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  • Treatment for cancer of the uterus

    Contents

    The treatment recommended by your doctor will depend on the results of your tests, the type of cancer, where the cancer is, whether it has spread, your age and your general health. Cancer of the uterus is often diagnosed early, before it has spread, and can be treated surgically. For many women, surgery will be the only treatment they need. If the cancer has spread beyond the uterus, radiotherapy, hormone treatment or chemotherapy may also be used.

    Surgery

    Cancer of the uterus is usually treated by an operation to remove the uterus and cervix (a total hysterectomy), along with both fallopian tubes and ovaries (a bilateral salpingo-oophorectomy). The ovaries are usually removed as they produce oestrogen, a hormone that may cause the cancer to grow. Removing them reduces the risk of the cancer coming back.

    The surgery will be performed under a general anaesthetic. The type of hysterectomy offered to you will depend on a number of factors, including your age and build, the size of your uterus, the size of the tumour, and the surgeon’s specialty and experience. Your surgeon will talk to you about the risks and complications of your procedure.

    How the surgery is done

    LaparotomyThe surgery is performed through the abdomen. A cut is usually made from the pubic area to the bellybutton. Sometimes the cut is made along the pubic line instead. Once the abdomen is open, the surgeon washes out the area with fluid. The uterus, fallopian tubes and ovaries are then removed. If the cancer has spread to the cervix, the surgeon may also remove a small part of the upper vagina and the ligaments supporting the cervix.

    Laparoscopic hysterectomyThis is sometimes called keyhole surgery. The surgeon will make three or four small cuts in the abdomen and use a thin telescope (laparoscope) to see inside the abdomen. The uterus and other organs are usually removed through the vagina. A robotic hysterectomy is a specialised form of laparoscopic hysterectomy where the surgical instruments are controlled by robotic arms guided by the surgeon, who sits next to the operating table.

    The lymph nodes in your pelvis may also be removed, depending on the size and type of cancer. This procedure is called a lymphadenectomy or lymph node sampling (see page 28). In certain cases, further biopsies or tissue might be taken depending on the type of tumour that you have. Your gynaecological oncologist will discuss this with you before the operation.

    All tissue and fluids removed are examined for cancer cells by a pathologist. The results will help confirm the type of uterine cancer you have, if it has spread (metastasised), and its stage.

    After the operation

    When you wake up after the operation, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be transferred to the ward where you will stay for around one to four days until you can go home. Your length of stay will depend on the type of surgery (laparoscopy or laparotomy) you have had.

    You will have an intravenous drip in your arm to give you medicines and fluid. There may also be a tube in your abdomen to drain the operation site and a tube in your bladder (catheter) to collect urine. These will usually be removed the day after the operation.

    As with all major operations, you will have some discomfort or pain. For the first day or two, you may be given pain medicine through a drip or via a local anaesthetic injection into the abdomen (a TAP block) or spine (an epidural). Let your doctor or nurse know if you are in pain so they can adjust your medicines to make you as comfortable as possible. Do not wait until the pain is severe.

    You can also expect some light vaginal bleeding after the surgery, which should stop within two weeks. Your doctor will talk to you about how to keep the wound clean once you go home to prevent it becoming infected.

    You will have to wear compression stockings for a couple of weeks to help the blood in your legs to circulate. You will also be given a daily injection of a blood thinner to reduce the risk of blood clots. Depending on your risk of clotting, you may be taught to give this injection to yourself, so you can continue it for a few weeks at home.

    Your doctor will have all the test results about a week after the operation. Whether further treatment is necessary will depend on the type, stage and grade of the disease, and the amount of any remaining cancer. If the cancer is at a very early stage, you may not need additional treatment.

    Side effects

    After surgery, some women experience side effects, such as:

    MenopauseIf you had a bilateral salpingo-oophorectomy and were not menopausal before the operation, the removal of your ovaries will cause menopause. If you have not been through menopause and are concerned about how surgery will affect your fertility speak to your specialist prior to the operation.

    Vaginal vault prolapseAfter a hysterectomy, the top of the vagina can drop towards the vaginal opening because the structures that support the top of the vagina have weakened. Talk to the hospital physiotherapist about pelvic floor exercises that can help strengthen the pelvic floor muscles to try to avoid a prolapse. They can usually be commenced one to two weeks after surgery.

    Internal scar tissue (adhesions)Tissues in the abdomen may stick together, which can sometimes be painful or cause bowel problems such as constipation. Rarely, adhesions to the bowel or bladder may need to be treated with further surgery.

    Impact on sexualityThe physical and emotional changes you experience after surgery may affect how you feel about sex and how you respond sexually. For more information about sexuality, call Cancer Council 13 11 20 or you can download the booklet Sexuality, intimacy and cancer

    LymphoedemaIf you have a lymphadenectomy, you may develop lymphoedema. Removing lymph nodes from the pelvis may prevent lymph fluid from draining, causing swelling in the legs. The risk of lymphoedema following most operations for cancer of the uterus in Australia is low. The risk is higher in women who had a lymphadenectomy followed by radiotherapy. Symptoms appear gradually, sometimes years after the treatment..

    Radiotherapy

    Radiotherapy (also known as radiation therapy) uses x-rays to kill or damage cancer cells so they cannot multiply. The radiation is targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.

    Radiotherapy for cancer of the uterus is commonly used as an additional treatment after surgery to reduce the chance of the disease coming back. This is called adjuvant therapy. Alternatively, radiotherapy may be recommended as the main treatment if you are not well enough for a major operation.

    There are two main ways of delivering radiotherapy: internally or externally. Some women are treated with both types of radiotherapy. Your radiation oncologist will recommend the course of treatment most suitable for you.

    Internal radiotherapy (vaginal brachytherapy)

    Internal radiotherapy is a way of delivering targeted radiotherapy directly to the tumour from inside your body. For cancer of the uterus, a cylinder containing radioactive material is inserted into the vagina. This cylinder is connected to a machine using plastic or metal tubes. These tubes move the radiation from the machine into your body.

    You will usually have four to five treatment sessions, two or three times a week, as an outpatient. Each session will last from five to 10 minutes, but it takes much longer to set up the equipment. The applicator is taken out after each dose of radiation is delivered.

    External radiotherapy (external beam radiotherapy)

    External radiotherapy directs the treatment at the cancer and surrounding tissue from outside the body. For cancer of the uterus, the lower abdominal area and pelvis are treated, but if the cancer has spread (metastasised), other areas may also be treated. You will lie on a treatment table under a machine called a linear accelerator, which delivers high energy x-rays.

    You will probably have external radiotherapy treatment from Monday to Friday for four to six weeks. Weekend rest breaks allow the normal cells to recover. You usually receive this treatment as an outpatient (at a radiotherapy centre) and you will not need to stay in hospital.

    The actual treatment takes only a few minutes each time, but a lot of planning is required to make sure the treatment is right for you. This may involve a number of visits to your doctor to have more tests (e.g. blood tests) and undergo special planning scans such as a PET scan.

    The machine used for external radiotherapy is large and kept in an isolated room. This can be confronting or frightening, especially when you have treatment for the first time. You may find you feel more at ease with each session you attend.

    It’s very important that you attend all of your scheduled sessions to ensure you receive enough radiation to kill the cancer cells or relieve symptoms.

    Brachytherapy and external radiotherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions are over and when you are at home.

    Which radiotherapy treatment will I have?

    The type of radiotherapy offered depends mostly on the type of cancer, how far it has spread, your general health and your age. But it can also depend on where you live and what services are available.

    For more information about radiotherapy, call Cancer Council 13 11 20 or you can download the booklet Understanding Radiation Therapy.

    Side effects

    Radiotherapy can cause both temporary and long-term side effects. This is because radiotherapy can damage healthy cells as well as cancer cells. The most common side effects occur during or soon after treatment. Most are temporary and steps can often be taken to prevent or reduce them. When you’re having radiotherapy, try to rest as much as possible. Drinking lots of water and eating small, frequent meals will also help.

    Different women may have different side effects even if the dose and frequency of the radiotherapy are the same. Before your treatment starts, talk to your radiation oncologist about possible side effects. You may experience some of the following side effects:

    Lethargy and loss of appetiteRadiotherapy can make you feel tired and you may lose your appetite.  

    Skin problemsRadiotherapy may make your skin dry and itchy in the treatment area.

    Hair lossRadiotherapy to your abdomen and pelvis can cause you to lose your pubic hair. This may be permanent.

    Reduced vaginal sizeRadiotherapy to the pelvic area can affect the vagina, which will become tender during treatment and for a few weeks afterwards. In the long term, radiotherapy can make the vagina drier and cause vaginal scarring. This can lead to the vagina becoming shorter, narrower and less flexible (vaginal stenosis). This may make vaginal examinations painful and sexual intercourse difficult or uncomfortable. Your doctor may recommend the use of a vaginal dilator.

    MenopauseIf both ovaries have been removed or if you’ve had radiotherapy in the pelvic area, you will no longer produce these hormones and you will stop having periods. This is called menopause.

    CystitisRadiotherapy to the pelvic area can cause a burning sensation when passing urine (cystitis).  

    DiarrhoeaHaving radiotherapy to your lower abdomen or pelvis may irritate the bowel and cause diarrhoea. Symptoms include loose and watery stools, abdominal cramps and frequent bowel movements.

    Hormone treatment 

    Hormones such as oestrogen and progesterone are substances that are produced naturally in the body. They help control the growth and activity of cells. Some cancers of the uterus depend on hormones (like oestrogen) to grow.

    Hormone treatment can be given if the cancer has spread or if the cancer has come back (recurred), particularly if it is a low-grade cancer. It is also sometimes offered in the first instance if surgery is not an option, for example, for young women who still want to have children. The main hormone treatment for women with oestrogen-dependent uterine cancer is progesterone.

    Progesterone
    Progesterone occurs naturally in women and can also be produced in a laboratory. High doses of progesterone can help shrink some cancers and control symptoms. Progesterone is available in tablet form (commonly either medroxyprogesterone or megestrol); as an injection given by your GP or nurse; or through a hormone-releasing intrauterine device (IUD) called a Mirena, which is fitted into the uterus by your doctor (if you have not had a hysterectomy). Talk to your doctor about the risks and benefits of the different methods.

    Side effects
    The common side effects of progesterone treatment include breast tenderness, headaches, tiredness, nausea, menstrual changes, and bloating. In high doses, progesterone may increase appetite and cause weight gain. If you have an IUD, it may move out of place and need to be refitted by your doctor.

    Chemotherapy

    Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy cancer cells while causing the least possible damage to healthy cells.

    Chemotherapy for uterine cancer may be used:

    • for certain types
    • when cancer comes back after surgery or radiotherapy to try to control the cancer and to relieve symptoms
    • if the cancer does not respond to hormone treatment
    • if the cancer has spread beyond the pelvis when the cancer is first diagnosed
    • in conjunction with radiotherapy.

    Chemotherapy is usually given by injecting the drugs into a vein (intravenously). You may be treated as an outpatient or, very infrequently, you may need to stay in hospital overnight. You will have a number of treatments, sometimes up to six, every three to four weeks over several months. Your doctor will talk to you about how long your treatment will last.

    Side effects

    The side effects of chemotherapy vary greatly for each woman and depend on the drugs you receive, how often you have the treatment, and your general fitness and health. Side effects may include feeling sick (nausea), vomiting, feeling tired, and some thinning and loss of body and head hair. Most side effects are temporary and steps can often be taken to prevent or reduce their severity.

    For more information about chemotherapy, call Cancer Council 13 11 20 or you can download the booklet Understanding Chemotherapy.

    Palliative treatment

    Palliative treatment helps to improve people’s quality of life by alleviating symptoms of cancer without trying to cure the disease, and is best thought of as supportive care.

    Many people think that palliative treatment is for people at the end of their life: however it may be beneficial for people at any stage of advanced uterine cancer. It is about living as long as possible in the most satisfying way you can.

    As well as slowing the spread of cancer, palliative treatment can relieve any pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other medicines such as hormone treatment.

    Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers.

    For more information, call Cancer Council 13 11 20 or you can download the booklet Understanding Palliative Care or Living with Advanced Cancer.

    This website page was last reviewed and updated July 2018.

    Information reviewed by: A/Prof Sam Saidi, Senior Staff Specialist, Gynaecological Oncology Group, Chris O’Brien Lifehouse, NSW; Lauren Atkins, Accredited Practising Dietitian, Peter MacCallum Cancer Centre, VIC; Dr Scott Carruthers, Radiation Oncologist, Royal Adelaide Hospital, SA; Prof Michael Friedlander, Medical Oncologist, Royal Hospital for Women Sydney, NSW; Roslyn McAullay, Social Worker, Women and Newborn Health Service, King Edward Memorial Hospital, WA; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, NSW; Christine O’Bryan, Consumer; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Department of Physiotherapy, King Edward Memorial Hospital for Women, WA.

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