Surgery is the best treatment for endometrial cancer and results in the highest cure rates. Sometimes a woman cannot have surgery, usually because she is too medically ill to have general anesthesia, or because she has other problems that make surgery technically difficult, such as morbid obesity. In these cases there are other options.
A woman with a grade I cancer that appears to be con-fined to the endometrium (based on MRI most commonly) can be treated with hormones alone. This treatment does not always work, but can be successful in “reversing” the cancer in approximately 60% of cases.
Most doctors use the hormone progesterone by mouth, but an IUD (intrauterine device) with progesterone in it can also be used. The woman must undergo sequential endometrial biopsies in order to be sure that the cancer has “reversed” and, after reversal, she must remain on lifetime progesterone. Progesterone has significant side effects, including weight gain, breast tenderness, and increased risk of blood clot.
Alternatively, the woman may be treated with radiation therapy. Usually intracavitary applicators (in the vagina) are used, along with whole pelvic radiation. A woman can be cured with radiation alone, but the cure rates are lower than they are for surgery or surgery plus radiation. There are also complications associated with radiation, including diarrhea, fatigue, and damage to bowel and bladder.