.

The side effects should stop once treatment has finished.

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Hormone therapy

Some womb cancers are affected by the female hormone oestrogen. These cancers may respond to treatment with hormone therapy. Your doctor will discuss whether this is a possible treatment for your womb cancer.

Hormone therapy usually replaces a hormone called progesterone, which occurs naturally in your body. It uses artificial progesterone and is usually given as tablets.

The treatment is mainly used for advanced-stage womb cancers or cancer that has come back, and can help shrink the tumour and control any symptoms.

The treatment may have some side effects, including mild nausea, mild muscle cramps and weight gain. Your doctor will discuss these with you.

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Clinical trials

A lot of progress has been made in the treatment of womb cancer, and more women are living longer with fewer side effects. Some of these advances came through clinical trials, where new treatments and combinations of treatments are compared with standard treatment.

All cancer clinical trials in the UK are carefully monitored to make sure the trial is worthwhile and safely conducted. Participants in clinical trials often do better overall than those in routine care.

If you're invited to take part in a trial, you'll be given an information sheet. If you wish to take part, you'll be asked to give consent. You're always free to refuse or withdraw from a clinical trial without it affecting your care.

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Page last reviewed: Tue Jun 2021 Next review due: Wed Feb 2020

NHS Attribution