Uterine cancer: treatments
- Early diagnosis of cancer of the uterus is common and, in most cases, is identified and treated before the cancer has spread. This means that for a large proportion of women, surgery may be all that is required to cure the cancer. The major side effect of the surgery is that women can no longer have children. The surgery also induces menopause.
- If the cancer has spread beyond the uterus, then radiotherapy, hormone therapy or chemotherapy may be used in addition to surgery.
- Treatment for cancer of the uterus has a very high cure rate.
- Many years of treating cancer patients and the studies done to evaluate different treatments help doctors to know what is likely to work for a particular form and stage of cancer.
Surgery
Surgery treats the cancer by removing the uterus in an operation called a hysterectomy. It also allows the doctors to find out which type of cancer of the uterus you have and to check for any sign of spread.
Through an incision from the pubic area to the belly button, the surgeon will first wash out the abdominal cavity with a fluid which will later be examined for cancer cells.
The surgeon will then check through the entire abdomen and pelvis for signs of cancer spread, often referred to as metastasis. This part of the operation is called a laparotomy.
The removal of the uterus (hysterectomy) is performed next, also removing fallopian tubes and ovaries. This is called a bilateral salpingo-oophorectomy, a procedure that is always done when treating cancer of the uterus.
As soon as the uterus is removed, it will be examined by a pathologist (sometimes this procedure is referred to as a 'frozen section') to establish the type of cancer and whether the cancer has invaded the muscle wall of the uterus. A frozen section is done while the operation is still underway. If the cancer is only on the surface or is in a very early stage, no further surgery or additional treatment will be needed.
If the cancer is shown to be invading into the muscle, this increases the risk of spread to the pelvic and abdominal lymph nodes. Removal of the pelvic and abdominal lymph nodes is called a lymphadenectomy. This procedure will accurately identify patients with negative lymph nodes who need no further treatment. It also identifies patients with lymph nodes affected by cancer who may benefit from additional therapy.
If the cancer of the uterus has spread to the cervix, a small portion of the upper vagina and the ligaments supporting the cervix are also removed. If this is necessary, the operation will be longer.
When you wake up from the operation, you will find that you have several tubes in place. You will have an intravenous drip, which will give you fluid as well as medication. One or 2 tubes may also have been inserted into your abdomen to drain away fluid from the operation site. There will be a catheter in your bladder to drain away urine. As you recover from the operation, these tubes will be removed, usually within 3 to 5 days.
As with all major operations, you will experience some discomfort or pain. Pain relievers will be given through an intravenous drip or through an epidural into your spine. Some patients are comfortable using patient controlled analgesic (PCA). PCA is delivered through a drip and allows you to choose when you receive a dose of pain-relieving medication.
A few days after your operation, your doctor will have all the test results and will discuss any further treatment with you. Further treatment will depend on the type of cancer found, the stage of the disease and the amount of any remaining cancer.
Side effects of surgery
This is a major surgery so you may be in hospital for up to 7 days. Your recovery time will depend on different factors. Don’t expect to get back to your normal activities too quickly. For some women it may take 6 weeks or longer. For others it may take 6–12 months before they feel completely well.
After surgery, some women develop internal scar tissue called adhesions. This scar tissue can glue together internal body surfaces. Sometimes this can be painful and may affect the working of the bowel and the bladder. If you have not been through menopause, the removal of your ovaries will induce menopause, and with this sudden stop, you may develop strong symptoms such as hot flushes. These may be more severe than a ‘normal’ menopause where the gradual slowing of the production of hormones allows your body to become accustomed to being without them more easily. You may want to discuss with your gynaecological-oncologist whether hormone replacement therapy (HRT) is suitable for you. Because cancer of the uterus can be hormone-sensitive, HRT may not be advisable for some women.
If surgery has induced an early menopause there are long and short-term effects. For example, you will not be able to get pregnant or bear children.
Radiotherapy
Radiotherapy is the use of X-rays to destroy cancer cells. If radiotherapy is advised, you will be treated by a doctor who specialises in radiotherapy treatment for women with cancer of the uterus. This doctor will work closely with your gynaecological-oncologist.
Radiotherapy may be advised if you are not well enough for a major operation. It is also used if there is any suspicion at the time of your operation that minute amounts of cancer may remain after the operation, which cannot be detected by the surgeon or the pathologist. In this case, radiotherapy may be advised as a protective additional therapy. Additional therapies are often referred to as adjuvant therapies.
Radiotherapy can be given by using both internal and external means, with each having slightly different purposes in treatment. It is possible you may have both forms of radiotherapy.
Internal radiotherapy
Internal radiotherapy is also called brachytherapy. Brachytherapy means that the radioactive material is placed close to the tumour. Women with cancer of the uterus generally receive radiotherapy using an internal implant.
If there are concerns about any risk of cancer developing in the scar at the top of the vagina following surgery, adjuvant internal radiotherapy may be advised. The implant is inserted through the vagina or the tissues around the vagina using special applicators.
Recently there have been changes in the equipment and treatment options available so you will need to talk with your specialists about the options that are available and best for you.
Internal radiotherapy can be done in 2 ways, either continuously for up to 30 hours as a low dose-rate treatment, or as high dose-rate treatment given as several short treatments.
If you are having low dose-rate continuous treatment, you will need to be in hospital to have an implant inserted under general anaesthetic. Because the implant is radioactive, it will be necessary to stay still in bed in a room on your own while the implant is in place. It is not advisable for children or pregnant women to visit you during this time. Your radiation-oncologist and the nursing staff will explain the necessary precautions to you and your family. These may vary from hospital to hospital depending on the equipment that each uses.
High dose-rate treatment may be given to you without you needing to be admitted to hospital. You will need to make between 4 and 8 visits to the treatment centre as an outpatient. The actual treatment time for each high dose-rate radiation treatment can be as little as 5–10 minutes.
External radiotherapy
In external radiotherapy, X-rays from a large machine are directed at the part of the body needing treatment. For women with cancer of the uterus, the area treated is the pelvic area but this can be extended to include other regions of the body if the cancer has spread.
External radiotherapy is usually given to you as an outpatient, 5 days a week for 4–6 weeks. The actual treatment takes a few minutes each time. However, the waiting and preparation time is longer as this radiation treatment involves careful measurement and planning so the X-ray treatment is delivered just to the necessary areas. External radiotherapy does not cause pain or discomfort as it is being given.
Side effects of radiotherapy
Radiotherapy may cause a number of acute side effects which are temporary and can be controlled. These may include tiredness, depression, loss of appetite, diarrhoea, pain when passing urine and frequent urination. There may also be skin problems, and the skin between your buttocks may look and feel as if it has been sunburnt. Sometimes this effect occurs after radiotherapy has been completed.
Special creams can be used to relieve this burning feeling. There may be some hair loss in the area where radiotherapy has been targeted and your pubic hair may become sparse. It will grow back over time after the treatment is finished, however full regrowth could take a number of months. Internal radiotherapy can also have the effect of narrowing the vagina. Techniques to improve this narrowing of the vagina include using dilators and lubricating jelly. Sometimes, the effects of having radiotherapy may not become apparent for some time after your radiotherapy treatment has been completed. These late side effects may also be long-term; for some women they will be permanent. The effects can include inflammation of the rectum and perhaps the bowel and the bladder. Bladder inflammation is called radiation cystitis.
Hormone therapy
Cancer of the uterus is a hormone-sensitive cancer, that is, the cancer is stimulated to grow by certain hormones. Some women with cancer of the uterus have cancers that are more dependent than others on hormones for growth. Your ovaries are always removed during surgery for cancer of the uterus for two reasons. Firstly, as a source of the hormone oestrogen, they may contribute to the growth of your cancer. Secondly, the cancer may have spread to the ovaries. When your operation is done, the samples taken for the pathologist will be tested to check if your cancer is likely to respond to hormone treatment.
There are a variety of drugs, including Provera, that block the body’s use of oestrogen. Provera is a form of the female hormone progesterone. Tamoxifen, an anti-oestrogen drug, is also commonly used. Drug-based hormone therapy is taken orally. This type of hormone therapy tends to be used when cancer has returned after other treatments, if the cancer is widespread, or if the cancer is considered to be a high-risk type.
Hormone therapy can be extremely effective for advanced or recurring cancer of the uterus. It also has the advantage of causing few, and sometimes no, side effects.
Chemotherapy
Chemotherapy is the treatment of cancer using anti-cancer drugs. The aim is to destroy cancer cells while causing the least possible damage to normal cells. The drugs kill cancer cells by stopping them from multiplying.
Chemotherapy is usually given to women who have a very high-risk cancer, to women whose cancer is quite advanced when they are first diagnosed, or whose cancer has returned. It is also the treatment given when a cancer of the uterus is not responsive to hormone therapy.
Chemotherapy is usually given through a needle inserted in a vein. You may need to stay in hospital overnight or you may be treated as a day patient, depending on the drugs you are given and how you are feeling. A number of chemotherapy treatments, usually 6, may be given every 3–4 weeks over several months, depending on the actual disease and what other treatment is being used.
Side effects of chemotherapy
The side effects of chemotherapy vary according to the particular drugs used. These may include feeling sick, vomiting, depression, feeling off-colour and tired, and some thinning or loss of your body and head hair. These side effects are temporary and measures are always taken to either prevent or reduce them.
Making decisions about treatment
Sometimes making decisions about what is the right treatment for you is very difficult. You need to make sure that you understand enough about your illness, the possible treatment and side effects to make your own decisions. Don’t be hurried into making decisions. Waiting a few days will not make a difference to the success of your treatment.
If you are offered a choice of treatments, you will need to weigh up the advantages and disadvantages of each treatment. If only one type of treatment is recommended, ask your doctor to explain why other treatment choices have not been advised.
Once you have discussed your treatment choices with your doctor, you may want to talk them over with your partner, family or friends. You may talk with nursing staff, the hospital social or pastoral-care workers, or your own minister or priest.
You may want to ask for a second opinion from another gynaecologist-oncologist. Your specialist or local doctor can refer you to another specialist and you can ask for your records to be sent to the second-opinion doctor.
Last Reviewed: 02 April 2001
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