Treatment options for womb cancer

A team of health professionals decides what treatment you might need. They also decide what treatment options you have.

The most common treatments for womb cancer are:

• surgery
• radiotherapy
• chemotherapy
• hormone therapy
• immunotherapy and targeted treatment

You might have one or more of these treatments.

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). Your doctor will talk to you about your treatment options, their benefits, and the possible side effects.

Most people are referred to a womb cancer MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team usually includes:

• a doctor who treats conditions of the female reproductive system (gynaecologist)
• a specialist surgeon
• cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
• a specialist cancer nurse (also called clinical nurse specialist)
• a pathologist (an expert who examines any cancer or tissue the surgeon removes)
• a pharmacist
• a radiologist (who looks at your scans and x-rays)
• a dietician (who offers support and advice about eating and drinking)

The MDT may also include health professionals who look after people with advanced (metastatic) womb cancer. They can help with symptom control. They include:

• the palliative care  team
• a clinical nurse specialist for palliative care

Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.

Your treatment will depend on:

• where your cancer is
• how big it is and whether it has spread (the stage)
• the type of cancer
• how abnormal the cells look under a microscope (the grade)
• the risk of your cancer coming back after surgery (low, intermediate, high-intermediate, high)
• whether your cancer has any gene changes (mutations)
• your general health and level of fitness
• your preferences

If you’ve been diagnosed with advanced cancer

Deciding about treatment can be difficult when you have advanced cancer.

It helps to understand:

• what treatment can do for you
• how it might affect your quality of life
• what side effects it has

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

For information and support you can contact our Cancer Research UK nurses on 0808 800 4040, from Monday to Friday, 9am to 5pm.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to support you at home.

Treatment overview

The main treatments are:

• surgery

• radiotherapy

• chemotherapy

• hormone therapy

• immunotherapy and targeted treatment

You have one or more of these treatments. This depends on the stage and risk group of your cancer and also how well the treatment works.

Treatment by risk group

Surgery is the main treatment for early stage womb cancer. Generally, your surgeon removes:

• your womb and cervix (hysterectomy)
• both ovaries and fallopian tubes

They might also remove lymph nodes in your pelvis to check for cancer cells.

When you are diagnosed with womb cancer your doctors will do various tests on your cancer. After your operation they do more tests on the tissue they remove.

These tests along with the scans you had to diagnose your cancer find out more about the cancer. It also helps them know more about the risk of it coming back after surgery. This helps them to decide on the best treatment for you.

Low risk womb cancer

You have surgery to remove the womb, fallopian tubes and ovaries. This is a hysterectomy. You usually don’t need any other treatment. If you can’t have surgery, you may be able to have radiotherapy.

For those with stage 1A low grade cancer and who are premenopausal it may be possible to keep your ovaries. Talk to your doctor about this if this is a concern for you.  

Intermediate risk womb cancer

Your first treatment is surgery, a hysterectomy. Your surgeon will remove your womb, fallopian tubes and ovaries. They may also remove some lymph nodes in the pelvis.

After surgery you usually have internal radiotherapy (brachytherapy).

For those under 60 years of age your doctor may say you don’t need to have any other treatment after your operation. They will discuss the risks and follow-up with you.

High-intermediate risk womb cancer

You have surgery to remove the womb, fallopian tubes and ovaries. This is a hysterectomy. This usually includes your surgeon checking the nearby lymph nodes for cancer cells. This is also called a sentinel lymph node biopsy.

After surgery you may have one of the following treatments:

• external radiotherapy – this is the most common treatment after surgery
• chemotherapy with radiotherapy or chemotherapy followed by radiotherapy, or both
• internal radiotherapy instead of external - this is sometimes considered if the risk is lower and lymph nodes that were removed during surgery are clear of cancer

High risk womb cancer

After surgery you may have one of the following:

• external radiotherapy with chemotherapy and then more chemotherapy
• chemotherapy followed by radiotherapy
• chemotherapy on its own

Some people may have treatment with immunotherapy or a targeted cancer drug. This will depend on your situation and whether you’ve had other treatments before. Possible treatments include:

• immunotherapy with chemotherapy
• immunotherapy on its own
• immunotherapy and a targeted cancer drug

If you have a carcinosarcoma, your treatment is the same as treatment for high-risk womb cancer.

Treatment for womb cancer that has come back

Your treatment will depend on what treatment you have already had.

If you've had surgery you may have surgery again and you usually have radiotherapy with internal radiotherapy. Your doctor may suggest chemotherapy as well.

If you had radiotherapy your doctor may suggest surgery to remove the cancer. They may also suggest cancer drug treatment after surgery. Cancer drug treatments include:

• chemotherapy – usually carboplatin with paclitaxel
• hormone treatments – you may be offered this if you have a low grade cancer. Hormone treatments include: medroxyprogesterone or megestrol acetate, letrozole, arimidex, fulvestrant 
• targeted treatments and immunotherapies – this includes pembrolizumab, lenvatinib and dostarlimab

Fertility preserving treatment for womb cancer

Most treatments for womb cancer will affect your ability to have children. Hearing this when you haven’t started a family or haven’t finished will be difficult.

Whether it is possible to have fertility preserving treatment will depend on:

• how big your cancer is and how far it has grown, this is the stage of your cancer
• how abnormal the cancer cells are, this the grade of your cancer

To have fertility preserving treatment your cancer needs to be at an early stage. This means it needs to be stage 1A grade 1 womb cancer.

The usual treatment for early stage womb cancer is surgery. This gets rid of the cancer for nearly all those having it. Choosing to have fertility preserving treatment means you aren’t having standard treatment. Your doctor will talk to you about possible risks of not having surgery straight away.

Anyone wanting to have fertility preserving treatment is usually seen at a specialist centre. First, they will want to confirm the stage of your cancer. This means that you will need to have a sample of tissue taken. This is called a biopsy. You will also need to have an MRI scan.

Fertility preserving treatment means taking the hormone treatment progesterone. This aims to shrink the cancer and for some it may go away. Then after six months of hormone treatment you have another biopsy of your womb and MRI scan to check about how well it is working.

If treatment hasn’t worked your doctor will recommend you have surgery to remove the cancer. If it is working you have a chance to get pregnant. Your doctor may refer you to a fertility specialist.

Your doctors will want to see you regularly and you will need tests. This is to monitor the cancer and whether it has grown. 

Once you have had your children, your specialist will recommend that you have surgery to remove your womb.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.