Endometrial Cancer Treatment: Surgery, Chemotherapy, Radiation, Immunotherapy, and More
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Endometrial Cancer Treatment: A Complete Guide

Endometrial Cancer Treatment: A Complete Guide
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Updated on September 18, 2025
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Endometrial cancer, also known as uterine or womb cancer, occurs when cancer cells develop in the endometrium, the inner lining of the uterus. Endometrial cancer treatments include surgery, chemotherapy, radiation therapy (radiotherapy), immunotherapy, targeted therapy, and hormone therapy.

“Endometrial cancer treatment generally has a high success rate, especially when the cancer is found early,” says John Wallbillich, MD, gynecologic oncologist at the Barbara Ann Karmanos Cancer Institute in Roseville, Michigan. Overall, the five-year estimated survival rate for endometrial cancer is about 81 percent, meaning that 81 percent of people with endometrial cancer will be alive five years after diagnosis.

“Even in [advanced] cases in which the cancer is incurable, there are many lines of treatment available, including clinical trials and personalized therapies targeting specific mutations,” says Dr. Wallbillich.

To find out which treatment options are best for you, speak to your oncologist and consider asking for a second opinion. Always talk to your doctor before making any changes to your treatment, whether it’s starting a new therapy or adding a new one to your current plan.

Surgery

Surgery is usually the first line of treatment for endometrial cancer. But the best treatment for you will depend on your individual circumstances, including cancer stage, whether you wish to become pregnant in the future, and overall health.

For example, if you want to try to conceive in the future, you and your doctor may avoid or postpone surgery and try other treatments first. If you’re not feeling well enough for surgery, radiotherapy may be your first option instead.

For stage 1 endometrial cancer, where the tumor has not spread outside the uterus and ovaries, surgery may be enough to remove the cancer. More advanced stages will require additional forms of treatment.

Hysterectomy

The main surgery for endometrial cancer is a hysterectomy, where the uterus is removed. Your doctor may also remove the fallopian tubes and ovaries if the cancer has spread there.

There are several types of hysterectomies:

  • Subtotal or Partial Hysterectomy Only the uterus is removed (the cervix is left intact).
  • Total Hysterectomy The uterus and cervix are removed together.
  • Radical Hysterectomy The uterus, cervix, upper part of the vagina, and surrounding tissues are removed.
  • Hysterectomy With Bilateral Salpingo-Oophorectomy (TH/BSO) The uterus, cervix, fallopian tubes, and ovaries are removed.
  • Vaginal Hysterectomy A surgical technique to remove the uterus through the vagina whereas abdominal hysterectomy is when the uterus is removed through the abdominal wall. Abdominal hysterectomies are more common in cancer treatment.

Other Surgical Procedures

If your doctor suspects that the cancer has spread to other areas, they may recommend one of the following forms of surgery in addition to hysterectomy:

  • Para-Aortic Lymph Node Dissection This procedure removes the lymph nodes in the pelvis and around the aorta. It also helps your doctor stage the cancer, to see how far it has advanced.

  • Omentectomy This procedure involves removing all or part of the omentum, a structure made of fatty tissue that covers and connects the stomach and other organs in the abdominal cavity. It’s not a common procedure for endometrial cancer treatment, but it can sometimes be recommended in more advanced cases.

During surgery, your doctor may also perform pelvic, or peritoneal, washings. In this procedure, a saltwater solution is used to “wash” the pelvic cavity and check for cancer cells in that area.

Chemotherapy

Following surgery, your healthcare team may recommend chemotherapy to destroy any remaining cancer cells. Chemotherapy may also be recommended if your endometrial cancer is recurrent, meaning that it has come back after treatment. In this case, chemo helps to either shrink cancer tumors or stop them from growing.

Most chemo drugs are given intravenously (through an IV). You may be given chemo on its own or in combination with other treatments (such as radiotherapy) depending on the stage of your cancer, whether it has spread and where, and your individual health needs and treatment goals.

Chemotherapy drugs commonly used to treat endometrial cancer include:

Doctors may recommend combinations of different chemo agents, as appropriate, rather than a single drug.

Chemotherapy can cause a range of side effects, including:

  • Anemia
  • Brain fog
  • Constipation or diarrhea
  • Dehydration
  • Fatigue
  • Fertility problems
  • Hair loss
  • Loss of appetite
  • Mouth sores
  • Muscle and joint pain
  • Nausea and vomiting
  • Nerve damage
  • Taste changes
  • A higher risk of infection and a weakened immune system

It’s important to discuss all side effects with your doctor. Depending on the severity of side effects, your doctor may adjust the dosage of your chemo drugs, give you medications or suggest other strategies to help relieve side effects, or switch you to a different chemotherapy drug.

Radiation Therapy

After surgery, your doctor may also recommend radiation therapy to remove any cancer cells that may persist in the body.

There are two different types of radiation therapy:

  • Internal Radiation Therapy, or Brachytherapy Radioactive materials are placed inside the body to kill cancer cells nearby. To treat endometrial cancer, a cylindrical applicator — similar to a tampon — that contains these materials is inserted into the vagina. Brachytherapy may be administered at a low-dose rate (lower radiation dose left in your body over a longer period of time) or at a high-dose rate (higher radiation dose administered for a shorter duration), though the low-does rate isn’t commonly used in the United States.
  • External Beam Radiation Therapy A specialized machine is used to aim radiation beams at a specific part of the body — in this case, your pelvic area.
Your radiation oncologist will recommend one of these methods depending on the stage and grade of the cancer. Sometimes, your doctor may advise a combination of both.

Radiation therapy can cause both short- and long-term side effects, such as:

  • Vaginal irritation or dryness
  • Bladder or bowel problems
  • Low blood cell counts
  • Skin changes and irritation
  • Weakened bones and a higher risk of fractures
  • Premature menopause
  • Lymphedema

Immunotherapy

In some cases, doctors may prescribe immunotherapy — a type of therapy that enhances the body’s own immune response against the cancer cells.

“The biggest innovation that’s led to significant improvements and outcomes for endometrial cancer patients is adding immunotherapy to chemotherapy for patients with advanced-stage, recurrent endometrial cancer,” says Wallbillich.

Some forms of cancer are able to evade the body’s immune cells. Immunotherapy drugs work by effectively “teaching” those immune cells to better recognize cancer in the body.

“If the tumor is what we call ‘immune hot’ (it’s more likely to be found and attacked by the immune system) and we give the patient an immune checkpoint inhibitor ... we found that it drastically improves survival. This has been the most significant improvement I’ve seen in my career and has happened in the past decade,” says Wallbillich.

The most commonly used immunotherapy drugs are PD-1 and PD-L1 inhibitors, so called because they inhibit the “off switches” that can prevent immune cells from attacking cancer cells.

 Both PD-1 and PD-L1 inhibitors are given by IV infusions.
The PD-1 inhibitors used for endometrial cancer are:

PD-L1 inhibitors used for endometrial cancer include durvalumab (Imfinzi).

Side effects of these immunotherapy drugs include:

  • Fatigue
  • Fever
  • Cough
  • Nausea
  • Skin changes such as itching or a rash
  • Muscle or joint pain
  • Constipation or diarrhea
  • Shortness of breath

“The side effects of chemotherapy and immunotherapy usually go away within a month or two of stopping the treatment,” says Wallbillich. “However, in some cases, side effects might persist, and we manage those. In general, most patients are as close to their full functioning as possible within a couple of months of finishing treatment.”

Targeted Therapy

Targeted therapy uses drugs that attack specific proteins on cancer cells. They are most often prescribed to treat tumors that have spread to other parts of the body, or to treat recurrent endometrial cancer.

Lenvatinib (Lenvima) is the only targeted therapy for endometrial cancer approved by the U.S. Food and Drug Administration (FDA). There are also additional targeted therapies that can be used off-label to treat endometrial cancer.

Monoclonal Antibodies

Monoclonal antibodies are artificial antibodies created in the lab. Monoclonal antibodies are proteins,and this form of targeted therapy is sometimes also considered an immunotherapy.

Monoclonal antibodies work by targeting cancer cells and destroying them, mimicking the way in which the body’s own immune cells work.

Trastuzumab (Herceptin) is a monoclonal antibody used to treat some endometrial cancers. It may be given along with chemotherapy for advanced or recurrent endometrial cancers.

Antibody-Drug Conjugates

Antibody-drug conjugates are antibodies linked to a chemotherapy drug. This allows the chemo drug to be delivered directly to the cancer cells.

Fam-trastuzumab deruxtecan (Enhertu) is an antibody-drug conjugate that may be used for advanced or recurrent endometrial cancer after at least one other treatment has already been attempted. It’s given as an IV infusion, and may cause lung or heart problems.

Kinase Inhibitors and Multikinase Inhibitors

These drugs target proteins called kinases in cancer cells that help them grow. They also prevent cancer cells from forming new blood vessels, which they need for nourishment and to grow. These are sometimes also considered targeted therapies.

Lenvatinib (Lenvima) is a kinase inhibitor used to treat advanced endometrial cancer, usually after chemotherapy has already been given without results. It is currently the only FDA-approved kinase inhibitor. Lenvatinib is given orally as capsules, usually in combination with pembrolizumab.

Angiogenesis Inhibitors

Angiogenesis inhibitors target a protein called VEGF on cancer cells to prevent them from forming new blood vessels and growing.

Bevacizumab (Avastin) is an angiogenesis inhibitor and a monoclonal antibody that may be given alone or in combination with chemotherapy for advanced endometrial cancer.

 It’s administered as an IV infusion.

mTOR Inhibitors

These drugs target a protein called mTOR, which helps cancer cells grow. There are two mTOR inhibitors used for endometrial cancer, although they are not abeled by the FDA for use in endometrial carcinoma:

  • everolimus (Afinitor), given as a pill
  • temsirolimus (Torisel), given as an IV infusion

NTRK Inhibitors

Sometimes, endometrial cancer cells have a mutation in the NTRK genes. When this genetic mutation occurs, the cells make abnormal TRK proteins, which lead to cancer.

Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are NTRK inhibitors that target these abnormal TRK proteins. They are used for advanced endometrial cancer, and are given orally as pills.

Targeted Therapy Side Effects

In general, side effects from targeted therapies for endometrial cancer include:

  • Fever
  • Nausea or vomiting
  • Diarrhea
  • Mouth sores
  • Tiredness
  • High blood pressure
  • Severe bleeding (rare)
Lenvatinib (Lenvima), the only FDA-approved targeted therapy for endometrial cancer, has side effects that include:

  • Hypertension
  • Diarrhea
  • Bladder pain
  • Bleeding gums
  • Unexpected weight loss or weight gain
  • Difficulty speaking (less common)

Hormone Therapy

Hormone therapy may be recommended for premenopausal women whose endometrial cancer has not spread beyond the uterine wall. It may also be used to prevent recurrence in women who can’t have surgery.

Some endometrial cancers have receptors for the hormones estrogen and progesterone (these are called “hormone receptor–positive” cancers). Low levels of progesterone and high levels of estrogen promote tumor growth. If your cancer cells have these receptors, your medical team may recommend hormone therapy.

Progestins

The most common form of hormone therapy for endometrial cancer is progestin therapy. Progestins are a synthetic form of progesterone that blocks the activity of estrogen to slow or prevent tumor growth.

Progestins used for endometrial cancer are:

  • medroxyprogesterone acetate (Provera), in pill or injection form
  • megestrol acetate (Megace), in liquid or pill form
  • levonorgestrel intrauterine device (IUD), inserted in the uterus, which releases levonorgestrel daily

Aromatase Inhibitors

For those with early-stage endometrial cancer, doctors may prescribe aromatase inhibitors as an additional treatment after the primary treatment to reduce the chances of the cancer coming back. This is called adjuvant therapy.

 Adjuvant therapies can also help treat more advanced-stage or recurrent cancers.
Aromatase inhibitors work by blocking the effect of an enzyme called aromatase, which converts androgen hormones into estrogen. Blocking this conversion to estrogen helps stop cancer cell growth. This class of drug is approved by the FDA for use in breast cancer but sometimes it is useful in endometrial cancer as well.

Aromatase inhibitors come in pill form and include:

  • letrozole (Femara)
  • anastrozole (Arimidex)
  • exemestane (Aromasin)

Aromatase inhibitors are frequently prescribed along with CDK 4/6 inhibitors.

CDK 4/6 Inhibitors

CDK 4/6 inhibitors target and block proteins called cyclin-dependent kinases (CDKs), cancer cells use to divide and spread.

CDK 4/6 inhibitors are a treatment option for people with hormone receptor–positive endometrial cancer, and are frequently used in combination with aromatase inhibitors.

Some of the most commonly prescribed CDK4/6 inhibitors are:

  • ribociclib (Kisqali)
  • palbociclib (Ibrance)

  • abemaciclib (Verzenio)
These drugs come in pill form, and their most common side effects include low blood counts and fatigue.

Tamoxifen

Though typically used in the treatment of breast cancer, doctors also sometimes prescribe tamoxifen as an adjuvant therapy for advanced-stage endometrial cancer. This drug, which comes in pill form, works by blocking the hormone estrogen from contributing to the growth and spread of cancer tumors.

However, tamoxifen can sometimes act like an estrogen in the uterus, increasing the risk of endometrial cancer growth. This risk is very low, but it’s important to discuss its potential effects with your doctor.

Fulvestrant

Fulvestrant is an estrogen receptor antagonist, which means it blocks the effects of estrogen on cancer cells, preventing tumor growth. Fulvestrant may be used for advanced or recurrent endometrial cancer. It’s given as monthly shots.

Hormone Therapy Side Effects

The side effects of hormone therapy may include symptoms of menopause. Others are similar to those of chemotherapy. Common side effects include:

  • Fatigue
  • Hair loss
  • Headaches
  • Hot flashes
  • Loss of appetite
  • Low blood cell counts
  • Mood changes
  • Muscle, joint, or bone pain
  • Nausea or vomiting
  • Night sweats
  • Vaginal dryness
  • Weight gain
  • Increased blood sugar levels (if you have diabetes)

Lifestyle Changes

Various lifestyle changes may help reduce a person’s risk of developing endometrial cancer and support recovery after endometrial cancer treatment, explains Ryan Matthew Kahn, MD, gynecologic oncologist at Miami Cancer Institute, part of Baptist Health South Florida. These include:

  • Eating a balanced diet
  • Engaging in regular exercise
  • Maintaining a healthy weight
Endometrial cancer is one of several cancer types that are strongly linked to obesity. Someone who is overweight or has obesity is 2 to 7 times more likely to be diagnosed with endometrial cancer compared with people at healthy weights.

“Healthy lifestyle choices such as staying active, eating well, and avoiding smoking not only aid recovery but may also reduce the risk of recurrence and improve overall well-being,” Dr. Kahn says.

Rehabilitation and Therapy

Surgery for endometrial cancer treatment is still a major surgery, Wallbillich emphasizes, but the recovery is quicker than it was in the past, as the surgery is now minimally invasive. “For the first couple of weeks and several weeks after surgery, recovery includes taking it easy, staying at home, and trying to become more active while avoiding heavy lifting,” says Wallbillich.

“With hysterectomy, there is an incision at the top part of the vagina that gets repaired and needs to heal, so pelvic rest is important. Lastly, the patient should try to be as healthy as possible by getting adequate rest, staying hydrated, and adopting a healthy diet with lean protein,” he says. Recovery from surgery can take two to eight weeks, based on the type of surgery and individual needs.

Rehabilitation After Treatment

After cancer treatment has ended, it’s important to stay in touch with your care team to ensure a smooth recovery. You’ll be monitored for any side effects from your treatment, and your care team will keep an eye out for potential cancer recurrence.

Having regular exercise and following a healthy diet remain important both during treatment and the recovery period. Wallbillich says, “Physical exercise can be very helpful. It can be just walking or walking in place if you’re not able to immediately go outside or the weather is not great for going out.”

“We're finding more and more that exercise and attaining a bit of a healthier weight can really help in the short-term and long-term,” he says.

Kahn agrees. “Rehabilitation should not be considered an afterthought in cancer care because the sooner these strategies are incorporated, the more effective they are in supporting recovery and improving quality of life,” he says.

Mental Health Treatment

People who receive a diagnosis of endometrial cancer are more likely to experience mental health problems as they begin their treatment. Some may also experience increased anxiety after the cancer treatment has ended, including worrying that the cancer might come back, or worrying about the discomfort and side effects of treatment.

“Financial toxicity, which refers to the financial burden of cancer treatment, is also a major stressor,” says Wallbillich. “This can be exacerbated by the high costs of treatment, insurance issues, and other socioeconomic factors.”

Therefore, it’s important to seek and receive personalized mental health support both throughout your cancer treatment journey and after.

“Research has shown that endometrial and other gynecological cancers can lead to unique psychological challenges, including anxiety and depression. Because physical health and quality of life are closely linked to mental well-being, it is important to integrate mental health support throughout the entire treatment and recovery process,” Kahn says.

The Takeaway

  • Endometrial cancer affects tens of thousands of people in the United States each year. But, the outlook for this form of cancer is generally favorable.
  • The first line of endometrial cancer treatment is usually minimally invasive surgery, which can be followed by a combination of other therapies, depending on the cancer stage and each person’s individual needs.
  • Immunotherapy has been the most significant advancement in endometrial cancer treatment, drastically improving survival for advanced cases.
  • Current advances in cancer therapy mean that doctors are now better able to tailor the therapeutic approach to each individual person, ensuring better outcomes overall.

Resources We Trust

EDITORIAL SOURCES
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Tawee Tanvetyanon, MD, MPH, is a professor of oncologic sciences and senior member at H. Lee Moffitt Cancer Center and Morsani College of Medicine at the University of South Florida in Tampa. He is a practicing medical oncologist specializing in lung cancer, thymic malignancy, and mesothelioma.

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