Treatment options for endometrial cancer c e n t r e

National Centre for
Gynaecological Cancers
national centre for
gynaecological cancers
Treatment options for endometrial cancer
Types of treatment
Treatment planning
Your doctor will advise you on the best treatment for your
cancer. This will depend on the results of your tests, where the
cancer is and if it has spread, your age, your general health,
and what you want.
When your doctor first tells you that you have cancer, it is very
stressful and you may not remember very much. It is often
difficult to take everything in, so you may want to see the
doctor a few times before deciding on treatment. Your doctor
may use medical terms you don’t understand; it’s okay to ask
your doctor to explain something again.
The main treatment of endometrial cancer is surgery because
this type of cancer is often diagnosed before it has spread.
This means that many women will not need treatment other
than surgery.
If the cancer has spread beyond the uterus, radiotherapy,
hormone treatment or chemotherapy may also be used.
In this factsheet:
Types of treatment 1
Radiotherapy may also be recommended if you are not well
enough for a major operation.
Treatment planning
Informed consent
Hormone treatment
Effects on fertility
Some cancers of the uterus depend on hormones (such as
oestrogen) for growth. Hormone treatment, which is taken
orally, can work well for advanced or recurrent endometrial
Treatment given after the main treatment to increase the
chances of a cure is called adjuvant therapy. Treatment given
before the main treatment is called neoadjuvant treatment.
If you want to try complementary therapies, which are
generally used in conjunction with conventional cancer
treatment, it is important that you discuss this with your
doctors and health professionals.
All these treatments are explained in more detail in the
following sections.
Complementary therapies
Benefits and disadvantages of cancer treatment 12
Second opinion
More information 13
page 2
Before you see the doctor, it may help to write down your
questions. Taking notes during the session or recording the
discussion can also help. Many people like to have a family
member or friend go with them, to take part in the discussion,
take notes or simply listen. For ideas about questions you
might want to ask, see our Question checklist factsheet.
Sometimes you may be asked to take part in a clinical
trial, which is a research study of a new treatment method.
For more information about this, see our factsheet on
Participating in clinical trials.
Making the right decision for you
Making a decision about treatment can be complex and
frightening, but most people make complex decisions every
day – often without realising it. For example, crossing the road
involves risk of injury and death, and requires you to consider
complex information about where cars are and the speed at
which they are travelling, before you decide that it is safe to
cross. Deciding which car to buy and where to live are also
complex decisions, but most people make these decisions
successfully many times during their life.
When deciding which treatment option is best for you, you can
• your personal and family needs
• the expected outcomes of each treatment option
• the likelihood that success or complications will occur.
Doctors and other health practitioners know a lot about
the treatments they recommend, but only you know about
your lifestyle, the demands of your job and family and your
personal needs and preferences. That is why you should
participate in decision-making about your health care.
Informed consent
Your treatment is your choice and when it comes to having a
test, treatment or operation that involves risk, you need to give
what is called ‘informed consent’.
Informed consent requires your health practitioner to discuss
with you the potential benefits and harms of your treatment
back to contents >
options. Before giving your consent to treatment, ask your
health practitioner these four questions:
1. What are my treatment options?
The discussion should include information about alternative
treatment options, including different types of surgery and
treatments. You are also entitled to seek a second opinion.
(For more about this go to Second opinion, below).
2. What are the expected outcomes of each option?
Successful treatment can never be absolutely assured and
different procedures carry different risks. You need to be
aware of the expected outcome of each treatment option,
including known complications, so that you can decide which
treatment option is best for you.
3. What is the likelihood that each expected outcome
will occur?
The likelihood of expected outcomes (success, side effects
and/or complications) varies with each treatment option, and
with individual patients’ characteristics, but knowing how
likely it is that each outcome will occur will help you and your
clinician weigh up the benefits and risks to decide which
option best suits your needs.
Some procedures that are new or uncommon may not have
sufficient research to support meaningful statistics and
your doctor will make recommendations based on other
information, such as personal surgical experience, training or
expert knowledge. Where your doctor is relying on alternative
information they should discuss this with you.
4. What is meant by consent to treatment?
Every patient has the right to participate in any decision about
their health care or medical treatment. In general, health
practitioners are required to inform you of the nature of the
proposed treatment and to gain your consent for all treatment,
before it starts.
The process and requirements for obtaining consent may vary
depending on the patient’s competency and age. However, it
will involve the following steps:
page 3
1. A discussion about the benefits and risks or each
treatment option.
2. The patient decides which treatment option is best for
them. Often this decision is shared by the clinician but it is
important that you participate to whatever degree you feel
able. If you need more time to consider your options or
discuss them with family and friends, talk to your doctor.
3. The health practitioner gains the patient’s consent for a
specific treatment, having appropriately disclosed any
material risks for that treatment.
4. The health practitioner records and documents the
consent process.
If you are not sure whether you want to have treatment, ask
your treatment team to explain what may happen if you do
not have it. For more information about this, see ‘Benefits and
disadvantages of cancer treatment’, below.
Hysterectomy and bilateral salpingo-oophorectomy
Endometrial cancer is usually treated by removing the uterus
and cervix. The operation is called a total hysterectomy. In
most cases, a woman will also have a bilateral salpingooophorectomy, which means her fallopian tubes and ovaries
are also removed. Women’s ovaries are removed during
surgery because the cancer may have spread, or because
ovaries produce oestrogen, a hormone which may cause
cancer to grow.
If you are premenopausal and feel concerned about how
surgery will affect your fertility, see ‘Effects on fertility’, below,
for more information.
Depending on the size and type of cancer you have, the
surgeon may also remove some other parts of your body. For
example, sometimes a small part of the upper vagina and
ligaments supporting the cervix are removed if the cancer has
spread to this area. The lymph glands in your pelvis may also
be removed. Your gynaecologic oncologist will discuss this
with you before the operation.
back to contents >
If the doctor has not confirmed the type of cancer you have or
how far it has spread, these operations may help to determine
this. A hysterectomy also gives your surgeon an opportunity to
examine the other organs in your abdomen for signs that the
cancer has spread (metastasised).
In a hysterectomy or bilateral salpingo-oophorectomy, a
cut is usually made from the pubic area to the belly button.
Occasionally a cut is made along the pubic line. Once the
abdomen is open, the surgeon washes out the area with fluid.
This fluid will be sent to a pathologist, who will check it for
cancer cells.
If appropriate, the operation may be performed as a
laparoscopic procedure (keyhole surgery). This means that
the surgeon makes a small cut in the abdomen and uses a
thin telescope to see inside the abdomen. The uterus (and any
other organs) are cut away and removed through the vagina.
Removing lymph nodes
If the cancer has spread into the muscular wall of the uterus,
this increases its risk of spreading to the abdominal lymph
nodes. You and your doctor may decide to remove some
lymph nodes in your pelvic region. Removal of lymph nodes is
called a lymphadenectomy.
Your surgeon may use extremely small titanium clips to seal
the lymph vessels when the nodes are removed. These should
not have long-term effects on your body.
If you do have cancer in your lymph nodes, your doctor may
advise additional therapy.
Side effects of surgery
After a hysterectomy and oophorectomy, some women
experience the following side effects:
• Pain. As with all major operations, you will have
some pain or discomfort. It is best to let your doctor
or nurse know when you are feeling uncomfortable
– don’t wait until the pain becomes severe. You will
be administered pain relief medication through an
intravenous drip. You may be able to use a patientcontrolled analgesia (PCA) system, which allows you to
page 4
choose when you receive a dose of medication. Some
people receive an epidural to relieve pain. An epidural
is a form of regional anaesthesia involving injection
of drugs into the spine. For more information, see our
factsheet Managing pain.
• Tiredness. Women usually feel extremely tired after
a hysterectomy. For tips on coping with tiredness, see
our factsheet Managing symptoms and side effects
of endometrial cancer.
• Nausea, vomiting, bladder and bowel problems.
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.
• Adhesions. Adhesions, or internal scar tissue
that glues together tissues in the body, may form.
Sometimes this can be painful. Adhesions to the bowel
or bladder may need to be treated with further surgery.
• Lymph fluid build-up. If you have had lymph nodes
removed (lymphadenectomy), parts of your body may
swell because your lymphatic system is not working
properly. This is called lymphoedema. Lymphoedema
symptoms may not appear for over two years after
surgery. Swelling in your limbs may be reduced
with gentle massage toward your heart, special
compression garments and gentle exercise. For more
information, see our factsheet Managing symptoms
and side effects of endometrial cancer.
• Not able to become pregnant. After a hysterectomy
you will not be able to become pregnant. For more
information see ‘Effects on fertility’, below.
• Menopause. If you have had a bilateral salpingooophorectomy and were not menopausal before
the surgery, the removal of your ovaries will cause
menopause. Hot flushes and other symptoms of
menopause caused by surgery may be more severe
than those caused by natural menopause. Hormone
replacement therapy (HRT) can help reduce your
symptoms. You will need to talk to your gynaecologic
back to contents >
oncologist about the benefits and risks of HRT.
Because cancer of the uterus can be hormonesensitive, HRT may not be suitable for some women.
For more information, see our factsheet Managing
symptoms and side effects of endometrial cancer.
• Effects on your sex life. The physical and emotional
changes you experience may also affect how you feel
about sex and how you respond sexually. For more
information, see our factsheet Emotional, social and
sexual aspects of endometrial cancer.
Recovery from surgery
When you wake up from a hysterectomy, you will have several
tubes in place. An intravenous drip will administer fluid as
well as medication. There may also be one or two tubes in
your abdomen to drain away fluid from the operation site and
a catheter in your bladder to drain away urine. These tubes
will usually be removed about three to five days after the
A hysterectomy is a major surgical procedure, and you may
be in hospital for up to seven days. Your recovery time will
depend on different factors, such as how much tissue was
removed and the stage of your cancer.
A few days after the operation, your doctor will have all
the test results and will discuss further treatment with you.
Further treatment will depend on the type of cancer, the stage
of the disease and the amount of any remaining cancer. If the
cancer is only on the surface of the uterus or is at a very early
stage, you may not require any further treatment.
It can help to schedule a consultation with your doctor and
take a close friend or relative to this appointment. This person
can provide you support and ensure you understand the
information you are given.
Taking care of yourself at home
It will take time to get back to your normal activities.
• Rest. Recovery time varies from woman to woman.
Most women feel better within six weeks but recovery
may take longer for women who have had extensive
surgery. You should take things easy and only do what
page 5
is comfortable. When your health care team advises
you to start exercising, you can start by walking. Start
with a short walk and try to go a little further each day.
• Lifting. Heavy lifting should be avoided for about three
months. If you have a partner or children, ask them
to help around the house. If you require some home
nursing care, ask hospital staff how to get in touch
with local services. See our factsheet Practical and
financial support for more information.
• Driving. Avoid driving for about four weeks after the
• Sex. Penetrative sexual intercourse should be avoided
for about six weeks after the operation to give your
wound time to heal. Check with your doctor about
when you can resume sexual intercourse.
Radiotherapy uses x-rays to kill cancer cells or injure them so
they cannot multiply. The radiation can be targeted at cancer
sites in your body. Treatment is carefully planned to do as little
harm as possible to your healthy body tissues.
Radiotherapy may be recommended if you are not well
enough for a major operation. It is also commonly used as an
additional therapy, which is called adjuvant therapy.
There are two ways radiotherapy is administered:
• From outside the body (external). A machine directs
radiation at the cancer and surrounding tissue.
• From inside the body (internal). Radioactive material is
put in thin tubes and inserted into your body on or near
the cancer.
Since internal and external radiotherapy have slightly different
purposes, it is possible to have both types of treatment. Your
gynaecologic oncologist and radiation oncologist will advise
the best form of treatment, based on your situation.
Internal radiotherapy (brachytherapy)
Internal radiotherapy, also called brachytherapy, is a type of
radiotherapy where the radiation source is placed close to
the cancer. If you need to have radiotherapy for cancer of the
back to contents >
uterus, you will probably have brachytherapy. You may also
have brachytherapy after a hysterectomy.
A radioactive implant will be inserted through the vagina or
the tissues around the vagina using special applicators.
Internal radiotherapy can be done in two ways: either
continuously for up to 30 hours as a low-dose rate treatment
or, more commonly, as high-dose rate treatment given in
several short sessions. Your choice of treatment may depend
on your location. For example, high-dose rate brachytherapy
may require several treatment appointments, which can be
difficult for a woman living in a rural area.
• Low-dose rate treatment: If you are having lowdose rate treatment, you will go to hospital to have an
implant put in. You will usually not be anaesthetised
if your doctor is able to slide the implant, which is
shaped like a cylinder, into your vagina. However, some
women may require a general anaesthetic when the
implant is inserted.
Because the implant is radioactive, you will need to
stay in a room on your own while the implant is in
place. You may not be allowed to have visitors during
this time.
Your radiation oncologist and the nursing staff will
explain the precautions associated with low-dose rate
brachytherapy, which vary from hospital to hospital
depending on the equipment used. These safety
measures may make you feel isolated and frightened
at a time when you would like people around you.
Talking on the phone, reading or sharing your feelings
with nurses may help pass the time.
• High-dose rate treatment: You may not need to stay
in hospital for high-dose rate brachytherapy, but you
will have four to eight outpatient treatment sessions.
Each brachytherapy session may last only five to 10
External radiotherapy
In external radiotherapy, x-rays from a large machine are
directed at the part of the body needing treatment. For
endometrial cancer, the lower abdominal area and pelvis are
page 6
treated, but if the cancer has spread (metastasised), this can
be extended to include other areas.
You will probably have radiotherapy treatment from Monday
to Friday for four to six weeks. You can usually receive this
treatment as an outpatient (at a radiotherapy centre) and you
will not need to stay in hospital.
The actual treatment only takes a few minutes each time,
but it can take several hours to undergo a simulator session
(work out where the treatment needs to be given), set up the
machine, see the doctor and have any other necessary tests,
such as blood tests.
External radiotherapy does not make you radioactive. It is safe
to be with other people in the period when you are having
treatment and afterwards. You will not hear or see the rays.
Side effects of radiotherapy
Radiotherapy can cause short- and long-term side effects.
The most common effects occur during or soon after
treatment. These side effects happen because radiotherapy
can damage healthy cells in addition to cancer cells.
You may experience some of the following side effects:
• Lethargy and loss of appetite: The radiotherapy will
make you feel tired and you may lose your appetite.
For tips on coping with tiredness and eating problems,
see our factsheet Managing symptoms and side
effects of endometrial cancer.
• Diarrhoea: Radiotherapy may irritate the bowel
and cause diarrhoea. This occurs when your stools
are loose and watery and you have frequent bowel
movements. For some ways to reduce diarrhoea, see
our factsheet Managing symptoms and side effects
of endometrial cancer.
• Hair loss: Radiotherapy can cause hair loss in the area
being treated, such as your pubic hair, and this may be
• Menopause: Radiotherapy to the pelvic region may
cause menopause. See ‘Effects on fertility’, below, and
our factsheet Managing symptoms and side effects
of endometrial cancer for more information.
back to contents >
• Shortening and narrowing of the vagina:
Radiotherapy to the pelvic area can affect the
vagina, which will become tender during the course
of radiotherapy and for a few weeks after it ends.
In the long term this irritation can make the vagina
drier and can leave scarring that makes the vagina
shorter, narrower and less flexible. This may make sex
uncomfortable or difficult. To keep your vagina open
and supple, use a dilator, which is a tube-shaped
device made of plastic or rubber, to keep the vagina
open. Your health care team can show you how to
use a dilator. A water-based vaginal lubricant can
help relieve painful irritation. Avoid Vaseline or other
oil-based lubricants as they may cause irritation. If you
are ready and able, have regular gentle sex to help
widen the vagina. For more information on your sex life
after treatment, see our factsheet Emotional, social
and sexual aspects of endometrial cancer.
• Cystitis: Radiotherapy to the pelvic area can
also cause a burning sensation when passing
urine (cystitis). These side effects can be mild or
troublesome depending on the strength of the
radiotherapy dose and the length of your treatment.
• Skin changes. Your skin may get red, itchy, dry or
swollen in the area being treated. Use lukewarm water
to shower or bathe, and a mild soap that does not have
fragrance or deodorant in it. Ask your radiographer or
nurse for advice on any skin problems.
When you’re having radiotherapy, you should allow yourself
plenty of time to rest. You should also try to drink lots of water
and have small, frequent meals. Ask your doctor or nurse
about ways to manage side effects.
The Cancer Council booklet, Understanding Radiotherapy,
has more information about managing the side effects of
radiotherapy. It is available free online or by calling the Cancer
Council Helpline (13 11 20).
back to contents >
page 7
Hormone treatment
Some cancers of the uterus depend on hormones (such as
oestrogen) for their growth. Hormone treatments include:
• provera, which blocks the body’s use of oestrogen, and
is a form of the female hormone progesterone
• tamoxifen, which is an anti-oestrogen drug.
Hormone treatment, which is taken orally, can work well for
advanced or recurrent endometrial cancer.
Side effects of hormone treatment
Side effects of provera include breast tenderness, nausea and
fluid retention. In high doses, it may increase appetite and
cause weight gain.
Tamoxifen can cause hot flushes, headaches and fluid retention.
You may have some or none of these side effects. Discuss any
problems or concerns with your doctors.
Chemotherapy uses drugs to kill or slow the growth of cancer
cells. The aim is to destroy cancer cells while causing the
least possible damage to healthy cells.
Chemotherapy may be used:
• for certain subtypes of endometrial cancer, such as
serous carcinoma
• when cancer returns after surgery or radiotherapy, to
gain control of the cancer and to relieve symptoms
• if the cancer does not respond to hormone treatment
• for women whose cancer has spread beyond the
uterus at the time of diagnosis, such that surgery is
not possible.
Chemotherapy is usually given through a needle inserted
into a vein (intravenously), by specialised nurses under
the guidance of an oncologist. You may need to stay in the
hospital overnight or you may be treated as an outpatient.
You may have a number of treatments, sometimes up to six,
every three to four weeks over several months. The length of
treatment will be determined based on your circumstances.
Side effects of chemotherapy
The side effects of chemotherapy vary according to the drugs
used. Most side effects are temporary and steps can often be
taken to prevent or reduce them. Talk to your health care team
for more information.
Most side effects go away after chemotherapy is over. But
sometimes it can take months or even years for them to go
Sometimes, chemotherapy may cause long-term side effects
that do not go away. These may include damage to your heart,
lungs, nerves, kidneys, or reproductive organs. Ask your doctor
or nurse about your chance of having long-term side effects.
Some women find that they can keep up with their
usual activities and even continue to work during their
chemotherapy. Others find they become very tired. Try to
adjust your schedule according to how you feel.
Common problems include:
• Lowered production of blood cells. Some
chemotherapy drugs affect the production of blood
cells so that your blood count is reduced. The count
may fall with each treatment. Blood tests will be done
regularly to make sure your blood cells return to
normal before your next treatment. When these cells
are reduced, you are more likely to get an infection,
bruise or bleed easily, and you may get very tired.
See your doctor if you are unwell: don’t wait out a cold
when you’re having chemotherapy. If you are having
chemotherapy in winter, check with your doctor about
having a flu injection. Contact your doctor or treating
hospital urgently if any of these problems occur:
-- fever over 38°C or chills
-- sweating, especially at night
-- easy bruising or any unusual bleeding
-- sore throat
-- mouth ulcers
-- persistent or severe vomiting more than 24 hours
after treatment
page 8
-- severe constipation, diarrhoea or abdominal pain
-- burning or stinging on passing urine
-- tenderness, redness or swelling around the place
where the injection goes in
-- any serious unexpected side effects or sudden
deterioration in health.
• Thrush. A common side effect in women having
chemotherapy is thrush, which includes vaginal itching or
burning and a whitish discharge. This is more common if
you are taking steroids or antibiotics to prevent infection.
Talk to your doctor about treatment for thrush. Creams are
available from the chemist. Wear loose cotton clothes and
avoid nylon pantyhose and tights, tight jeans or trousers.
Don’t use soap, bubble baths or oils or creams that might
irritate the genital area.
• Nausea and vomiting. Some chemotherapy drugs
may cause nausea (feeling sick) and vomiting. If
nausea does occur, it usually starts a few hours after
treatment and may last many hours. If you still feel
nauseous after a few days, contact your doctor. Antinausea medication can help. It may be taken as tablets
before treatment or added to the drip before and
during treatment. If nausea is likely, you will be given
anti-nausea tablets to take at home.
• Mouth sores. Some chemotherapy drugs can cause
mouth sores such as ulcers or infections. If you notice
any change in your mouth or throat, such as sores,
ulcers or thickened saliva, or find it difficult to swallow,
contact your doctor. You may be given a special
mouthwash to help prevent mouth infections. Don’t
use commercial mouthwashes that contain alcohol
without first asking the doctor.
• Loss of appetite. Loss of appetite is a common
problem that is often caused by the effects of cancer
on the body. If you can, try to have three small meals
and three snacks each day. A few mouthfuls of food
are better than none. For more information see our
factsheet Managing symptoms and side effects
of endometrial cancer. The Cancer Council booklet
back to contents >
Food and Cancer also includes tips on coping with
eating problems, including nausea, loss of appetite,
and chewing and swallowing difficulties. Call the
Cancer Council Helpline (13 11 20) for a copy.
• Hair loss. Most people having chemotherapy worry
about losing their hair. Some drugs may cause hair to
thin or fall out but many others do not cause hair loss.
If you do lose some or all of your hair, it will usually
grow back when your treatment stops.
When hair loss does occur, it usually starts two to
three weeks after the first treatment. Although losing
head hair is most common, some people may also lose
hair from their eyebrows, eyelashes, arms, legs, chest,
pubic region and eyelashes.
If you do lose your hair, you may choose to wear a hat,
scarf or wig. The important thing is to do whatever
feels comfortable and gives you the most confidence.
The Cancer Council Helpline (13 11 20) or your doctor
or nurse can help you find a wig. If you want to buy a
wig, ask your social worker about financial assistance.
It takes between 4–12 months to grow back a full
head of hair. When your hair first grows back it may
be a little different. It may be a different colour and
sometimes it will be curly even though you have
always had straight hair. In time your hair will return to
its normal condition and you will be able to continue
your usual hair-care routine.
Your scalp can be itchy when your hair is growing
back. Frequent shampooing can relieve the itching.
• Menopause. Chemotherapy may cause your ovaries
to stop working, if you haven’t had them removed
by surgery. If you haven’t already been through
menopause, your periods may stop temporarily, or
you may go through premature menopause. Early
menopause means you will experience menopausal
symptoms, and you will not be able to become
pregnant. For more information, see ‘Effects on
fertility’, below, and our factsheet Managing
symptoms and side effects of endometrial cancer.
page 9
• Other side effects. Chemotherapy may also cause
skin rash, tingling or numbness in your hands and
feet, hearing problems, loss of balance, joint pain,
or swollen legs and feet. Your treatment team can
suggest ways to control many of these problems.
Safety precautions for doctors, nurses and carers
While chemotherapy drugs can help treat people with cancer,
they can harm people who don’t have cancer.
The nurses and doctors giving chemotherapy take precautions
to avoid direct contact with the drugs. They will wear special
gloves, masks and goggles when preparing and giving you the
chemotherapy drugs, and dispose of these in special bags.
Chemotherapy may remain in the body for up to three days
after treatment, and is passed in urine and stool. Vomit may
also contain traces of chemotherapy. If you go to hospital
everyday for your chemotherapy or have it at home, your
carers will need to take extra care.
• Flush toilet twice after using for 48 hours after
receiving chemotherapy.
• Wear gloves when handling clothing or bed sheets that
have vomit on them.
• Wash skin with soap and water if chemotherapy spills
on the skin. Contact the hospital if any redness or
irritation caused by the spillage doesn’t clear within
the hour.
• Store chemotherapy tablets, capsules or injections as
directed by your doctor or pharmacist.
The Cancer Council booklet, Understanding Chemotherapy,
has more information about chemotherapy. It is available free
by calling the Cancer Council Helpline (13 11 20).
Effects on fertility
Endometrial cancer more commonly affects older women,
for whom fertility is not usually a concern. However, there are
some younger women aged 30–40 years, particularly those
who have a long history of polycystic ovary syndrome (PCOS),
who may be diagnosed with endometrial cancer.
back to contents >
The usual recommended treatment for endometrial cancer is
to surgically remove the uterus, including the cervix, and often
the fallopian tubes and ovaries as the disease may spread
locally to involve these organs.
The cancer poses a significant threat to your subsequent
chance of having a baby. This presents a further psychological
burden when you are already coping with the distressing
news that you have cancer.
In this time of anxiety and concern it is essential that you
receive concise and up-to-date information from a recognised
fertility expert. You should be referred to a respected unit
for this advice. The Reproductive Technology Accreditation
Committee (RTAC), under the Fertility Society of Australia
(FSA), administers a national Code of Practice and a system
for the accreditation of assisted reproductive technology
clinics. For a list of accredited clinics in Australia and New
Zealand, see the website of the Fertility Society of Australia at
If the diagnosis of endometrial cancer is made early and the
cancer does not invade the muscle of the uterus but appears
confined to the lining of the uterus (endometrium) then it may
be possible to conserve the ovaries, as the risk of spread to
the ovaries in this situation is considered to be very low.
In this situation your ovaries will still be producing eggs
and you may consider surrogacy (using your own eggs and
your partner’s sperm; the resulting embryo is placed in a
surrogate’s uterus).
If you have had a bilateral salpingo-oophorectomy as well as
a hysterectomy, you may consider surrogacy using a donor’s
eggs, or adoption.
Fertility-sparing options
If your ovaries are retained, chemotherapy and/or radiotherapy
may affect the number of eggs left within the ovary, and in
many cases, accelerate the normal age-related decline in egg
back to contents >
page 10
In some cases this may lead to an early menopause, and
hence the need to use another woman’s eggs (egg donation
treatment) to become pregnant. Hormone replacement
therapy can help with managing the symptoms of early
menopause; see our factsheet Managing symptoms and
side effects of endometrial cancer for more information.
A surgical procedure called ovarian transposition, which lifts
the ovaries as far from the source of the radiation as possible,
can reduce the harmful effects of the radiation on the ovaries.
You can talk to a fertility specialist about your options to limit
harm to your ovaries from chemotherapy. These may include:
Ovarian suppression
An implant containing a drug called a GnRH analogue may
be used to suppress the function of the ovaries for the
duration of chemotherapy. There is some evidence that this
may limit the harm to the ovaries for women embarking on
chemotherapy only.
Ovarian tissue freezing
One potential way to save some eggs for the future is to
take a small slice of ovarian tissue. This is done by a minor
operation before starting chemotherapy, or at the time of
ovarian transposition surgery before starting radiotherapy.
The major downside to this technique is that it is still
experimental – very few babies have been born from this
treatment. Furthermore, it involves undergoing an operation,
and then further surgery to re-implant the ovarian tissue.
Evidence suggests that many women do not want the ovarian
tissue replaced due to their fear of re-introducing tissue that
may still contain cancer cells.
Freezing of eggs
If you are not in a stable relationship, you may opt to go
through an IVF cycle. This takes up to one month before
starting chemotherapy or radiotherapy. It involves daily
injections to stimulate the ovaries, and then after a couple
of weeks, a minor surgical procedure to have the eggs
collected. These eggs are then rapidly frozen until they are
needed. However, this technique should still be considered
developmental and success so far is limited.
Freezing embryos
If you are in a stable relationship and time permits, you may
opt to go through an IVF cycle (described above), but in this
case your eggs are fertilised with your partner’s sperm and
the resulting embryos are frozen until they are used. The
freezing of embryos is a more successful procedure than the
freezing of eggs.
“Wait and see” policy
Many women find these choices are too hard to make at
this time of great anxiety. It may help to talk to the fertility
counsellor that is always attached to an IVF unit.
More information
(When reading international materials, please note that some
of the information may not apply to Australian patients.)
• The UK’s Cancerbackup website has more about cancer
and fertility in women:
(click on ‘Cancer support’ then ‘Fertility’).
• The American Society for Reproductive Medicine
( has a one-page factsheet for
patients on Cancer and Fertility Preservation.
• Fertile Hope ( is a US non-profit
organisation with online calculators to assess fertility
risk and fertility-sparing options for people with cancer.
• Access ( is an Australian nonprofit organisation that provides infertility support,
information and advocacy.
Complementary therapies
Complementary therapies are used in conjunction with
conventional treatments. Sometimes called natural therapies,
holistic therapies or traditional therapies, they may offer you
physical, emotional and spiritual support, reduced side effects
from medical treatment, and improved quality of life.
Examples of complementary therapies include acupuncture,
massage, aromatherapy, meditation, herbal medicine and
Although not all complementary therapies have been
scientifically proven to work, and their safety and effectiveness
back to contents >
page 11
is not always clear, research and clinical trials are increasing
to determine the value of these therapies and how they may
be able to help people with cancer.
It is important to know that complementary therapies are
usually safe when you see qualified practitioners who
have an understanding of the needs of people with cancer.
However, you should weigh up the pros and cons of using
these therapies, and discuss your decision with your doctor,
to minimise the risk of any problems. Some herbs and
high doses of some vitamins, for example, may affect how
chemotherapy and radiation work.
Alternative therapies
Unlike complementary therapies, alternative therapies are
used in place of conventional treatments. These therapies
may be harmful if people with cancer delay or stop using
conventional treatments in favour of them.
Alternative therapies may carry claims that they stop cancer
growth or cure cancer. They are often expensive and may
promote extreme dietary and lifestyle protocols. Many therapies
have not been scientifically tested, so there is no proof that
they work and their side effects are not always known. Some
therapies have been researched and proven not to work.
Examples of alternative therapies are microwave therapy,
ozone therapy, magnet therapy, coffee enemas, or taking
high-dose supplements of vitamins or other compounds such
as laetrile (vitamin B17), shark cartilage, mistletoe extract or
Nutrition is an important part of cancer care but when a
specific type of diet is used in place of conventional cancer
treatment in the hope that it will cure cancer, it is considered
an alternative therapy. Sometimes these diets omit major
food groups or recommend extreme practices, such as eating
one kind of food or drinking nothing but fruit and vegetable
juices. Examples of extreme diets promoted for cancer control
include the macrobiotic diet and the Gerson diet.
Some people will try to take advantage of others who are in a
vulnerable situation. People at any stage of cancer are often
targeted with offers of cures that are too good to be true. If
you are feeling helpless or unsure about different treatments,
talk to your doctor or a counsellor.
Be wary of the following situations:
• The practitioner has no qualifications or studied at an
unaccredited college or university.
• The practitioner tells you not to have conventional
treatment, or that medical treatment will stop their
treatment from working.
• The practitioner asks you not to speak about the
treatment with your doctors, or won’t tell you the
secret ingredients.
• The treatment claims to cure all cancers.
• The practitioner says there are clinical studies for the
remedy’s effectiveness but does not show you proof.
• The treatment costs a lot of money or you need to pay
in advance for several months supply of a remedy.
• You need to travel overseas to have the treatment.
Questions to ask your complementary health care provider
1. What are your qualifications? Are you a member of a
professional association?
2. What training or experience do you have in treating people
with cancer? Have you treated anyone with my type of
3. Are you willing to work with my doctors or other health
professionals I may need to see?
4. How can the therapies you practise help me? Are there
any specific precautions you would take for me?
5. Are there side effects or risks associated with these
6. Has the therapy been tested in clinical trials?
7. Have the findings been published and are they available
for me to read?
8. Can these therapies be combined with conventional
9. How long should I use this therapy and how will I know if
it’s working?
back to contents >
page 12
10.Are you able to do home visits if I am not well enough to
attend your clinic?
• Is there a chance that a new treatment will be found
while we try the old one?
11.How long are your consultations?
• What’s the most likely result of trying this treatment?
12.What do you charge for a consultation?
• What are the possible side effects and other
downsides of the treatment? How likely are they?
13.What can I expect from a consultation?
14.Do you dispense your own medicine and supplements?
15.How much can I expect to pay for medicines?
16.Have the products or medicines you dispense been
approved by the Therapeutic Goods Administration?
The Cancer Council booklet, Understanding Complementary
Therapies, has more information about complementary
therapies. It is available free by calling the Cancer Council
Helpline (13 11 20).
Benefits and disadvantages of cancer treatment
• Are the possible rewards bigger than the possible
It is important to ask your health care team what to expect in
the future. It’s also important to be clear with them about how
much information you want to receive from them.
If you feel that you would like to stop treatment, but your
family or your partner does not want you to, it might help for
you and your doctor or a counsellor or psychologist to talk to
your family or your partner about their feelings.
If you are offered a choice of treatments, you will need to
weigh the advantages and disadvantages of each treatment. If
only one type of treatment is recommended, ask your doctor
to explain why other choices have not been offered.
Second opinion
Some people with more advanced cancer will choose
treatment, even if it only offers a small chance of cure. Others
want to make sure the benefits of treatment outweigh any
side effects. Still others will choose the treatment they believe
offers them the best quality of life.
A second opinion can be a valuable part of your decisionmaking process. It can confirm or clarify your doctor’s
recommended treatment plan and reassure you that you
have explored all of your options. A second specialist can also
answer any questions you may still have.
Some people may choose not to have treatment to eradicate
cancer, but instead will choose to have symptoms managed
to optimise their physical and emotional well-being. See our
factsheet Palliative care for more information about this.
You may wish to discuss your options with you treatment
team, family and friends, or with a counsellor, psychologist or
Your original specialist or family doctor can refer you to
another specialist and you can ask for your initial results to be
sent to the second-opinion doctor.
Questions you may want to ask include:
• What’s the best we can hope for by trying another
treatment? What is the goal?
• Is this treatment plan meant to help side effects, slow
the spread of cancer, or both?
You may want to get a second opinion from another specialist.
Some people feel uncomfortable asking their doctor for a
second opinion, but specialists are used to patients doing this.
It may take some time and effort to gather your medical
records and see another doctor. In most cases, it’s not a
problem to take several weeks to get a second opinion. The
delay in starting treatment usually will not make treatment
less effective. To make sure, you should discuss this delay
with your doctor.
You may later decide you would prefer to be treated by the
doctor who provided the second opinion, and this is your right.
You can ask for a second opinion even if you have already
started treatment or still want to be treated by your first doctor.
back to contents >
page 13
More information
For more information on side effects, see our factsheet
Managing symptoms and side effects of endometrial
We thank the following organisations and individuals for
allowing their information to be used for this factsheet:
For more information about the effects of your treatment on
your emotions and sexuality, see our factsheet Emotional,
social and sexual aspects of endometrial cancer, or call
the Cancer Council Helpline (13 11 20) for a copy of the
booklet, Sexuality for Women with Cancer.
For information about services that may be able to assist
you during your treatment and recovery, see our factsheet
Practical and financial support.
For links to more websites and contact details of support
organisations, see our factsheet Other resources.
Cancer Council New South Wales
National Cancer Institute (USA)
Professor Roger Hart, School of Women’s and Infants’ Health,
University of Western Australia, King Edward Memorial
Hospital and Medical Director, Fertility Specialists of Western
Professor Ian Hammond, WA Gynaecologic Cancer Service,
Perth, Western Australia
Karen Carey, Patient First, Western Australian Council for
Safety and Quality in Health Care
ABN 21075951918
The National Centre for Gynaecological Cancers is an Australian Government initiative to improve outcomes for women affected by
gynaecological cancers, their families and carers, and to lessen the impact of cancer on their lives. It has been established by Cancer Australia.
Treatment options for endometrial cancer 2010
Last updated 2009. The information in this fact sheet was current at the time of publication. To check if it is the most up-to date version, please call 02 6217 9818
Disclaimer: This information is presented by Cancer Australia for the purpose of disseminating information free of charge to the public. It should not be used
for therapeutic purposes or as a substitute for your own health professional’s advice. Cancer Australia does not accept any liability for any injury, loss or damage
incurred by use of or reliance on the information provided on this website.
National Centre for Gynaecological Cancers, Cancer Australia, PO Box 1201, Dickson ACT 2602
Tel: 02 6217 9818 | Email: [email protected]