If you’ve been diagnosed with advanced endometrial cancer, you might feel like you don’t have many options. However, doctors and researchers are searching for new ways to treat uterine cancer. Studies show that new and existing treatments improve survival with advanced endometrial cancer.

In this article, we’ll cover eight treatments for advanced endometrial cancer and how they work. We’ll also talk about supportive care options that can improve your quality of life while living with cancer. If you have questions about your individual treatment plan, your cancer care team will have more details.

Standard Treatments for Advanced Endometrial Cancer

People with advanced endometrial cancer have either stage 3 or stage 4 disease. This means that the cancer has spread outside the uterus. Your treatment options depend on where the cancer has spread to and how aggressive it is.

Standard treatments for advanced cancer typically include surgery, radiation therapy, and chemotherapy.

1. Surgery

Surgery is usually the first treatment option for stage 3 endometrial cancer. At this point, your cancer has spread outside your uterus. This can include your fallopian tubes and ovaries. Your oncologist (cancer doctor) will likely recommend a total hysterectomy bilateral salpingo-oophorectomy. This surgery involves removing the uterus, ovaries, and fallopian tubes. A radical hysterectomy removes the same organs along with part of the vagina (if the cancer has spread there) and any nearby lymph nodes — small, bean-shaped organs located throughout the body.

Your surgeon might also take tissue samples during surgery to check for further spread of the cancer. The overall goal of surgery for stage 3 cancer is to remove as much of the cancerous tissue as possible to prevent it from continuing to spread.

If you have stage 4 endometrial cancer, your cancer has reached other parts of your body. A special type of surgery known as debulking removes as much tumor tissue as possible. This procedure helps if your cancer has spread to nearby lymph nodes and other surrounding structures in the abdomen. Debulking may help improve your outcome with advanced endometrial cancer.

Large tumors can be painful and press on your pelvis and upper abdomen. Debulking surgery can often relieve some discomfort and improve your quality of life. Many studies have shown that people who undergo successful debulking surgery often have better survival rates compared to those who do not have this procedure.

2. Radiation Therapy

Radiation therapy uses intense radiation energy to destroy cancer cells and shrink your tumor.

Oncologists often recommend radiation therapy before surgery to shrink tumors, which makes removing them easier and more effective. After surgery, radiation therapy also helps prevent cancer from returning. Radiation therapy also provides a way to shrink tumors and help prevent further cancer spread for people who aren’t healthy enough to have surgery.

A form of radiation therapy called brachytherapy plays a large role in the treatment of advanced endometrial cancer. Brachytherapy uses applicators that contain radioactive material. The applicators place the materials near your tumor to deliver high doses of radiation directly to the tissue, sparing healthy tissue. This targeted approach can lead to better treatment outcomes and improve quality of life. Vaginal brachytherapy helps treat people who have their uterus and cervix removed.

3. Chemotherapy

Chemotherapy, or chemo, is a standard advanced endometrial cancer treatment. It involves powerful drugs that target and destroy fast-growing cancer cells. Each chemotherapy drug works differently to stop cancer cells from growing and dividing.

Doctors often recommend chemotherapy after surgery to destroy any cancer cells left behind. This is common when treating stage 3 endometrial cancer. You may be a candidate if you have a high-grade cancer like clear cell or serous adenocarcinoma. People with carcinosarcoma are also eligible for chemotherapy treatment.

Chemotherapy is a systemic therapy. This means it travels in your bloodstream and affects your entire body. Chemotherapy drugs help shrink tumors that have moved into other organs. This treatment can help relieve some of the uncomfortable stage 4 cancer symptoms.

Certain chemotherapy drugs work well for endometrial cancer. They’re usually given in different combinations. Examples include:

• Carboplatin (Paraplatin) and paclitaxel (Abraxane)
• Docetaxel (Taxotere) and carboplatin
• Doxorubicin and cisplatin, with or without paclitaxel

Combining chemotherapy with radiation therapy uses the strengths of both approaches to better target and destroy cancer cells.

Newer Therapies for Endometrial Cancer

Over time, doctors and researchers find new ways to treat endometrial cancer. Some treatments involve new medications, and others offer more effective ways to combine existing drugs.

4. Targeted Therapies

Targeted therapies work by aiming at certain proteins or gene changes in cancer cells. Unlike traditional chemotherapy, which attacks all rapidly dividing cells, targeted therapies aim to interfere with processes that allow cancer cells to grow and spread. These drugs work by focusing on specific molecules involved in cell growth. Many targeted therapies are combined with chemotherapy or immunotherapies.

Lenvatinib (Lenvima) prevents endometrial cancer tumors from forming new blood vessels. Without enough oxygen and nutrients, the tumors shrink. Lenvatinib also blocks proteins that help cancer cells grow.

Another drug that stops new blood vessel formation is bevacizumab (Avastin). It works by stopping the vascular endothelial growth factor (VEGF) protein from making new vessels. This anti-VEGF drug helps shrink tumors and slow endometrial cancer growth. Bevacizumab can be given alone or with chemotherapy.

Other drugs block mammalian target of rapamycin (mTOR), a protein that helps cancer cells grow. Known as mTOR inhibitors, these drugs are usually combined with hormone therapy or chemotherapy for advanced endometrial cancer. Examples include temsirolimus (Torisel) and everolimus (Afinitor).

5. Immunotherapy

Immunotherapy helps your immune system to better recognize and destroy tumors. Some cancer cells hide from the immune system, making them hard to treat. Immunotherapies called immune checkpoint inhibitors help your immune cells target these hidden tumors.

Two immunotherapies have been approved by the U.S. Food and Drug Administration (FDA) for endometrial cancer — pembrolizumab (Keytruda) and dostarlimab-gxly (Jemperli).

Pembrolizumab works by blocking proteins that prevent immune cells from attacking cancer cells. Pembrolizumab may be given alone or with other medications. Your doctor may suggest this drug if:

• You’ve tried other treatments but they haven’t worked.
• You can’t have radiation therapy or surgery.
• Your cancer cells have deficient mismatch repair genes (dMMR), high microsatellite instability (MSI-H), or high tumor mutational burden (TMB-H).

Before you start treatment, your cancer cells will be tested for dMMR (inability to correct errors during DNA replication), MSI-H (many changes in short, repeated parts of DNA due to a faulty repair system), and TMB-H (many mutations). People without these changes can be treated with pembrolizumab and lenvatinib together.

Dostarlimab-gxly blocks certain proteins to let the immune cells act normally. This stops tumor cells from sneaking past the immune system. This drug is usually given with chemotherapy in people with dMMR and MSI-H. If you’ve already tried chemotherapy, your doctor can give dostarlimab-gxly by itself. This is also an option if you can’t have radiation therapy or surgery.

6. Hormone Therapies

Endometrial cancer cells often grow in response to hormones, particularly estrogen and progesterone. Hormone therapy works by either reducing the levels of these sex hormones in the body or blocking their effects on cancer cells. People with stages 3 and 4 endometrial cancer may be offered hormone therapy.

There are many types of hormone therapy. According to the American Cancer Society, no one type seems to work better than the others. Hormone therapy is a less invasive treatment option than surgery or radiation therapy. For some people, hormone therapy can help control the disease for an extended period.

Many hormone therapies stop the body from making or using estrogen and progesterone. Examples include:

• Aromatase inhibitors, such as anastrozole (Arimidex) and letrozole (Femara)
• Luteinizing hormone-releasing hormone agonists, such as leuprolide (Lupron) and goserelin (Zoladex)
• Progestins, such as megestrol acetate (Megace ES) and medroxyprogesterone acetate (Provera)
• Tamoxifen, which also treats breast cancer

7. Clinical Trials

Cancer researchers are always looking for better ways to treat advanced endometrial cancer. The National Cancer Institute has a list of ongoing clinical trials for this type of cancer. These large studies in people look at whether new treatments are more effective and at least as safe as older therapies.

Clinical trials at cancer centers recruit volunteers to learn more about new cancer treatments. Note that placebos (inactive treatments) aren’t typically used in cancer treatment studies. Instead, some participants get current standard therapy, and some get the newer treatment being studied. This way, all participants receive a potentially effective treatment.

If you’re interested in joining a clinical trial for cancer research, talk to your oncologist. If you’re eligible, you may get access to a new immunotherapy, targeted therapy drug, or combination of treatments.

Supportive and Palliative Care for Advanced Endometrial Cancer

Treating your cancer itself is only one part of managing your disease. It’s also important to control your symptoms to live a more comfortable life.

8. Supportive and Palliative Care

Palliative care focuses on helping you feel better as a whole person, addressing not just your cancer but also your overall well-being. This type of care focuses on improving quality of life for you and your loved ones throughout your cancer journey. Your doctor can connect you with health care specialists who specialize in providing supportive care in your cancer journey.

Examples of services provided in palliative care include:

• Managing treatment side effects, including pain, nausea, and insomnia
• Appointments with a registered dietitian to offer healthy eating advice and nutrition support
• Emotional and spiritual support from psychologists, chaplains, and social workers
• Support for family and friends who are caregivers

Palliative care aims to help meet your physical, emotional, social, and spiritual needs. By managing symptoms and providing comprehensive support, palliative care can greatly improve your quality of life. Palliative care teams often work closely with your oncologist and other health care providers to make sure you receive coordinated, consistent care.

Talk With Others Who Understand

On MyEndometrialCancerCenter, the site for people with endometrial cancer and their loved ones, people come together to gain a new understanding of endometrial cancer and share their stories with others who understand life with endometrial cancer.

Have you been diagnosed with advanced endometrial cancer? Which treatments have you had? Share your experience in the comments below.