If you are diagnosed with uterine cancer, your provider will probably refer you to an oncologist who specializes in the treatment of cancer. Treatment generally begins within a few weeks of diagnosis, after you’ve had time to review your treatment choices, get a second opinion, and learn more about your condition.
Your provider will explain the risks and benefits of each of these treatments, and suggest the treatment or combination of treatments that will work best for you.
Surgery
Most women with uterine cancer will have a hysterectomy, where the uterus is removed either through the vagina, or through an incision in the abdomen. In most cases, the surgeon will also remove both fallopian tubes and both ovaries. This procedure is called a bilateral salpingo-oophorectomy.
The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have spread into the lymph nodes, it is possible that the cancer has also spread to other parts of the body. On the other hand, if the cancer cells have not spread beyond the lining of the uterus, you may not need to have any other treatment. The length of the hospital stay will usually vary from one day to a week.
Hysterectomy Side Effects
The side effects after a hysterectomy will vary depending upon your condition, overall health, and the type of surgery that is performed. In general, you will remain in the recovery room for an hour or two after your surgery. During this time, you will be given medications to control any pain.
The length of time that you’ll spend in the hospital can also vary. In general, a stay from one to five days can be expected, although your stay may be longer if any complications develop. In most cases, patients are encouraged to begin walking the day after surgery. It’s normal to have bloody discharge for several days or longer after a hysterectomy, so sanitary pads will be provided.
It usually takes somewhere between six and eight weeks for a woman to recuperate from a hysterectomy. Although you may feel fine relatively quickly, it is important to adhere to the activity restrictions suggested by your provider. Remember to get plenty of rest. Do not drive until cleared by your provider. Do not lift anything heavy for a full eight weeks after the surgery. Your provider may recommend other restrictions, but eventually you should be able to resume your normal activities.
If you are premenopausal, having your ovaries removed results in the sudden loss of hormone production. The loss of these hormones causes menopause to begin, which can lead to hot flashes, night sweats, and eventually vaginal dryness. This is referred to as surgical menopause. Some women are afraid they will lose their desire for sex; however, this is not common. When side effects are experienced, your provider may prescribe estrogen or other hormonal therapy to counteract this side effect, although in some cases, hormone replacement therapy may not be an option.
If your hysterectomy does include the removal of your ovaries, you are at increased risk of osteoporosis. Be sure to ask your provider about an osteoporosis prevention program.
Many women fear depression or other emotional changes following hysterectomy; however, research has shown little or no increase in depression after hysterectomy.
Chemo Therapy
The term chemotherapy refers to treating cancer with drugs. Chemotherapy is not used as often to treat uterine cancer as it is for other types of cancer. In general, chemotherapy is only used to treat uterine cancer that has spread too widely to be treated effectively with surgery or radiation therapy. It is also used to treat uterine cancer that has recurred, or come back.
Chemotherapy is given on various schedules, depending in part on which drugs you receive. You may receive chemotherapy treatments once a week or once every three or four weeks. Chemotherapy treatments typically continue for a period of three to six months.
The side effects of chemotherapy depend mainly on which type and the amount of drugs that are given. Although these drugs can be very effective in terms of destroying cancer cells, they can also harm normal cells that grow rapidly.
Blood cells are one type of rapidly dividing cell that can be harmed by chemotherapy drugs. Different kinds of blood cells fight infection, help the blood to clot, and carry oxygen to all parts of your body. When chemotherapy affects your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your healthcare team will monitor you for low levels of blood cells. If blood tests show low levels, your healthcare team can suggest medicines that can help your body make new blood cells.
Chemotherapy drugs can damage the roots of your hair, leading to hair loss. Your hair will grow back, although it may be somewhat different in terms of color and texture.
Chemotherapy drugs can also damage the cells that line the digestive tract, causing poor appetite, nausea and vomiting, diarrhea, or sores in your mouth and lips. Ask your healthcare team about medicines that help with these side effects.
Radiation Therapy
Radiation therapy uses targeted, high-energy rays to kill cancer cells. Like surgery, radiation therapy is a local therapy, meaning it affects cancer cells only in the treated area.
Some women with Stage I, II, or III uterine cancer will receive both radiation therapy and surgery. Radiation therapy may be administered before surgery in order to shrink the tumor, or after surgery to destroy any cancer cells that remain in the area. Also, some providers may suggest radiation treatments for the small number of women who cannot have surgery.
There are two types of radiation therapy used to treat uterine cancer. They include external radiation therapy, in which a large machine outside the body is used to aim radiation at the tumor area. External radiation is usually administered on an outpatient basis five days a week for several weeks. This schedule helps protect healthy cells and tissues by distributing the total dose of radiation. No radioactive materials are put into the body during external radiation therapy.
In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. Hospitalization is required for internal radiation therapy, and often visitation is limited to protect visitors from radiation exposure. Once the implant is removed, the woman has no radioactivity in her body.
Some patients need both external and internal radiation therapies. The side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or bloody stools. Also, your skin in the treated area may become red, dry, and tender. Although the side effects can be uncomfortable, your provider can usually treat or control them. These side effects gradually go away after treatment ends.
Radiation can have side effects many years later as well. These include scarring, painful intercourse, blood in your urine, and rarely fistula formation (abnormal connections between organs such as your bladder, vagina, and/or rectum).
Hormonal Therapy
Hormonal therapy involves administering substances that prevent cancer cells from receiving or using the hormones that they need to grow. Before therapy begins, the provider may request a hormone receptor test. This special lab test of uterine tissue helps the provider determine if estrogen and progesterone receptors are present. If the tissue has receptors, the patient is more likely to respond to hormonal therapy.
Hormonal therapy is considered a systemic therapy because it can affect cancer cells throughout the body. Usually, hormonal therapy is a type of progesterone taken as a pill.
Providers may use hormonal therapy for women with uterine cancer who are unable to have surgery or radiation therapy. Also, the provider 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 recurred.
Follow-up Care
Follow-up care after treatment for uterine cancer is extremely important. Your provider will monitor your recovery and check for recurrence of the cancer. Checkups will help ensure that any changes in your health are discovered and, if necessary, treated. Checkups will often include a physical exam as well as Pap tests and imaging studies. Between scheduled visits, you should feel free to contact your provider at any time if you have any health problems or concerns.
Emotional issues after treatment are fairly common, including fears about whether or not the cancer will return. These are natural concerns, and can be quite stressful. It’s important for patients to develop a wellness plan that includes ways to address physical, emotional, social, and spiritual needs. This may include physical rehabilitation, counseling, or group support. Your provider can help you design a wellness plan that will work best for you.