Many women want to take an active part in making decisions about their medical care for cancer of the uterus. They want to learn all they can about their disease and their treatment choices. However, the shock and stress that people may feel after a diagnosis of cancer can make it hard for them to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some women also want to have a family member or friend with them when they talk to the doctor – to take part in the discussion, to take notes, or just to listen.

 

The patient's doctor may refer her to doctors who specialize in treating cancer, or she may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for the woman to talk with the doctor about her treatment choices, get a second opinion, and learn more about uterine cancer.

 

Preparing for treatment

The choice of treatment depends on the size of the tumor, the stage of the disease, whether female hormones affect tumor growth, and the tumor grade. (The grade tells how closely the cancer cells resemble normal cells and suggests how fast the cancer is likely to grow. Low-grade cancers are likely to grow and spread more slowly than high-grade cancers.) The doctor also considers other factors, including the woman's age and general health.

 

These are some questions a woman may want to ask the doctor:

 

What kind of uterine cancer do I have?

Has the cancer spread? What is the stage of the disease?

Do I need any more tests to check for spread of the disease?

What is the grade of the tumor?

What are my treatment choices? Which do you recommend for me? Why?

What are the expected benefits of each kind of treatment?

What are the risks and possible side effects of each treatment?

What is the treatment likely to cost?

How will treatment affect my normal activities?

How often should I have checkups?

Would a clinical trial (research study) be appropriate for me?

 

Women do not need to ask all their questions or understand all the answers at once. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

 

Methods of treatment

Women with uterine cancer have many treatment options. Most women with uterine cancer are treated with surgery. Some have radiation therapy. A smaller number of women may be treated with hormonal therapy. Some patients receive a combination of therapies.

 

The doctor is the best person to describe the treatment choices and discuss the expected results of treatment.

 

A woman may want to talk with her doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of uterine cancer. The section entitled "The promise of cancer research" has more information about clinical trials.

 

Most women with uterine cancer have surgery to remove the uterus (hysterectomy) through an incision in the abdomen. The doctor also removes both fallopian tubes and both ovaries. (This procedure is called a bilateral salpingo-oophorectomy.)

 

The doctor may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean that the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the woman may not need to have any other treatment. The length of the hospital stay may vary from several days to a week.

 

These are some questions a woman may want to ask the doctor about surgery:

 

What kind of operation will it be?

How will I feel after the operation?

What help will I get if I have pain?

How long will I have to stay in the hospital?

Will I have any long-term effects because of this operation?

When will I be able to resume my normal activities?

Will the surgery affect my sex life?

Will followup visits be necessary?

 

In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area.

 

Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the area. Also, the doctor may suggest radiation treatments for the small number of women who cannot have surgery.

 

Doctors use two types of radiation therapy to treat uterine cancer:

 

External radiation. In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation 5 days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.

Internal radiation. In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.

 

Some patients need both external and internal radiation therapies.

 

These are some questions a woman may want to ask the doctor about radiation therapy:

 

What is the goal of this treatment?

How will the radiation be given?

Will I need to stay in the hospital? For how long?

When will the treatments begin? When will they end?

How will I feel during therapy? Are there side effects?

What can I do to take care of myself during therapy?

How will we know if the radiation therapy is working?

Will I be able to continue my normal activities during treatment?

How will radiation therapy affect my sex life?

Will followup visits be necessary?

 

Hormonal therapy involves substances that prevent cancer cells from getting or using the hormones they may need to grow. Hormones can attach to hormone receptors, causing changes in uterine tissue. Before therapy begins, the doctor may request a hormone receptor test. This special lab test of uterine tissue helps the doctor learn if estrogen and progesterone receptors are present. If the tissue has receptors, the woman is more likely to respond to hormonal therapy.

 

Hormonal therapy is called a systemic therapy because it can affect cancer cells throughout the body. Usually, hormonal therapy is a type of progesterone taken as a pill.

 

The doctor may use hormonal therapy for women with uterine cancer who are unable to have surgery or radiation therapy. Also, the doctor may give hormonal therapy to women with uterine cancer that has spread to the lungs or other distant sites. It is also given to women with uterine cancer that has come back.

 

These are some questions a woman may want to ask the doctor about hormonal therapy:

 

Why do I need this treatment?

What were the results of the hormone receptor test?

What hormones will I be taking? What will they do?

Will I have side effects? What can I do about them?

How long will I be on this treatment?

 

Side effects

Because cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. These side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, doctors and nurses will explain the possible side effects and how they will help you manage them.

 

Surgery

After a hysterectomy, women usually have some pain and feel extremely tired. Most women return to their normal activities within 4 to 8 weeks after surgery. Some may need more time than that.

 

Some women may have problems with nausea and vomiting after surgery, and some may have bladder and bowel problems. The doctor may restrict the woman's diet to liquids at first, with a gradual return to solid food.

 

Women who have had a hysterectomy no longer have menstrual periods and can no longer get pregnant. When the ovaries are removed, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Hormone replacement therapy (HRT) is often given to women who have not had uterine cancer to relieve these problems. However, doctors usually do not give the hormone estrogen to women who have had uterine cancer. Because estrogen is a risk factor for this disease, many doctors are concerned that estrogen may cause uterine cancer to return. Other doctors point out that there is no scientific evidence that estrogen increases the risk that cancer will come back. NCI is sponsoring a large research study to learn whether women who have had early stage uterine cancer can take estrogen safely.

 

For some women, a hysterectomy can affect sexual intimacy. A woman may have feelings of loss that may make intimacy difficult. Sharing these feelings with her partner may be helpful.

 

Radiation therapy

The side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation include dry, reddened skin and hair loss in the treated area, loss of appetite, and extreme tiredness. Some women may have dryness, itching, tightening, and burning in the vagina. Radiation also may cause diarrhea or frequent and uncomfortable urination. It may reduce the number of white blood cells, which help protect the body against infection.

 

Doctors may advise their patients not to have intercourse during radiation therapy. However, most can resume sexual activity within a few weeks after treatment ends. The doctor or nurse may suggest ways to relieve any vaginal discomfort related to treatment.

 

Hormonal theapy

Hormonal therapy can cause a number of side effects. Women taking progesterone may retain fluid, have an increased appetite, and gain weight. Women who are still menstruating may have changes in their periods.

 

Nutrition

People need to eat well during cancer therapy. They need enough calories and protein to promote healing, maintain strength, and keep a healthy weight. Eating well often helps people with cancer feel better and have more energy.

 

Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment such as poor appetite, nausea, or vomiting can make eating difficult. Foods may taste different.

 

The doctor, dietitian, or other health care provider can advise patients about ways to maintain a healthy diet.

 

Follow-up care

Followup care after treatment for uterine cancer is important. Women should not hesitate to discuss followup with their doctor. Regular checkups ensure that any changes in health are noticed. Any problem that develops can be found and treated as soon as possible. Checkups may include a physical exam, a pelvic exam, X-rays, and laboratory tests.

 

Support for women with uterine cancer

Living with a serious disease such as cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group.

 

It is natural for a woman to be worried about the effects of uterine cancer and its treatment on her sexuality. She may want to talk with the doctor about possible side effects and whether these effects are likely to be temporary or permanent. Whatever the outlook, it may be helpful for women and their partners to talk about their feelings and help one another find ways to share intimacy during and after treatment.

 

People living with cancer may worry about caring for their families, holding on to their jobs, or keeping up with daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team will answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

 

Research

Doctors all over the country are conducting many types of clinical trials, research studies in which people take part voluntarily. Many treatment studies for women with uterine cancer are under way. Research has already led to advances, and researchers continue to search for more effective approaches.

 

Patients who take part in clinical trials have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take many very careful steps to protect people who take part.

 

In a large trial with hundreds of women, doctors are studying a less extensive method of surgery to remove the uterus. Normally, the doctor makes an incision in the abdomen to remove the uterus. In this study, doctors use a laparoscope (a lighted tube) to help remove the uterus through the vagina. Also, the doctor can use the laparoscope to help remove the ovaries and lymph nodes and to look into the abdomen for signs of cancer.

 

Other researchers are looking at the effectiveness of radiation therapy after surgery, as well as at the combination of surgery, radiation, and chemotherapy. Other trials are studying new drugs, new drug combinations, and biological therapies. Some of these studies are designed to find ways to reduce the side effects of treatment and to improve the quality of women's lives.

 

A woman who is interested in being part of a clinical trial should talk with her doctor.