Treatment of Stage IV Endometrial Cancer

The goal of treatment for Stage IV endometrial cancer is to reduce symptoms and lengthen survival. Stage IV endometrial cancer is difficult to cure with surgery. However, you might be treated with a radical hysterectomy and bilateral salpingo-oophorectomy to prevent excessive bleeding (see below).

• Radical hysterectomy - This operation removes the entire uterus, the tissues next to the uterus (parametria and uterosacral ligaments), and the upper part (about 1 inch) of the vagina next to the cervix.
• Bilateral salpingo-oophorectomy - The surgeon removes both ovaries and both fallopian tubes (the two hollow tubes on either side of the uterus where the egg and sperm meet to begin the process of fertilization). A BSO is usually performed during a hysterectomy. 

If your cancer is located in the pelvis, you will probably be treated with a combination of external beam radiation therapy and internal radiation therapy.

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. EBRT can harm both the cancer cells and nearby healthy tissue. Most women are treated with EBRT for a few minutes 5 days a week for 4 or 5 weeks as an outpatient.
• Internal radiation therapy (brachytherapy or interstitial radiation therapy) - Small pellets (or “seeds”) that contain radioactive materials are placed in your body through the vagina so that they are in or near the tumor. The radioactive pellets release their radiation slowly over time. Brachytherapy lets the doctor use a higher dose of radiation than EBRT without damaging nearby areas, such as the bladder and rectum, but it can only be used to treat a small area of the body. This procedure is done about 4 to 6 weeks after hysterectomy in the radiation suite of a hospital or cancer care center. You may need several treatments.
  

If your cancer has spread (metastasized) to other parts of the body, such as the lungs, you will probably receive hormone therapy.

• Delalutin ^® (hydroxyprogesterone caproate) - Hydroxyprogesterone caproate is a progesterone, or female hormone, that is involved in women’s monthly cycles and pregnancies. It stops cancer cells from growing, which kills them. Hydroxyprogesterone caproate is given by injection into the muscle. The dose depends on your weight and type of cancer.
• Provera ^® (medroxyprogesterone acetate) - Medroxyprogesterone acetate is a progesterone, or female hormone, that is involved in women’s monthly cycles and pregnancies. It stops cancer cells from growing, which kills them. Medroxyprogesterone acetate is taken in pill form, usually once a day. The dose depends on your weight and type of cancer.
• Megace ^® (megestrol acetate) - Megestrol acetate is a progesterone, or female hormone, that is involved in women’s monthly cycles and pregnancies. It stops cancer cells from growing, which kills them. Megestrol acetate is taken in pill or liquid form by mouth. Megestrol acetate pills are usually taken four times a day. The dose depends on your weight and type of cancer.
• Tamoxifen - Tamoxifen blocks estrogen, the female sex hormone made by the ovaries that is responsible for the development of female sex characteristics, such as a uterus and breasts. The cancer cells that need estrogen to divide stop growing, and this kills them. Tamoxifen is usually taken in pill form twice a day with an 8-ounce glass of water. The dose depends on your weight and type of cancer. Tamoxifen is sometimes used to treat advanced or recurrent endometrial cancer.

In addition to hormone therapy, you might be treated with combinations of certain chemotherapy drugs, such as:

• Adriamycin^® (doxorubicin) - Doxorubicin hydrochloride belongs to the group of chemotherapy drugs known as anthracycline antibiotics. Doxorubicin stops the growth of cancer cells, which kills them. This drug is given by a shot in a vein over about 15 minutes. The dose and how often you get the medicine depend on your size, your blood counts, how well your liver works, and the type of cancer being treated. Your blood counts will be checked before each treatment; if they are too low, your treatment will be delayed.
• Adrucil ^® or Efudex ^® (5-fluorouracil, or 5-FU) - 5-FU belongs to the group of chemotherapy drugs known as antimetabolites. 5-FU prevents cancer cells from making DNA and RNA, which stops them from growing. 5-FU is given as a shot in the vein over 5 to 10 minutes or 20 to 60 minutes, or it may be given continuously over 22 to 24 hours for 1 to 4 days or longer. The treatment can be repeated every week, every other week, or every 3 weeks. The dose depends on your size.
• Cytoxan ^® (cyclophosphamide) - Cyclophosphamide belongs to a group of chemotherapy drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Cyclophosphamide can be given by mouth as a pill or liquid or by a shot into a vein. The dose depends on your size and your type of cancer.
• Hycamtin ^® (topotecan hydrochloride) - Topotecan hydrochloride belongs to the group of chemotherapy drugs known as topoisomerase inhibitors. Topotecan hydrochloride stops cancer cells from growing by preventing the development of elements necessary for cell division. Topotecan hydrochloride is given as a shot in the vein over 30 minutes for 3 to 5 days; this is usually repeated every 3 to 4 weeks. The dose and schedule depend on your weight, your blood counts, how well your kidneys are working, and the type of cancer being treated.
• Paraplatin ^® (carboplatin) - Carboplatin is a platinum chemotherapy drug that belongs to a group of drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Carboplatin is given as an injection in the vein over 15 to 60 minutes. The dose depends on your size but may be lowered or not given if your blood counts are low. It can also be injected into a vein over 24 hours or directly into the peritoneal cavity in advanced ovarian cancer.
• Platinol ^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein over at least 1 hour. Your dose depends on the type of cancer you have, your size, and how well your kidneys work.
• Rheumatrex^® or Trexall™ (methotrexate) - Methotrexate belongs to a group of chemotherapy drugs known as antimetabolites. It prevents cancer cells from making DNA and RNA, which stops their growth. Methotrexate is given as a pill by mouth, an injection into a vein for up to 20 minutes, or an injection into a muscle. The dose depends on your size, the type of cancer you have, and how well your kidneys work.
• Taxol^® (paclitaxel) - Paclitaxel belongs to a group of chemotherapy drugs known as taxanes. It is also called a mitotic inhibitor because it affects cells during mitosis (cell division). It stops cancer cells from dividing, which kills them. Paclitaxel is given by an injection into a vein, usually over a 3-hour period, every 3 weeks. Sometimes smaller doses are given once a week over shorter periods. The dose depends on your weight, how well your liver works, the side effects you have, and how often the medicine is given.
  

This content has been reviewed and approved by Myo Thant, MD.