Uterine Cancer Treatment Options

This page is for people facing treatment for uterine cancer. It covers surgery, treatment after surgery, and options for advanced cancer.

Uterine cancer is also called endometrial cancer. Doctors most often treat it with surgery. The surgery removes the uterus. Doctors call this a hysterectomy. NCI says people with localized disease are usually cured. For low-risk stage I cancer, most people do well with surgery alone. Your team may add more treatment, depending on the stage. That can mean radiation, chemotherapy, hormone therapy, targeted therapy, or immunotherapy.

NCI calls surgery the most common treatment. The main operation is a total hysterectomy. It removes the uterus and cervix. Surgeons can do this through the vagina, through the abdomen, or with small laparoscopic tools. They usually also remove both ovaries and both fallopian tubes at the same time. Doctors call this a bilateral salpingo-oophorectomy. Surgeons often check nearby lymph nodes too. They remove some and send them to a lab. This shows whether cancer cells have spread beyond the uterus. Some cancers need a wider operation instead. This is called a radical hysterectomy. It also removes part of the vagina.

The Office on Women's Health says that removing both ovaries may cause menopausal symptoms right away. These include hot flashes. Ask your team what to expect and how to manage them.

After surgery, a pathologist grades the cancer. Grades run from 1 to 3, based on how the cells look. NCI says grade 1 and grade 2 tumors are low-risk unless they are serous or clear cell types. Grade 3 tumors are high-risk. So are any serous tumors, clear cell tumors, and carcinosarcomas. Grade and stage together shape what comes next.

For low-risk stage I cancer, NCI says most people do well with surgery alone. Some people also get radiation inside the vagina or from outside the body. The goal is to lower the chance the cancer returns. For high-risk stage I or stage II cancer, NCI lists chemotherapy after surgery, with or without radiation.

For stage III or IV cancer, NCI says treatment is usually surgery followed by chemotherapy, radiation, or both. Immunotherapy is now also part of treatment for many people whose cancer has spread or come back. Two immunotherapy drugs, pembrolizumab and dostarlimab, were tested with chemotherapy in large trials. The FDA approved pembrolizumab (Keytruda) with chemotherapy on June 17, 2024. It approved dostarlimab (Jemperli) with chemotherapy on August 1, 2024. Both approvals cover newly diagnosed advanced cancer and cancer that has come back, and neither requires a change called dMMR or MSI-H. Before that, dostarlimab had been approved only for dMMR or MSI-H tumors (July 31, 2023). A third drug, durvalumab (Imfinzi), was approved on June 14, 2024 for dMMR tumors only.

In the trials, chemotherapy plus immunotherapy ran for about six months. Immunotherapy then continued alone. That lasted up to 14 cycles in one trial and up to 3 years in the other.

dMMR stands for deficient mismatch repair. In these cancers, the cells cannot fix certain DNA copying errors. NCI says these tumors tend to make abnormal proteins that attract immune cells. Immunotherapy then helps the immune system attack the cancer.

The early results were strongest for this group. The numbers below measure time before the cancer got worse, not how long people lived. In the dostarlimab trial, about 61% of people with dMMR cancer were alive without their cancer getting worse at 24 months. On chemotherapy alone, it was 16%. In the pembrolizumab trial, 74% of people with dMMR cancer were alive without their cancer getting worse at 12 months. On chemotherapy alone, it was 38%.

People whose tumors are not dMMR (called pMMR) also did better on the combination, but by less. In the pembrolizumab trial the numbers were 50% and 30% at 12 months. In the dostarlimab trial they were 28% and 19% at 24 months.

Hormone therapy is an option for some uterine cancers. NCI says tumors with hormone receptors respond best to progestin therapy. NCI also says people who cannot have surgery or radiation may receive hormone therapy.

Targeted therapy is another option in some cases. NCI's patient summary lists everolimus, ridaforolimus, and the antibody bevacizumab for stage III, stage IV, and recurrent endometrial cancer. NCI's summary for doctors describes these drugs as tested in smaller trials. Everolimus and ridaforolimus mostly held the disease steady, and bevacizumab alone shrank tumors in about 1 in 7 people. NCI says targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do.

Uterine cancer found early is usually cured. Stage, grade, cell type, and how your body responds to treatment all affect the outlook. No single number can tell you what will happen in your case. Your care team is best placed to talk through what your own results mean.

Ask your team the grade and stage of your cancer. Ask whether it counts as low-risk or high-risk. Ask whether your tumor has been tested for dMMR or MSI-H. That result can affect which immunotherapy is offered and how well it may work. Ask what side effects to expect from each treatment, and whether a clinical trial fits your situation. Ask what symptoms should prompt a call to your team between visits.

• Call 911 or go to the nearest emergency department if vaginal bleeding is heavy or will not stop, including after surgery, or if you have chest pain or trouble breathing after surgery.
• Call your care team right away if you have new or worsening pain, swelling, or unusual bleeding.
• Call your surgeon right away if you recently had a hysterectomy and have a fever above 100.4°F (38°C), bleeding heavier than light spotting, a bad-smelling or heavy watery vaginal discharge, a surgical wound that bleeds, looks red and warm, or drains pus, swelling, redness, or pain in one leg, vomiting or being unable to eat or drink, being unable to pass gas or stool, or pain or burning when you pass urine or being unable to pass urine. MedlinePlus lists these for people recovering from an abdominal hysterectomy.
• Call your care team right away, day or night, if you are having chemotherapy and your temperature is 100.4°F (38°C) or higher. CDC uses this number. The same goes for chills, a sore throat, sores in the mouth, or pain when you pass urine, even with a normal temperature. NCI lists these among the signs of infection. It says infection during cancer treatment can be life threatening.

• NCI — Endometrial Cancer Treatment (PDQ®) Patient Version
• NCI — Endometrial Cancer Treatment (PDQ®) Health Professional Version
• NCI Cancer Currents — Immunotherapy Approved for Advanced, Recurrent Endometrial Cancer
• FDA — FDA approves pembrolizumab with chemotherapy for primary advanced or recurrent endometrial carcinoma (June 17, 2024)
• NCI — Infection and Neutropenia during Cancer Treatment
• CDC — Fever and cancer treatment
• MedlinePlus — Hysterectomy, abdominal: discharge
• FDA — Dostarlimab-gxly expanded endometrial cancer indication
• FDA — Pembrolizumab with chemotherapy for endometrial carcinoma
• NCI Cancer Currents — Imfinzi, Keytruda approved for some endometrial cancers
• Office on Women's Health — Early or Premature Menopause