Endometrial cancer is a type of uterine cancer that begins when cells in the endometrium (inner lining of the uterus) grow out of control. Surgery is the most common treatment for the majority of people with endometrial cancer. You may need additional treatments based on the results of other tests.

This article will explain seven treatment options for endometrial cancer, including surgery, radiation therapy, and hormone therapy, so you can better understand your care choices.

Factors in Choosing Treatment

There is no single treatment that works best for everyone with endometrial cancer. A gynecologic oncologist (a doctor who specializes in cancers of the female reproductive system) can help you choose the best treatment for you based on several factors, including:

• Type of endometrial cancer — These include endometrioid and serous cancers.
• Cancer stage and grade — Cancer stage and grade describe how far the cancer has spread and how aggressive it is.
• Hormone receptor status — Treatment will depend on whether the cancer grows in response to hormones like estrogen or progesterone.
• Tumor biomarkers — Genes or proteins provide more information about your cancer.
• Your age and overall health — These factors can help determine which treatments your body can handle.
• Whether you want to have children in the future — Some treatments can affect fertility.

Potential side effects may also be a factor in which treatment option is most suitable for you. Your oncologist can share which side effects are possible with each treatment, how common or rare they are, and ways to manage them. Together, you can discuss the potential risks and benefits of each treatment and decide on the best treatment plan for you.

Continue reading to learn more about the different treatment options for endometrial cancer.

1. Surgery

Surgery to remove the cancer is usually the first endometrial cancer treatment for most people.

It may be the only treatment needed for early-stage endometrial cancers.

There are several types of surgical procedures your cancer care team may recommend:

• Total hysterectomy — Removes the uterus and cervix
• Radical hysterectomy — Removes the uterus, cervix, parametrium (tissue surrounding the uterus), uterosacral ligaments (supportive bands of tissue), and the upper part of the vagina
• Bilateral salpingo-oophorectomy (BSO) — Removes the ovaries and fallopian tubes

A BSO is usually done at the same time as a hysterectomy. If you haven’t gone through menopause, your cancer care team may suggest a hysterectomy alone.

Additional Surgery Options

Depending on the type and grade of your cancer, your cancer care team may recommend removing nearby lymph nodes during a hysterectomy or BSO. Lymph nodes are small, bean-shaped structures in the immune system that help filter harmful substances and fight infections. Testing lymph nodes can determine if the cancer has metastasized (spread), which is essential for staging and choosing effective treatments.

If your cancer has spread throughout the abdomen (stomach area), you may need debulking surgery. Debulking aims to reduce the size of a tumor when it cannot be completely removed. This procedure can help other treatments work better.

Surgery Side Effects

Removing your uterus with any type of hysterectomy will cause infertility. This means you won’t be able to become pregnant in the future. If you have your ovaries removed with a BSO, you’ll start menopause (if you haven’t already).

If you have your lymph nodes removed, it can cause a buildup of fluid and swelling in the area called lymphedema.

2. Radiation Therapy

Radiation therapy uses high-energy X-rays or other radiation to kill cancer cells. It is often started about four to six weeks after surgery, giving your body time to heal.

In some cases, radiation therapy may be given before surgery to shrink very large tumors, making them easier to remove. Radiation therapy may also be given as the main treatment, instead of surgery, for people who aren’t healthy enough for surgery.

Types of Radiation Therapy

There are two main types of radiation therapy used for endometrial cancer — brachytherapy and external beam radiation therapy.

In brachytherapy (internal radiation therapy), a small cylinder with radioactive material is placed inside the vagina. This limits radiation exposure to nearby healthy tissues, like the bladder and rectum. Treatments are done in a hospital or treatment center and may last a few minutes to a few days, depending on the dose and type.

External beam radiation therapy uses a machine outside of your body to focus radiation on the affected area. This type of radiation is usually given five days a week for up to six weeks.

In some cases, you may receive both brachytherapy and external beam radiation therapy for the best results.

Radiation Side Effects

In the short term, radiation for endometrial cancer may cause side effects including a skin rash or irritation to the bladder, rectum, or vagina. In the longer term, it may leave you with a higher risk for:

• Scar tissue in the vagina, which may make penetrative sex painful
• Weakening of the bones
• Earlier menopause
• Severe swelling known as lymphedema
• Rarely, a bowel blockage

3. Chemotherapy

Chemotherapy (chemo) uses drugs to kill cancer cells. It’s often used to treat advanced endometrial cancer or high-grade early-stage endometrial cancer (cancers that are more aggressive).

How Chemotherapy Is Given

Chemo drugs for endometrial cancer are usually given intravenously (directly into a vein), though some for later-stage cancer are taken orally (by mouth). Chemotherapy is usually given in cycles. Each cycle involves a period of active treatment followed by a period to rest and recover.

Common Chemotherapy Regimens

Chemotherapy for endometrial cancer often involves a combination of two or more drugs. Common regimens include:

• Carboplatin (Paraplatin) plus paclitaxel (Taxol)
• Carboplatin plus docetaxel (Taxotere)
• Cisplatin (Platinol) plus doxorubicin (Adriamycin)
• Cisplatin, paclitaxel, and doxorubicin

Read more about chemotherapy for endometrial cancer and its potential side effects.

4. Hormone Therapy

Hormone therapy uses drugs that mimic or block hormones to slow the growth of endometrial cancer. This treatment is often combined with chemotherapy for people with advanced endometrial cancer or recurrent endometrial cancer (cancer that returns after treatment). Progestins and drugs that block or lower estrogen levels are the main types of hormone therapy used for endometrial cancer.

Progestins

Progestins are the most common type of hormone therapy used to slow the growth of endometrial cancer. Medroxyprogesterone acetate (Provera) and megestrol acetate (Megace ES) are the most common types of progestins. These drugs can be taken as a pill, a liquid, or an injection.

Some types of early endometrial cancers can be treated with an intrauterine device (IUD) inserted into the uterus that releases a progestin called levonorgestrel.

Progestins may be the main treatment for individuals with early-stage endometrial cancer who want to have children in the future.

Hormone Therapies That Affect Estrogen

Other hormone treatments for endometrial cancer work by blocking the effect of estrogen or decreasing its production. While these therapies aren’t approved by the U.S. Food and Drug Administration (FDA) specifically for treating endometrial cancer, they are sometimes prescribed “off-label.” These treatments include:

• Selective estrogen receptor modulators (SERMs) — This category of drugs blocks estrogen from reaching cancer cells. Tamoxifen (Soltamox) is a commonly used SERM.
• Luteinizing hormone-releasing hormone (LHRH) agonists — LHRH agonists stop the ovaries from making estrogen and are often used in individuals with functioning ovaries. They include goserelin (Zoladex) and leuprolide (Lupron Depot).
• Aromatase inhibitors — These prevent fat tissue from producing estrogen. They’re mostly used in cases where surgery isn’t an option, though researchers are looking into other uses for these drugs. Examples include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).

Hormone Therapy Side Effects

Hormone therapy for endometrial cancer largely mirror symptoms of menopause. They may include:

• Bloating
• Weight gain
• Vaginal dryness
• Hot flashes

5. Immunotherapy

Immunotherapy uses your own immune system to kill cancer cells. This type of treatment may be recommended for people with advanced or recurrent endometrial cancer or if other treatments, like surgery and radiation, aren’t possible.

Immune checkpoint inhibitors (ICIs) are the main type of immunotherapy used to treat endometrial cancer. These drugs block proteins that stop the immune system from attacking cancer cells, allowing it to target and destroy them more effectively. Examples of ICIs include:

• Dostarlimab-gxly (Jemperli)
• Durvalumab (Imfinzi)
• Pembrolizumab (Keytruda)

Immune checkpoint inhibitors are generally given by IV every three to six weeks.

Some immune checkpoint inhibitors work best against cancer cells with specific biomarkers. Talk to your cancer care team to find out if your cancer cells have been tested for these biomarkers.

Immunotherapy Side Effects

Immunotherapies can cause a wide range of side effects depending on which type is used. Common side effects include:

• Weakness
• Rash or itching
• Fever
• Joint pain
• Constipation
• Diarrhea

In rare cases, immunotherapies may cause an infusion reaction (like an allergic reaction) or an autoimmune reaction. These are more serious problems that will require medical treatment.

6. Targeted Therapy

Targeted therapies use drugs to block specific proteins or genetic changes that help cancer cells grow and spread. This treatment is typically used for advanced or recurrent endometrial cancer. It may be given alone or with other treatments, such as chemotherapy or immunotherapy.

The use of targeted therapy drugs for endometrial cancer is relatively new. As of December 2024, lenvatinib (Lenvima) is the only targeted therapy approved by the FDA for treat endometrial cancer. Lenvatinib is a kinase inhibitor that works by targeting proteins that cancer cells use to grow. It can also stop the formation of new blood vessels that help tumors grow. You take lenvatinib once a day as a pill.

Doctors will sometimes prescribe certain targeted therapies off-label for endometrial cancer, including:

• Bevacizumab (Avastin) — This drug blocks the formation of new blood vessels. It’s given as an IV infusion every two to three weeks.
• Everolimus (Afinitor) and temsirolimus (Torisel) — These targeted drugs block a protein called mTOR that helps cancer cells grow. Everolimus is given as a daily pill, while temsirolimus is given as a weekly IV infusion.

Targeted Therapy Side Effects

In general, side effects of targeted therapy for cancer can include:

• Skin problems such as a rash or sensitivity to sunlight
• Hair changes such as hair thinning or more hair on the face
• Higher blood pressure
• Heart damage
• Autoimmune reactions

7. Clinical Trials

Clinical trials are research studies that investigate whether a new treatment for endometrial cancer is safe and effective. The American Cancer Society recommends that women with stage 4 or recurrent endometrial cancer consider joining a clinical trial. Talk to your cancer care team to find out if you qualify for any clinical trials.

Work With Your Care Team

Endometrial cancer treatment isn’t one-size-fits-all — it depends on the type and stage of your cancer, your health, and your personal preferences, like preserving fertility. Work with your gynecologic oncologist to create a personalized plan that fits your needs.

It’s important to stay proactive by informing your doctor about side effects or changes during treatment. Following your treatment plan, attending follow-ups, and staying in touch with your care team will give you the best chance for success. Remember, your care team is there to support you.

Find Your Team

On MyEndometrialCancerTeam, the social network for people living with endometrial cancer and their loved ones, members come together to ask questions, give advice, and share their experiences with life and care challenges related to life with endometrial cancer.

Have you been diagnosed with endometrial cancer? What treatments are you using to manage your condition? Share your experience in the comments below, or post to your Activities feed.