Uterine Cancer Treatment Timeline

Uterine cancer, often referred to as endometrial cancer (the most common form of uterine cancer), is usually treated with surgery. Other treatments, such as radiation therapy and chemotherapy, also may be needed. After a diagnosis, you and your health care team will work out a treatment schedule. The timeline presented here is typical, but the cancer stage and type, as well as your overall health, will determine your specific treatment plan.

There is no routine screening for uterine cancer, as there is for certain other cancers. But if you have symptoms, such as pelvic pressure or pain or vaginal bleeding or discharge, your health care provider may do some diagnostic tests. These usually include an endometrial biopsy and imaging, such as  a transvaginal ultrasound, among others. Doctors use these test results to find out the cancer's stage and type.

Surgery is usually the first treatment for uterine cancer. The surgery is called a hysterectomy, and it involves the removal of the uterus. Often the surgery will also include removal of the fallopian tubes, ovaries, and nearby lymph nodes. Uterine cancer surgery may be done laparoscopically (through small cuts in the belly area) or through open surgery with one larger cut in the belly area. A vaginal hysterectomy is done through the vagina, with no cuts in the belly area. It  has the shortest recovery time.

After surgery, tissue samples removed during the operation are analyzed to see if the cancer has spread to the lymph nodes or elsewhere. The tumor is also given a grade to help find out how aggressive the cancer is. Your doctor will discuss with you if any further treatments such as radiation therapy or chemotherapy are needed.

Radiation often follows surgery to make sure any remaining cancer cells are killed. Uterine cancer radiation usually starts a month or so after surgery to allow your body to heal. Sometimes radiation is used before surgery to shrink the tumor. Treatment is done either by placing a small tampon-sized cylinder containing radioactive material into the vagina or by focusing a beam of radiation from outside the body (like an X-ray) on the tumor.

Uterine cancer chemotherapy, or chemo, also may be needed after surgery to kill cancer cells that are still there after the hysterectomy. There are several different types of chemo drugs. You may be given a combination of two or more medicines. Some are taken orally, though most chemo drugs are given through a needle in your vein at appointments over a period of several weeks.

After you complete your initial treatment, your follow-up treatment plan will be tailored to your specific health needs. Your doctor may give you a survivorship care plan. Generally, you can expect physical exams every three to six months for the first two or three years after surgery and then every six to 12 months for up to five years or so. One visit a year may be advised after that. If you have symptoms or if an exam suggests cancer may be back, imaging and other tests may be ordered.

Advanced-stage cancer generally refers to stage III or stage IV cancers – those that have spread from where they started  into nearby tissues or elsewhere in the body. With stage III uterine cancer, your doctor may suggest a hysterectomy and the removal of the ovaries and fallopian tubes. You also may have radiation and/or chemotherapy. The same may be true for stage IV cancer, along with the use of hormone therapy, targeted therapies, and immunotherapy.

For someone with stage I uterine cancer, fertility-sparing treatment may be an alternative to a hysterectomy, which makes pregnancy impossible. The treatment uses progestin, a hormone that helps control the growth of cancer cells. You'll have regular biopsies of the uterus until you are ready to conceive. Hormone therapy then stops. After having children, or if conception isn't possible, you'll be advised to have a hysterectomy.

When a postmenopausal patient has symptoms such as abnormal vaginal bleeding, it can signal a high-grade uterine cancer that needs prompt treatment. Rather than going through the usual, months-long process of seeing a primary care doctor, gynecologist, getting a biopsy, and scheduling a hysterectomy, a fast-track approach involves having a biopsy and getting results within a few days and surgery within a couple of weeks.

If you have been diagnosed with uterine cancer, you should think about seeing a gynecologic oncologist soon to talk about your treatment options and work out a personalized plan for your care. Your gynecologic oncologist will be part of a health care team that may also include your primary care doctor,  a radiation oncologist, and other specialists. They'll let you know about what to expect before, during, and after treatment.