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Endometrial cancer - Treating womb cancer

Stages of womb cancer

Health professionals use a staging system to describe how far womb cancer has advanced. These stages are:

  • stage 1 – the cancer is still contained inside the womb (uterus)
  • stage 2 – the cancer has spread to the neck of the womb (the cervix)
  • stage 3 – the cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes
  • stage 4 – the cancer has spread to the soft tissues of the abdomen, or into other organs, such as the bladder, bowel, liver, or lungs

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

If womb cancer is diagnosed at stage 1, the outlook is good and around 95% of women live for at least five more years. Many women with stage 1 womb cancer are cured.

If womb cancer is diagnosed at stage 2, you have around a 77% chance of living at least five more years.

If the condition is diagnosed at stage 3, you have a 40% chance of living at least another five years.

Around one in four womb cancers are diagnosed at stage 4. By this point, you only have a 15% chance of living at least five more years.

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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 haven't been through the menopause

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

In this case, under very specific circumstances it may be possible 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 both ovaries and the fallopian tubes in a procedure called a bilateral salpingo-oophorectomy (BSO), as well as the uterus (hysterectomy).

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.

The most common hysterectomy technique involves using one large cut across your tummy to access the womb and remove it.

It's sometimes possible to use a technique called a laparoscopic hysterectomy, also known as a keyhole hysterectomy. This involves using several small cuts so a special type of telescope (laparoscope) and other surgical instruments can be used.

This means the surgeon can see inside your body and remove your womb through your vagina with little scarring.

You'll probably be ready to go home three to five days after your operation, or less if you had keyhole 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, and 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 treatment 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 known as brachytherapy) – where a plastic tube is inserted inside the uterus 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 five days a week with a break at the weekend. The treatment takes a few minutes. The whole course of radiotherapy may last approximately four weeks depending on the stage and position of the womb cancer.

Some women have internal radiotherapy (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 continue with long-term treatment effects, such as diarrhoea and rectal bleeding.

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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 being 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 naturally occurs in your body. Artificial progesterone is used and is usually given as tablets.

It's mainly used to treat 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 were discovered 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 sign your consent. You're always free to refuse or withdraw from a clinical trial without it affecting your care.

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