Endometrial Cancer Treatment Options

Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can’t have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:

• External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
• Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can’t be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for uterine cancer is usually given by vein (intravenous). It’s usually given in cycles. Each cycle has a treatment period followed by a rest period.

Hormone therapy may be used for women with advanced uterine cancer or cancer that has returned. It’s most often used along with chemotherapy. There are a few types of hormone therapy available:

• Progestins: This is the most common hormone therapy for uterine cancer. The drug acts like the hormone progesterone which slows the growth of the endometrial cancer cells.
• Tamoxifen: An anti-estrogen drug used to block estrogen from fueling the endometrial cancer cells. It may be alternated with progesterone during treatment because that’s often tolerated better than progestins alone.
• Luteinizing hormone-releasing hormone agonists (LHRH agonists): These drugs reduce estrogen levels in women with functioning ovaries by inhibiting their ability to produce the hormone.
• Aromatase Inhibitors: These drugs stop the production of additional estrogen in the body's fat tissue after the ovaries have been removed.

Targeted therapy is a category of drugs that target and attack specific changes in cells that cause cancer to grow. Compared to chemotherapy, targeted therapy causes less harm to normal cells. Currently, the use of targeted therapy for endometrial cancer is under extensive research.

A common test performed on removed endometrial cancer cells determines whether the HER2 protein is overexpressed, which can cause rapid cell growth. If overexpressed, targeted therapy involving HER2-blocking drugs is used to slow down or block rapid cell reproduction.

Targeted therapies for endometrial cancer include:

• Anti-angiogenesis therapy, which blocks the growth of blood vessels supporting tumor growth.
• Mammalian target of rapamycin (mTOR) inhibitors, which prevent cancer cell growth and new blood vessel formation by blocking the mTOR protein.
• Kinase inhibitors, which help block the formation of new blood vessels in tumors and target some of the proteins in cancer cells that promote growth. These drugs may be used in combination with immunotherapy to treat some advanced endometrial cancers when other drugs have been unsuccessful.

Immunotherapy is a form of cancer treatment that harnesses your body's immune system to identify, target, control, and eliminate cancer cells. Endometrial cancer can be treated with a category of immunotherapy drugs known as checkpoint inhibitors, which target PD-1, a protein found on T cells, a type of immune system cell. These drugs make it possible for the body to recognize cancer cells as harmful so they can be destroyed.

Cancer research plays a crucial role in improving endometrial cancer care. Our participation in clinical trials enables us to provide eligible patients in the Portland and Vancouver area access to new treatment options. Your endometrial cancer specialist may discuss clinical trial options with you if you are eligible and could benefit from participating. Learn more about the available clinical trials at Compass Oncology.