Radiation therapy can significantly reduce local recurrence rates, especially in intermediate- and high-risk patients, but it may be associated with side effects such as fatigue, skin irritation, changes in bowel or bladder habits, vaginal dryness or narrowing, and long-term pelvic tissue changes, which are carefully managed through supportive care and follow-up. Chemotherapy plays a particularly important role in the treatment of advanced-stage uterine cancer, aggressive histologic subtypes such as uterine serous carcinoma or clear cell carcinoma, and recurrent disease, and it involves the use of anti-cancer drugs, most commonly administered intravenously, that circulate throughout the body to kill cancer cells that may have spread beyond the uterus.
The most frequently used chemotherapy regimens include combinations of drugs such as carboplatin and paclitaxel, which have been shown to improve survival outcomes, although chemotherapy can also cause side effects including nausea, hair loss, fatigue, lowered blood counts, increased risk of infection, neuropathy, and changes in appetite, all of which are closely monitored and managed by oncology teams to maintain patient safety and comfort. Hormone therapy is another important treatment option, particularly for cancers that are hormone receptor-positive, meaning the cancer cells grow in response to estrogen or progesterone, and it is often used in patients with advanced or recurrent disease, those who cannot tolerate chemotherapy or radiation, or younger patients who wish to preserve fertility under very carefully selected circumstances and strict medical supervision. Hormone therapy works by blocking hormones or lowering hormone levels in the body and commonly involves the use of progestins, aromatase inhibitors, or drugs that affect estrogen receptors, and while it is generally associated with fewer side effects than chemotherapy, it can still cause weight gain, fluid retention, hot flashes, mood changes, and increased risk of blood clots in some patients.
In recent years, targeted therapy has emerged as a promising option for certain patients with uterine cancer, focusing on specific molecules or pathways that cancer cells use to grow and survive, and drugs such as those targeting the HER2 protein or angiogenesis pathways that affect blood vessel formation can be particularly effective in selected cases when tumors express specific Robotic cancer surgery, allowing for a more personalized treatment approach that may improve effectiveness while reducing damage to healthy cells. Immunotherapy has also become an important advancement in uterine cancer treatment, especially for patients with advanced or recurrent disease that does not respond well to traditional therapies, and these treatments work by stimulating the body’s own immune system to recognize and attack cancer cells, with immune checkpoint inhibitors such as those targeting PD-1 or PD-L1 showing encouraging results in tumors that are mismatch repair deficient or microsatellite instability-high, a genetic characteristic found in a subset of uterine cancers.
The identification of these molecular features through tumor testing has transformed treatment planning by allowing clinicians to match patients with therapies most likely to benefit them, highlighting the growing importance of precision medicine in gynecologic oncology. Fertility-sparing treatment is a highly specialized and carefully considered option for a small group of younger patients with early-stage, low-grade endometrial cancer who strongly desire future pregnancy, and it typically involves high-dose hormone therapy combined with close surveillance using imaging and endometrial sampling, with the understanding that definitive surgical treatment is usually recommended once childbearing is complete or if the cancer does not respond adequately to hormonal management. Supportive and palliative care is an essential component of uterine cancer treatment at all stages of the disease, focusing on symptom management, pain control, emotional support, nutritional guidance, and overall quality of life, and it can be provided alongside curative treatments or as the main focus of care in advanced cases, ensuring that patients’ physical, psychological, and social needs are addressed with compassion and respect.