The main treatment for womb cancer is surgery. Other treatments you might have include:
- hormone therapy
You might have one or more of these treatments.
Deciding what treatment you need
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)
- tests on the cancer cells to check for changes in the genes
- your general health and level of fitness
Treatment by cancer stage and 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.
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.
After surgery you may have one of the following treatments:
- external radiotherapy – this is the most common treatment after surgery
- chemotherapy followed by radiotherapy
- internal radiotherapy instead of external - this is only if there are cancer cells in one or two blood vessels
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
If you have a carcinosarcoma your treatment is the same as treatment for high risk womb cancer.
Locally advanced womb cancer
You usually have surgery. This will mean a total hysterectomy and removing any other areas of cancer. This includes removing any enlarged lymph nodes. You will usually then have chemotherapy and radiotherapy after surgery.
You may have chemotherapy if surgery isn’t possible, or you don’t want an operation.
Your doctor may suggest you have chemotherapy as a first treatment. This aims to reduce the size of the cancer and to make surgery easier.
If surgery isn’t possible because it is too big and it has grown into nearby structures making it too difficult to remove you may have
- radiotherapy, both external and internal
- chemotherapy followed by surgery or radiotherapy which can be both external and internal radiotherapy
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.
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.