Your care team may recommend surgery to diagnose, stage, or treat cancer:

• Diagnosis: A pathologist who specializes in gynecologic cancers analyzes tissue taken during biopsy or surgery to diagnose endometrial cancer.
• Staging: Surgery can help determine the stage of endometrial cancer by showing the size of the tumor and other details.
• Treatment: Surgery to remove the uterus is an important part of your treatment.

• Hysterectomy: During this procedure, a surgeon removes the uterus. They may also remove the cervix, fallopian tubes, and ovaries.
• Surgery that preserves the ovaries: In some cases, doctors can preserve the function of the ovaries so women can collect their eggs for future use. By collecting their eggs, they may be able to have children through a surrogate in the future. Ovarian preservation is usually appropriate for younger women with early endometrial cancer.
• Laparoscopic surgery: The surgeon uses a small incision and performs the operation by inserting a tiny camera and small surgical tools. Sometimes, surgeons use robotic equipment to guide the tools. These minimally invasive surgeries involve less recovery time and a lower risk of complications than traditional (open) surgery.

• Neoadjuvant therapy: This treatment takes place first to make surgery easier and more effective. Undergoing chemotherapy before surgery, for example, may shrink a tumor and make removal more successful.
• Adjuvant therapy: This treatment occurs after surgery to reduce the risk of the cancer coming back. Chemotherapy or radiation therapy after surgery can destroy remaining cancer cells.

Drug therapy, also called systemic or medical therapy, is treatment that works throughout the body to fight endometrial cancer. These drugs slow the growth of cancer cells or destroy them. At Stanford Health Care, our gynecologic oncologists use several types of drug therapy, including:

• Chemotherapy: This group of medications stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. Although it is powerful, chemotherapy can cause more side effects than other medication types because it cannot distinguish between cancerous and healthy cells. Chemotherapy is a treatment option for many cancers.
• Hormone (endocrine) therapy: Some cancers grow in response to hormones such as estrogen. Hormone therapy lowers the amount of these hormones or blocks their effect, slowing or even stopping the cancer’s growth.
• Immunotherapy: These medications help your body’s own immune system target and destroy cancer cells.

• By mouth (orally) as a pill
• Through the blood vessels (intravenously, or IV) as an injection or infusion

Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our radiation oncologists have years of experience safely and effectively treating endometrial cancer with radiation. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.

Radiation therapy may provide effective treatment for the type of endometrial cancer you have. If so, your doctor will speak with you about the best options. The types of radiation therapy we use for endometrial cancer treatment at Stanford Health Care include:

External radiation
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are located. We’re skilled at using several types of external radiation, including:

• 3D conformal radiation therapy (3D-CRT): With this method, 3D images help the doctor better target the tumor. The images are created using a special machine—a computed tomography (CT) or magnetic resonance imaging (MRI) machine. Your doctor can aim the radiation beams from many different angles to match the exact shape of the cancer.
• Intensity-modulated radiation therapy (IMRT): IMRT is similar to 3D-CRT, but the doctor can adjust how much radiation you get from each beam. In certain situations, this adjustment enables the doctor to avoid nearby healthy cells to reduce the risk of side effects.
• Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR): This method works like the first two methods, and the total amount of radiation you get is similar. With SBRT, you receive fewer radiation doses, but each dose is stronger. Doctors often use SBRT to treat cervical cancers or other cancers.

• Low-dose rate (LDR): The radioactive material stays in place from 1 to 7 days. You may stay in the hospital during that time, and you are radioactive until the doctor removes the radioactive material. At Stanford Health Care, we do not perform this type of brachytherapy.
• High-dose rate (HDR): The radioactive material is implanted for only 10 to 20 minutes at a time, then removed. You are not radioactive at any time other than the few minutes of treatment, meaning you can safely be around others when you return home. Most people receive three to six treatments total: once a day, twice a week. Most of the time, you can have treatments as an outpatient (no hospital stay needed) and return home the same day. At Stanford Health Care, we exclusively use HDR-brachytherapy.

If you have a strong family history of uterine cancer, you may benefit from our comprehensive genetic risk assessment. With 5% to 10% of uterine cancers tied to hereditary causes, we can help you understand and manage your risk and decide on further intervention. Learn more about our Cancer Genetics Program.

Risk Assessment
Assessing your risk involves looking at your personal medical history and family histories from both sides. We may also suggest genetic testing, using the latest techniques to analyze dozens of genes at once. If you have uterine cancer, the particular pathology also guides testing recommendations.

Throughout the process, our genetic counselors discuss the implications for your health, life, and family. We can help you share results with relatives. Learn more about cancer risk assessment with genetic testing and counseling.

Risk Management
Uterine cancer is typically diagnosed in treatable stages. Still, you may want to consider uterus removal if you have a high-risk, inherited mutation and related cancers in your family. Even if no mutation is found, some women with a strong family history of uterine cancer choose prophylactic surgery.

Depending on your circumstances, you may have the option of minimally invasive, laparoscopic surgery.

Genetic Mutations and Uterine Cancer
Your genes contain needed, inherited information, but some may be missing, duplicated, or miscoded. Several of these changes increase uterine cancer risk. Known mutations tied to uterine cancer include:

• Genes related to Lynch syndrome: Mutations in the MLH1, MSH2, MSH6, PMS2, and EPCAM genes cause most inherited uterine cancers. These mutations also have ties to skin, brain, and colorectal and other gastrointestinal cancers. Together, such familial cancers are called Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC).
• PTEN: This is one of the main genes tied to Cowden syndrome (a disorder that causes benign growths) and PTEN hamartoma tumor syndrome (PHTS). PTEN mutations can also increase risk for melanoma and breast, thyroid, colorectal, and kidney cancers. Our team has extensive experience treating people with rare conditions, including mutations in PTEN.
• Other genes, including FH, BRCA1, TP53, CHEK2, and POLD1: Mutations in these genes can increase the risk of tumor growth and cancer.

After completing endometrial cancer treatment, your care team works with you to develop an ongoing care plan. Regular follow-up care, also known as surveillance, is important to:

• Check for possible signs of the cancer coming back (recurring)
• Manage any side effects
• Monitor your overall health