Treatment Options For Early Endometrial Cancer and Beyond
- Endometrial cancer often causes symptoms such as abnormal vaginal bleeding, which is a flag for earlier detection.
- Recognizing other risks — like hormonal imbalances, family history, and genetics — aids in early diagnosis and treatment.
- Certain factors, like pregnancy, using birth control, and IUDs, can lower a woman’s risk of developing endometrial cancer.
- There is treatment for every stage, even when the cancer is advanced. The approach may include surgery, chemotherapy, and hormone therapy. Treatment for early-stage cancer tends to have good outcomes.
The cure rate for this disease is particularly high when the cancer is confined to the uterus at the time of diagnosis. However, even in the advanced stages, there are often still options.
Read MoreWhy is Early Diagnosis So Important?
Endometrial cancer typically starts in the endometrium, the inner lining of the uterus. This lining undergoes changes during menstrual cycles and plays a vital role in supporting a baby’s growth during pregnancy.While most cases of endometrial cancer show early symptoms, some do not. As the cancer spreads and the stage increases, the amount of treatment needed to cure the cancer increases and the survival rate decreases.
That’s why it’s so important to catch it as early as possible. But no matter when you receive your diagnosis, there is always hope, notes Dr. Dana Chase, gynecologic oncologist at the David Geffen School of Medicine at UCLA.
“There are a lot of new exciting treatments for advanced endometrial cancer that we’ve just discovered over the last couple years,” she says. “So even if you’re diagnosed with an advanced stage, ask your treating doctor what are the latest treatments or even potentially is there a clinical trial I can participate in for my endometrial cancer? … There’s a lot of research being done in new treatments for endometrial cancer, which is very exciting. ”
What Are the Symptoms?
“Often, people are having something like spotting, abnormal bleeding, or bleeding after menopause, and in situations like that, an ultrasound and an endometrial biopsy, or a biopsy that’s taken from the canal or the cavity of the uterus, is what we start with,” Dr. Mueller says.
Dr. Mueller says she can not overstate the importance of seeing a doctor if you have abnormal bleeding:
- More than 90% of women with endometrial cancer experience abnormal vaginal bleeding.
- If you are still having periods, abnormal bleeding might mean bleeding between periods or having very heavy periods.
- If you have gone through menopause and stopped having periods, any amount of vaginal bleeding is considered unusual. This is even more important if you are not taking hormone therapy for menopause symptoms like hot flashes or vaginal dryness.
- It’s normal for people who are taking hormone therapy for menopause to experience some bleeding in the first few months of treatment. But, if you are on hormone therapy and notice any bleeding, it’s still something you should talk to your doctor about.
Dr. Chase says that if you’ve always had irregular periods, it’s less likely that that you have endometrial cancer. However, doctors won’t rule it out.
“It’s important for women that haven’t gone through menopause yet … like if you’ve always had normal periods, they’ve always come every 28 days, for example, and all of a sudden for the last couple months you’re having bleeding in between periods. I would encourage you to go to the doctor and discuss that because that could lead them to want to do an endometrial biopsy,” she says.
Other symptoms of endometrial cancer may include:
- Pelvic pain: Some women may experience pain or discomfort in the pelvic area.
- Pain during intercourse: This symptom is less common but can occur in some cases.
- Unusual vaginal discharge: Watery or blood-tinged discharge may be a sign of endometrial cancer.
- Weight loss: Unexplained weight loss can sometimes be associated with cancer.
- Urinary problems: Difficulty or pain when urinating.
Many of these symptoms could generally be a sign that something is wrong and don’t necessarily point to endometrial cancer. All the more reason to proactively seek a medical opinion when you notice something unusual happening with your health.
Who is at Risk for Endometrial Cancer?
Many risk factors for endometrial cancer are linked to an imbalance of female hormones, especially estrogen and progesterone. These imbalances can stimulate abnormal growth of the endometrial lining, leading to cancer.
These are conditions and factors associated with a higher risk of endometrial cancer:
- Lynch Syndrome: This is a genetic mutation that affects the ability of cells to repair themselves. You will need a genetic test to see if you have this mutation. If you do, doctors recommend you start endometrial cancer screening at age 35.
- Strong Family History of Endometrial or Colorectal Cancer: If your mother, sister, aunt or cousin was diagnosed with endometrial cancer, especially at an early age, this puts you at higher risk for an endometrial cancer diagnosis.
- PCOS: The hormonal imbalances plus insulin resistance associated with this condition raises the risk of endometrial cancer.
- Never Giving Birth: This increases risk mainly due to the significant hormonal changes that pregnancy provides
- History of Breast Cancer Treated with Tamoxifen: Tamoxifen mimics estrogen in the uterus, raising endometrial cancer risk.
- Early Menstruation or Late Menopause: Starting periods before age 12 or entering menopause after 55 extends the time your body is exposed to estrogen, increasing the risk.
- Obesity: Obesity increases estrogen levels, which can stimulate endometrial cell growth. By some estimates, obesity increases the chances of endometrial cancer threefold.
- Estrogen-Only Hormone Therapy: This treatment boosts endometrial growth without progesterone’s balancing effect, increasing cancer risk.
- Older women: Women between 55-64 years old who have gone through menopause are at greater risk, though a woman of any age can be diagnosed.
Dr. Chase points out that is very important to understand your risks for endometrial cancer because unlike many other cancers, there is no screening test.
“That being said, we’re still able to find endometrial cancers in early stages because most women, thankfully come to the doctor when they have irregular bleeding and we can find it at an early stage, but to this day, with the exception of Lynch Syndrome, we do not have a screening test for endometrial cancer,” Dr. Chase says.
If you have any of these conditions or factors, you should talk to your doctor about getting screened for endometrial cancer.
Also keep in mind that women who have gone through menopause and women who are white are generally at higher risk — though any woman can be diagnosed with the disease.
Some factors may reduce a woman’s risk of developing endometrial cancer, including:
- Pregnancy: Being pregnant reduces the number of menstrual cycles a woman experiences in her lifetime, decreasing prolonged exposure to estrogen, which can protect against endometrial cancer.
- Birth Control Pills: The use of birth control pills balances estrogen with progesterone, reducing the risk of endometrial overgrowth and thereby lowering the risk of cancer. The protective effect can last for years even after you stop taking them.
- Intrauterine Device (IUD): These devices, inserted into the uterus, release progestin, which helps thin the endometrial lining and can lower the risk of endometrial cancer.
What are the Treatment Options?
Treatments for endometrial cancer usually include one or more of the following:
Surgery
Doctors usually treat early-stage endometrial cancer with surgery as the main approach.
The most common procedure is a hysterectomy, where the surgeon removes the uterus. This can be done through different methods: an abdominal incision, laparoscopically, or vaginally. They often also remove both ovaries and fallopian tubes in a procedure called bilateral salpingo-oophorectomy. This helps lower the risk of the cancer spreading or coming back.
“Doctors usually treat early-stage endometrial cancer with surgery as the main approach,” explains Dr. B.J. Rimel, a gynecologic oncologist at Cedar-Sinai Medical Center in Los Angeles. “During the surgery, doctors may also perform staging to see how far the cancer has spread. This involves taking out and examining nearby lymph nodes and tissues.”
Dr. Rimel adds that even in more advanced stages, doctors might still use surgery to remove as much of the tumor as possible, a process known as debulking.
This helps ease symptoms and makes other treatments like radiation or chemotherapy more effective. In cases where curing the cancer isn’t possible, surgery can still help improve quality of life by relieving symptoms.
Chemotherapy and Radiation
Radiation therapy, which uses high energy radiation to kill cancer cells, is a common treatment for endometrial cancer, particularly when the cancer is at an advanced stage or when surgery isn’t a complete solution. Chemotherapy is also considered especially useful in more advanced stages or when the cancer has spread beyond the uterus.
When they are used in endometrial cancer treatment, radiation and chemo are often combined to enhance the effectiveness, a strategy known as chemoradiation.
“A patient might get chemotherapy first or maybe even radiation first before you reconsider or consider taking her for surgery. But usually surgery is really the first step in the treatment for endometrial cancer for the majority of patients. Radiation is sometimes used in addition to surgery to kill any remaining cancer cells, reduce the risk of recurrence, or as an alternative when a patient cannot undergo surgery due to health reasons,” Dr. Chase says.
Hormone therapy
This therapy involves using medications that affect hormone levels in the body, aimed at slowing the growth of hormone receptor-positive endometrial cancer cells. Hormone therapy is especially useful for patients whose cancer has progressed or returned after initial treatment, and for those who may not be suitable candidates for surgery or radiation due to health reasons.
The most common hormone used in this therapy is progesterone, available in various forms such as pills, injections, or intrauterine devices. This can be a less aggressive option compared to chemotherapy, offering a treatment pathway that can significantly improve quality of life with potentially fewer side effects.
“Hormonal therapy commonly works because most of endometrial cancers are estrogen receptor positive,” Dr. Michael Toboni, an assistant professor in the division of gynologic oncology at the University of Alabama at Birmingham tells SurvivorNet. “So if you give progesterone, it can counteract the estrogen feeding the cancer. This is commonly given with multiple anti-estrogen medications or an anti-estrogen medication in combination with another medication that inhibits a common pathway in endometrial cancer.”
Immunotherapy and targeted drug therapy
According to Dr. Rimel, immunotherapy and targeted drugs are two new treatments that offer a lot of promise to patients in all stages of endometrial cancer.
Both of these innovative treatments target cancer cells without affecting normal cells. Immunotherapy boosts the body’s immune system to fight the cancer, while targeted therapy drugs interfere with specific molecules involved in tumor growth and progression, offering a precise approach to halt or slow the spread of the disease.
For example, the targeted drug trastuzumab deruxtecan, known as Enhertu, was recently approved for any tumor that expresses a high amount of the protein HER2 (human epidermal growth factor receptor 2), including endometrial cancers. It is one of several option doctors may consider to treat your cancer if tests show your cancer is advanced and is strongly HER2 positive.
As an ADC, or Antibody-Drug Conjugate, Enhertu is a type of targeted cancer therapy that combines an antibody with a chemotherapy drug. The treatment is designed to deliver the chemotherapy directly to cancer cells by binding to specific proteins that sit on the surface of the cells, reducing the impact on healthy cells and increasing the effectiveness of the drug.
Enhertu specifically finds and neutralizes HER2 (Human Epidermal Growth Factor Receptor 2), a protein that can promote the growth of cancer cells.
“It’s actually a type of chemotherapy because the antibody is bringing the drug directly to the cancer cell, that drug can be dumped in directly to the cancer cell and hopefully avoid a lot of the systemic kinds of symptoms that people have as a result of chemotherapy,” Dr. Rimel explains. “It’s not only an efficient way of bringing drug to cancer cell, but it’s also a very effective way. And recently it was approved for tumors that express this molecule, HER2, which is present in a proportion of endometrial cancers, not all of them.”
Dr. Rimel says your doctor should test you to see if your cancer has high levels of HER2. If it does, this drug is one option that may help you live longer with fewer side effects than chemo or radiation.
The treatment options vary based on several factors, including:
- Staging: This takes into account the local invasion of the disease, if there is lymph nodes involved, and if there is distant or metastatic disease. More local invasion, positive lymph nodes, and distant disease spread all increase the stage of the disease and change what treatment is recommended. Staging information is gathered from imaging and surgery results. Generally, early stages are more treatable with good outcomes. Doctors will often perform staging based on samples they take from surgery, a procedure known as a biopsy.
- Pathology: This is what the cells look like under the microscope after a biopsy or surgery. If there is evidence of more aggressive pathology with invasion into blood vessels or a more aggressive cell type treatment can change.
- Patient specific factors: The patients age, overall health, ability to undergo surgery or chemotherapy, and treatment goals are all taken into consideration when recommending treatment
The combination of treatments and the expected outcomes depend on how advanced your cancer is. The earlier it’s treated, the better the results. However, there are options at every stage.
The National Comprehensive Cancer Network (NCCN), a coalition of about 30 top cancer treatment centers, generally recommends the following treatment approaches:
Stage I (Cancer is confined to the uterus)
- Surgery: The main treatment is typically a hysterectomy (removal of the uterus) often with bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes). Lymph node dissection may also be performed to check for the spread of cancer.
- Radiation Therapy: May be recommended after surgery to eliminate any remaining cancer cells, particularly for patients at higher risk of recurrence.
- Hormone Therapy: Progestin therapy might be used for patients who wish to preserve fertility or for those for whom surgery is not an option.
Stage II (Cancer has spread from the uterus to the cervical stroma, the connective tissue that holds the cervix in place, but not beyond)
- Surgery and Radiation Therapy: A combination of hysterectomy and radiation therapy is typically recommended.
- Chemotherapy or Hormone Therapy: May be considered in certain cases, especially if the cancer has high-risk features.
Stage III (Cancer has spread beyond the uterus but is still within the pelvic area)
- Surgery: Attempt to remove as much of the cancer as possible.
- Radiation Therapy and Chemotherapy: Often used after surgery to target any remaining cancer cells in the pelvis or to manage cancer that cannot be surgically removed.
Stage IV (Cancer has spread to distant organs)
- Palliative Care: Focuses on relieving symptoms and improving quality of life.
- Chemotherapy: Common treatment to slow the spread of cancer and relieve symptoms.
- Hormone Therapy: May be effective for cancers that are hormone receptor-positive.
- Targeted Therapy and Immunotherapy: Might be options based on the cancer’s specific genetic markers.
- Enhertu: Doctors may consider as a choice for treating advanced endometrial cancer that is HER2-positive and has come back after previous treatments, as predetermined through testing.
“When you meet with your surgeon and you go through the pathology report, that gives us a lot of information that helps us to decide if you need additional treatment. There are actually a lot of risk factors that can be inside the uterus itself and so the pathology report tells us about the cell type,” Dr. Mueller says.
Of course, the choice of treatment is highly personal. It depends on your goals and expectations. You will need to have detailed discussions with your doctor to make the best decisions for you.
Questions to Ask Your Doctor
- What stage is my cancer?
- What treatments are likely to be most effective for me?
- For the treatment we choose, what are the benefits, side effects, and expected outcomes?
- Should I undergo any genetic testing to determine the specific characteristics of my cancer?
- What part of my treatment will be covered by my insurance and how much can I expect to pay out of pocket?
Learn more about SurvivorNet's rigorous medical review process.
