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 1 Informed consent 2 Surgery 3 Radiotherapy 5 Hormone treatment 7 Chemotherapy 7 Effects on fertility 9 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 cancer. 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 10 Benefits and disadvantages of cancer treatment 12 Second opinion 12 More information 13 Sources 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 consider: • 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. Surgery 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 operation. 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 operation. • 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 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 minutes. 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 permanent. • 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 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 away. 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 www.fertilitysociety.com.au 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 numbers. 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: www.cancerbackup.org.uk (click on ‘Cancer support’ then ‘Fertility’). • The American Society for Reproductive Medicine (www.asrm.org) has a one-page factsheet for patients on Cancer and Fertility Preservation. • Fertile Hope (www.fertilehope.org) is a US non-profit organisation with online calculators to assess fertility risk and fertility-sparing options for people with cancer. • Access (www.access.org.au) 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 nutrition. 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 melatonin. 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 cancer? 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 therapies? 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 treatment? 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 drawbacks? 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 psychiatrist. 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 Sources For more information on side effects, see our factsheet Managing symptoms and side effects of endometrial cancer. 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 www.cancercouncil.com.au National Cancer Institute (USA) www.cancer.gov 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 Australia Professor Ian Hammond, WA Gynaecologic Cancer Service, Perth, Western Australia Karen Carey, Patient First, Western Australian Council for Safety and Quality in Health Care NATIONAL CENTRE FOR GYNAECOLOGICAL CANCERS CANCER AUSTRALIA 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] www.gynaecancercentre.gov.au