Your medical team will consider the type, grade, and stage of your cancer, as well as any other medical conditions you have to decide what is the best treatment option for you. These decisions are made by the multi-disciplinary team or MDT, a team composed of lots of different specialists.
Surgery
Most people with womb cancer have surgery to remove the womb and cervix (a total hysterectomy). Usually, both tubes and ovaries are removed at the same time (bilateral salpingo-oophorectomy). Sometimes your surgeon will also remove other tissue from the pelvis, such as surrounding lymph nodes (glands), tissue from around the womb or from the top of the vagina. Sometimes surgery for early stage cancer can be done by keyhole (laparoscopic or robotic) rather than through a large incision.
For more information on different types of surgery, what to expect or how to prepare for surgery, Cancer Research UK has good information.
Chemotherapy
Chemotherapy is a type of medication used to kill cancer cells. It is offered after surgery for some types of womb cancer (such as serous and clear cell) and if the cancer is high-grade. It is also sometimes offered as a first line treatment for advanced womb cancer. Chemotherapy medications are given through a drip into a vein and you may need to stay in hospital for several hours or sometimes overnight. There are a few different chemotherapy drugs that are given for womb cancer and sometimes two or three can be given in the same course.
Chemotherapy is well known to cause side effects. The nature of these often depends on which drug is given. They may include nausea, hair loss, tiredness, numbness or pins and needles in your hands and feet. Chemotherapy affects the immune system so you may be more susceptible to infections and infections may make you more unwell than they would normally. Your medical team will provide you with information about the side effects specific to the drugs you are given and let you know who to contact if you are unwell.
Radiotherapy
Radiotherapy uses high-energy rays of radiation (x-rays) to directly kill cancer cells. You might be offered this treatment after surgery to try to reduce the chance of the cancer coming back. Other reasons why radiotherapy might be used are that the cancer was not completely removed at surgery or that surgery is not possible, perhaps because of an advanced cancer diagnosis. There are different ways that radiotherapy can be given to treat womb cancer. It can be given externally to the pelvis from a machine that moves around the couch, known as external beam radiotherapy. Alternatively, it can be given internally by a small rod that is inserted into the vagina. This is known as brachytherapy.
Undergoing radiotherapy is not painful but there can be side effects, including diarrhoea, tiredness, dryness or sores in the vagina or an irritable bladder.
Hormone treatment
For advanced womb cancer, in those who are too unwell for surgery, or for whom surgery is very high risk, hormone treatment is sometimes considered. This is usually in the form of progesterone tablets or a hormone-releasing intrauterine device, or coil (a small device that is inserted into the womb and releases the progestin hormone locally to the womb lining). The coil may also be considered in those who have not yet gone through the menopause, have early stage cancer and who wish to preserve their fertility.
There are very few side effects to the coil. Some women find it painful when it is put in and a period-like pain might last for a few days afterwards. The coil does not always work as a treatment and some women, if they are fit enough, may still need to have a hysterectomy further down the line.
Targeted and immunotherapy drugs
Cancer cells differ to normal cells and these differences give them the ability to grow and survive. A group of drugs can target those changes and are called targeted cancer drugs.
Immunotherapies are drugs to assist the immune system in recognising and attacking cancer cells.
The current targeted and immunotherapy drugs are reserved for those with advanced womb cancer and are called Dostarlimab (Jemperli), Pembrolizumab (Keytruda) and Lenvatinib (Lenvima, Kisplyx).
Not all patients are suitable for targeted or immunotherapy drug treatment. You may be suitable if you have advanced or recurrent womb cancer and have received other treatments. Some patients may need to have changes in certain genes in their womb cancer to be suitable.
Endometrial hyperplasia (pre-cancerous change)
The risk of endometrial hyperplasia without atypia progressing to endometrial cancer is less than 5% over 20 years and the majority of cases of endometrial hyperplasia without atypia will return to normal during follow-up. You may be offered progesterone-based medication to treat this condition and help the womb lining return to normal. You may be offered follow-up in the gynaecology clinic and repeat biopsies until the womb lining returns to normal.
Atypical endometrial hyperplasia has a higher risk of developing into womb cancer and may be found alongside a womb cancer. For this reason, a hysterectomy is usually offered, especially if fertility is not needed. Sometimes progesterone-based medication is used to treat this condition and help the womb lining return to normal. This treatment may be offered to those who have not yet completed their families and want to keep their wombs.
Cancer Research UK has further detailed information on the current targeted and immunotherapy drugs available for womb cancer in the UK.
