After the diagnostic tests are done, your cancer care team will recommend one or more treatment options. Don't feel rushed about making a decision. If there is anything you do not understand, ask to have it explained again. The choice of treatment depends largely on the type of cancer and stage of the disease when it is diagnosed. Other factors might play a part in choosing the best treatment plan. These might include your age, your overall state of health, whether you plan to have children, and other personal considerations. Be sure you understand all of the risks and side effects of different treatment options before making a decision.

From the start, keep in mind that you will be dealing with your own body and emotions. In the process of deciding what kind of treatment to have, you will find it helpful to discuss options with your family and friends, as well as with your primary care doctor and nurse. At every step of the way, before treatment, during treatment, and in recovery, you should talk with your cancer care team about side effects and ways to avoid them or make them easier to endure. They want to answer your questions, so ask them!

You may want to get a second opinion. This can provide more information and help you feel confident about the treatment plan you choose. Some insurance companies require a second opinion before they will pay for certain treatments, but a second opinion is usually not required for routine cancer treatments.

The 4 basic types of treatment for women with uterine sarcoma are surgery, radiation therapy, chemotherapy, and hormone therapy. A combination of these treatments may be used. The choice of treatment(s) will depend on the type and stage of your cancer and your overall medical condition.

Treatment Options by Stage

Stage I: If the cancer seen on endometrial biopsy or D&C is grade 1, a hysterectomy and a bilateral salpingo-oophorectomy (BSO) will be done first. As soon as the uterus is removed, it will be examined to see how deep and far the cancer may have spread. This may simply involve a close look at the uterus after it has been cut in half. Sometimes a pathologist will look at a piece of the uterus under a microscope to determine the exact extent of the cancer.

If the cancer involves the upper two thirds of the body of the uterus and extends less than halfway through the thickness of the uterus, the surgeon may decide not to remove any lymph nodes or may remove selected pelvic and para-aortic nodes. If these nodes do not have cancer cells and if washings and other cell or tissue samples of the cavity inside the pelvis and abdomen do not contain any cancer cells, no more treatment will be needed. If the pelvic nodes are found to contain cancer, then radiation therapy to the entire pelvis may be recommended.

If the cancer seen on endometrial biopsy or D&C is grade 2 or 3 (See How is Endometrial Cancer Diagnosed" and look under, �Testing of Endometrial Tissue") or if the cancer has spread deeper than half the thickness of the wall of the uterus, then the pelvic and para-aortic lymph nodes are sampled. Biopsies of the omentum (fatty tissue from the abdomen) may also be taken, especially for certain types of endometrial cancer (such as uterine papillary serous cancer).

Even if cancer has not spread to pelvic lymph nodes but is a high intermediate grade (grade 2 or 3, involves the outer third of the uterus, or invades lymph or blood vessels), radiation therapy is often given to reduce the risk of cancer coming back in the vagina or pelvis. In patients with lower risk factors (invasion of less than outer third of uterus, no lymph node or blood vessel invasion) radiation may not be given after surgery. A recent study showed that pelvic radiation given right after surgery will reduce pelvic recurrence but does not improve survival when compared to patients who only received pelvic radiation when the cancer came back. The advantage to waiting for recurrence is that fewer women receive radiation. The chance of being cured with this approach seems to be the same as for women who have received radiation right after surgery.

If the cancer comes back, it usually does so in the vagina. Many doctors, therefore, recommend only brachytherapy to the vagina. Others recommend external beam radiation to the whole pelvic area.

Progestin therapy may be especially useful in young women with early-stage uterine cancer who still want to have children. This experimental treatment may cause the cancer to shrink, allowing the option of getting pregnant, but this approach is very controversial and it has risks, including disease recurrence and spread outside the uterus. A second opinion from a gynecologic oncologist and pathologist (to confirm the grade of the cancer) before starting progestin therapy is important. Patients need to understand that this is not a conventional method of treatment.

Stage II: Standard treatment usually combines surgery with radiation therapy. For women with stage IIA, the surgery is most often a simple hysterectomy and bilateral salpingo-oophorectomy (BSO), usually with removal and biopsies of pelvic and para-aortic lymph nodes. Radiation therapy is usually given after surgery. If the tumor is seen to be invading the cervix (stage IIB), a radical hysterectomy (removing extra tissue around the uterus and part of the vagina) with bilateral salpingo-oophorectomy (BSO) is one option. The other option is radiation therapy first, followed by a simple hysterectomy and BSO.

The surgeon will usually remove most of the pelvic and para-aortic lymph nodes so they can be checked for cancer cells. If lymph nodes show cancer, then the pelvic lymph nodes will be treated with radiation after surgery. The para-aortic lymph nodes may be treated as well. If the para-aortic nodes do contain cancer from the endometrium then a woman might want to consider entering a clinical trial that looks at treatments to prevent the cancer from coming back.

In some cases, a woman with stage I or II endometrial cancer might be too frail or ill from other diseases to withstand surgery. These women are treated with radiation therapy alone; about half can be cured.

Stage III: If the surgeon thinks that all visible cancer can be removed, a hysterectomy and bilateral salpingo-oophorectomy (BSO) with or without pelvic and para-aortic lymph node sampling is done. Sometimes patients with stage III require a radical hysterectomy. Patients with stage III will usually receive radiation therapy to the pelvis after surgery and sometimes brachytherapy to the vagina. If para-aortic nodes are involved, additional radiation will be aimed at the upper abdomen to treat this area. If the surgeon feels that it is not possible to remove all visible cancer, radiation therapy may be given without removing the uterus. Radiation therapy may shrink the tumor enough to make surgery an option. Another approach would be taking part in a clinical trial that looks at treatments to prevent the cancer from coming back.

There have been some studies that show that chemotherapy is at least as effective as radiation in keeping the cancer from coming back. Sometimes both radiation and chemotherapy will be given after surgery.

Sometimes the only sign of cancer spread is that cancer cells are found in fluid removed from the abdomen. Depending on other risk factors determined at surgery and by pathologic review, these patients will be treated with radiation with or without chemotherapy after surgery.

Stage IV: The extensive spread of the cancer makes a surgical cure nearly impossible at this stage. A hysterectomy and bilateral salpingo-oophorectomy may still be done to prevent excessive bleeding. Radiation therapy may also be used for this reason. When the cancer has spread to other parts of the body, hormone therapy is often used. High-grade cancers and those without detectable progesterone receptors are less likely to respond to hormone therapy.

Combinations of chemotherapy drug have been found to be effective for a time in about 20% to 40% of women with advanced endometrial cancer. The drugs used most often are doxorubicin (Adriamycin), paclitaxel (Taxol), cisplatin, topotecan, carboplatin, cyclophosphamide, fluorouracil (5-FU), and methotrexate.. These are usually used in combinations of two drugs. Patients with stage IV endometrial cancer should consider taking part in clinical trials of chemotherapy or other new treatments.