Uterine Cancer Treatment

Uterine Cancer (Endometrial Cancer): Diagnosis, Staging, and Modern Treatment Options

What is generally meant by uterine cancer is the type of cancer arising from the endometrium, the tissue lining the inside of the uterus, and it is medically referred to as Endometrial Cancer. This is the most common gynecological cancer in women. It is different from cervical cancer and generally occurs at more advanced ages, especially in the postmenopausal period. Since the most important and most common symptom of uterine cancer is abnormal vaginal bleeding (particularly postmenopausal bleeding), most cases can be diagnosed at an early stage (when the cancer is confined to the uterus). When diagnosed at an early stage, treatment success is quite high.

Uterine cancer treatment is a complex process that requires a multidisciplinary approach. The treatment plan is determined based on many factors, including the stage of the cancer (how far it has spread), its histological type (cell type), its grade (level of aggressiveness), the patient’s age, general health status, and personal preferences. In this process, it is essential for physicians from different specialties, such as a Gynecologic Oncology Surgeon, Medical Oncologist, Radiation Oncologist, Pathologist, and Radiologist, to work together. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt performs the initial evaluation of patients suspected of having uterine cancer, manages the diagnostic process, and, once a diagnosis is made, helps ensure the treatment process is planned as accurately as possible by referring her patients to experienced oncology centers and specialist teams in Ankara.

What Is Uterine Cancer (Endometrial Cancer)? What Are Its Types and Risk Factors?

Endometrial cancer occurs when cells in the uterine lining (endometrium) proliferate uncontrollably, forming a malignant tumor. It differs from the rarer sarcomas that arise from the uterine muscle.

Types of Endometrial Cancer: Pathological examination identifies different histological (cellular) types of endometrial cancer. The most common type is Endometrioid Adenocarcinoma (around 80%). This type is generally associated with the hormone estrogen, tends to have a slower course (low grade – grade 1-2), and generally has a better prognosis (disease course). Types that occur less frequently but can behave more aggressively include Serous Carcinoma, Clear Cell Carcinoma, and Carcinosarcoma. The cancer type and grade (Grade 1: well differentiated, Grade 2: moderately differentiated, Grade 3: poorly differentiated/aggressive) significantly affect the treatment plan and prognosis.

Risk Factors for Uterine Cancer: The most important factor in the development of uterine cancer is the body’s prolonged exposure to estrogen unopposed by progesterone. The main risk factors are as follows:

  • Advanced Age: Most commonly seen after menopause (average age in the 60s).
  • Unopposed Estrogen Exposure:
    • Obesity: Fat tissue produces estrogen. It is one of the most important risk factors.
    • Estrogen-Only Hormone Therapy: Use of HRT without progesterone in women who still have a uterus (no longer recommended).
    • Polycystic Ovary Syndrome (PCOS): Chronic absence of ovulation.
    • Early Menarche (First Period) / Late Menopause: Prolonged exposure to estrogen.
    • Never Having Given Birth (Nulliparity).
    • Estrogen-Secreting Ovarian Tumors (Rare).
  • Tamoxifen Use: This drug, used in breast cancer treatment, can increase the risk.
  • Endometrial Hyperplasia: In particular, atypical endometrial hyperplasia is a precursor lesion for uterine cancer.
  • Diabetes.
  • Hypertension.
  • Hereditary Factors: A family history of uterine, ovarian, breast, or colon cancer. In particular, the hereditary syndrome known as Lynch Syndrome (HNPCC) significantly increases the risk of uterine cancer.
  • History of Radiotherapy to the Pelvic Region.

What Are the Symptoms of Uterine Cancer? Why Is Early Diagnosis Vital?

The most common and earliest symptom of uterine cancer is abnormal vaginal bleeding. For this reason, a gynecological evaluation must definitely be performed, particularly in the following situations:

  • Postmenopausal Bleeding: Any vaginal bleeding or spotting occurring after menopause (after 1 year without a period) should be considered a symptom of uterine cancer until proven otherwise and must be investigated urgently. This is the first symptom in 90% of cases.
  • Abnormal Bleeding in the Premenopausal Period:
    • Menstrual bleeding that is much heavier than normal, contains clots, or lasts longer than usual.
    • Menstrual cycles becoming irregular.
    • Bleeding or spotting between two menstrual periods (particularly if over age 40 or if additional risk factors are present).

Other symptoms that may be seen less frequently or as the disease progresses include:

  • Abnormal, watery, pinkish, or foul-smelling vaginal discharge.
  • Pain or a sensation of pressure in the pelvic region (groin, lower abdomen).
  • Pain during intercourse (dyspareunia).
  • Abdominal swelling or a palpable mass.
  • Difficulty urinating or frequent urination.
  • Changes in bowel habits or constipation.
  • Unexplained weight loss, weakness, fatigue.

Early diagnosis is the single most important factor determining the chance of successful treatment for uterine cancer. When the cancer is caught while still confined to the uterus (Stage I), full recovery rates with treatment are very high (over 80-90%). For this reason, it is vital never to ignore abnormal vaginal bleeding, especially postmenopausal bleeding, and to see a doctor immediately.

How Is Uterine Cancer Diagnosed? Why Is Staging Important?

In patients presenting with abnormal bleeding or other suspicious symptoms, the diagnostic process includes the following steps (Prof. Dr. Nuray Bozkurt plays an important role in this process):

  1. Taking a Detailed Medical History and Assessing Risk Factors.
  2. Gynecological Examination: To assess the size and mobility of the uterus and ovaries.
  3. Transvaginal Ultrasonography (TVUS): This is the first method used to measure the thickness of the uterine lining (endometrium). After menopause, an endometrium thicker than 4-5 mm or of irregular appearance is suspicious. In the premenopausal period, thickness is assessed relative to the menstrual cycle. Ultrasound can also reveal other causes of bleeding, such as myomas (fibroids) or polyps.
  4. Endometrial Biopsy (Taking a Tissue Sample from Inside the Uterus): Necessary for a definitive diagnosis. Pathological examination of the tissue sample taken from the uterine lining determines the presence of cancer cells, the cancer type (histological subtype), and grade. Biopsy is usually performed in the office with a Pipelle biopsy or, if needed, under anesthesia with Dilatation and Curettage (D&C) or Hysteroscopy. Hysteroscopy offers the advantage of directly visualizing the inside of the uterus and taking targeted biopsies from suspicious areas.

Once a cancer diagnosis is made, it is necessary to determine how far the cancer has spread in order to plan treatment and predict the disease course (prognosis). This process is called staging. Staging of uterine cancer is performed mainly during surgery.

  • Surgical Staging: This is usually performed during the surgery (hysterectomy + BSO) carried out after the cancer diagnosis. The surgeon removes the uterus, tubes, and ovaries, carefully examines the abdominal cavity, takes samples from suspicious lymph nodes (pelvic and para-aortic) — lymphadenectomy or sentinel lymph node biopsy — and takes a sample of the abdominal washing fluid (peritoneal cytology). All removed tissues are examined pathologically to determine how deeply the cancer has invaded the uterine wall, whether it has reached the cervix, and whether it has spread to the lymph nodes or other organs. It is recommended that this surgery ideally be performed by a Gynecologic Oncology Surgeon.
  • Imaging Methods: Radiological imaging methods such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), or Positron Emission Tomography (PET-CT) may be used before or after surgery to assess the extent of the disease.

Stages: Put simply, Stage I means the cancer is confined to the uterus, Stage II means it has spread to the cervix, Stage III means it has spread to other tissues within the pelvis or to lymph nodes, and Stage IV means it has spread to neighboring organs such as the bladder or rectum, or to distant organs such as the liver or lungs (metastasis).

Uterine Cancer Treatment Methods: A Multidisciplinary Team Effort

Uterine cancer treatment is planned individually based on many factors, including the stage, type, and grade of the cancer, as well as the patient’s general health status and preferences. Treatment decisions are generally made by a multidisciplinary tumor board consisting of a Gynecologic Oncologist, Medical Oncologist, and Radiation Oncologist. Prof. Dr. Nuray Bozkurt ensures the process is managed correctly by referring her patients to these specialist teams after diagnosis. The main treatment methods are as follows:

1. Surgical Treatment (Surgery):

  • It is the cornerstone of uterine cancer treatment and can be curative (providing full recovery), especially in early stages (Stage I and II).
  • Standard Surgery: This is generally a Total Hysterectomy (complete removal of the uterus and cervix) together with Bilateral Salpingo-Oophorectomy (BSO) (removal of both fallopian tubes and ovaries). The ovaries are removed both to reduce the risk of cancer spread and because some cancer types are estrogen-sensitive (ovarian preservation may be considered in very rare cases in young patients).
  • Surgical Staging: The exact stage of the disease is determined during surgery by performing lymph node removal (pelvic and/or para-aortic lymphadenectomy) or sentinel lymph node biopsy and peritoneal washing cytology. This is very important for deciding whether additional treatment is needed after surgery.
  • Surgical Method: Depending on the patient’s condition and the surgeon’s experience, surgery can be performed laparoscopically (minimally invasive), robotically assisted laparoscopically, or via laparotomy (open surgery). Minimally invasive methods (laparoscopy, robotic surgery) provide faster recovery in suitable patients. It is recommended that these surgeries be performed by Gynecologic Oncology Surgery Specialists for the best oncological outcomes.
  • Fertility-Sparing Approach: Very rarely, in selected patients who are very young, wish to have children in the future, and whose cancer is at a very early stage (Stage IA, Grade 1 endometrioid type), high-dose progesterone hormone therapy may be attempted while preserving the uterus. However, this is not a standard treatment, carries a risk of cancer progression, and requires very close follow-up.

2. Radiotherapy (Radiation Therapy):

  • Aims to kill cancer cells or stop their growth using high-energy X-rays or other types of radiation.
  • When Is It Used?
    • Adjuvant (Preventive) Therapy: After surgery, to reduce the risk of recurrence based on the pathology results (particularly in Stage IB, Stage II, Stage III, or high-risk Stage I patients).
    • Primary Treatment: In patients whose general health is too poor to undergo surgery.
    • Palliative Treatment: To control symptoms such as bleeding or pain in advanced-stage disease.
  • How Is It Administered?
    • External Radiotherapy (External Beam Radiation): Radiation is delivered to the pelvic region from a machine outside the body.
    • Brachytherapy (Internal/Close-Range Radiation): A radioactive source is temporarily placed inside the vagina to deliver a high dose of radiation directly to that area. It is usually used after external radiotherapy or on its own.
  • It is planned and administered by a Radiation Oncologist.

3. Chemotherapy:

  • This involves administering drugs intravenously or sometimes orally to kill cancer cells or prevent them from multiplying. It can reach cancer cells throughout the body.
  • When Is It Used?
    • Adjuvant Therapy: To reduce the risk of recurrence after surgery in high-risk (high-grade, aggressive type) or advanced-stage (Stage III-IV) uterine cancers, usually combined with radiotherapy or on its own.
    • Treatment of Recurrent Cancer:
    • Treatment of Advanced (Metastatic) Cancer:
  • It is often given as a combination of several drugs, in cycles at specific intervals. It is planned and managed by a Medical Oncologist.

4. Hormone Therapy:

  • This works by altering hormone levels in the body or blocking the effect of hormones on cancer cells.
  • When Is It Used? It is particularly effective in hormone receptor (estrogen/progesterone receptor) positive, low-grade (Grade 1-2), advanced-stage, or recurrent endometrioid-type cancers. It is also used in fertility-sparing treatment.
  • Drugs used include progestins (Megestrol acetate, Medroxyprogesterone acetate), Tamoxifen, and Aromatase inhibitors. It is managed by a Medical Oncologist or Gynecologic Oncologist.

5. Targeted Therapies and Immunotherapy:

  • These are drugs that target specific molecules that help cancer cells grow and spread, or treatments that stimulate the body’s own immune system to fight cancer (immunotherapy).
  • These are increasingly used in the treatment of uterine cancers that are advanced-stage, recurrent, or have specific genetic features (e.g., MSI-high, POLE mutation). Immunotherapy agents such as Pembrolizumab or targeted drugs such as Lenvatinib fall into this group. It is managed by a Medical Oncologist.

Follow-Up After Treatment and Prognosis (Disease Course)

After uterine cancer treatment is completed, it is very important for patients to be followed up regularly. The purpose of this follow-up is to detect any possible recurrence (return of the disease) early, manage the side effects of treatment, and monitor the patient’s general health. Follow-up visits are usually more frequent in the first few years (every 3-6 months), becoming less frequent in later years (once a year), and include a gynecological examination, a Pap smear (from the vaginal cuff), and imaging or blood tests if needed.

The prognosis of uterine cancer (the disease course and expected survival) depends on many factors, but the most important are the stage, histological type, and grade of the cancer. For cancers caught at an early stage (Stage I), particularly low-grade endometrioid type, 5-year survival rates are over 90%. Unfortunately, the prognosis worsens as the disease progresses and in more aggressive types. This is why early diagnosis is vital.

Prof. Dr. Nuray Bozkurt’s Role in Uterine Cancer Diagnosis and Treatment in Ankara

When facing a serious illness such as uterine cancer, proper guidance and support throughout the process — from diagnosis to treatment and follow-up — is very important. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt supports her patients throughout this process in the following ways:

  • Early Diagnosis and Management of Suspicion: She carefully evaluates patients presenting with symptoms such as abnormal bleeding, performs the necessary ultrasound examinations, and, when there is suspicion, performs or arranges diagnostic procedures such as endometrial biopsy or hysteroscopy.
  • Accurate Information: When a cancer diagnosis is made, she explains the disease, its type, its grade, and the possible treatment options in language the patient can understand.
  • Referral to Specialist Teams: Aware that uterine cancer treatment must be carried out by a multidisciplinary oncology team, she refers her patients as quickly and accurately as possible to experienced Gynecologic Oncology Surgeons, Medical Oncologists, and Radiation Oncologists in Ankara. She helps coordinate the treatment process.
  • Contribution to Primary Surgery (If Appropriate): If Prof. Dr. Bozkurt has specific competence and experience in gynecologic oncology surgery, she may perform the primary surgical treatment (hysterectomy, BSO) for very early-stage, low-risk patients, or participate in the surgery together with the oncology team. (This role needs to be clarified according to Prof. Dr. Bozkurt’s specific practice; the standard approach is generally referral to a gynecologic oncologist).
  • Gynecological Follow-Up After Treatment: Staying in communication with the oncology team, she provides long-term gynecological follow-up for patients who have completed cancer treatment.
  • Psychosocial Support: Aware of the psychological burden created by a cancer diagnosis and its treatment, she offers her patients empathetic support, answers their questions, and provides encouragement. Accessibility is important (0538 983 18 78)(0312 284 00 12).

Important Message: Uterine cancer treatment requires specialized expertise and experience. While Prof. Dr. Nuray Bozkurt plays a critical role in the diagnostic process and in referring patients to oncology specialists, she emphasizes that the actual management of treatment must be carried out by specialized oncology teams.

If you are experiencing abnormal vaginal bleeding (especially postmenopausal bleeding) or think you may be at risk for uterine cancer, please do not lose time. Early diagnosis saves lives. You can schedule the necessary evaluations with Prof. Dr. Nuray Bozkurt at our clinic in Ankara. In the event of suspected or confirmed cancer, she will be by your side throughout the process of referring you to specialist oncology teams for the most accurate and up-to-date treatment options. To make an appointment, contact us at 0538 983 18 78.

Frequently Asked Questions

No, they are different. Uterine cancer arises from the lining of the uterus (endometrium), while cervical cancer arises from the cervix, the lowest part of the uterus. Their causes, risk factors, screening methods (Pap smear is for the cervix), and sometimes their treatments differ.

The most important symptom is abnormal vaginal bleeding. In particular, any bleeding or spotting occurring in the postmenopausal period is very important and must always be investigated. In the premenopausal period, heavy, prolonged, irregular, or intermenstrual bleeding should raise suspicion.

Women in the postmenopausal period in particular, as well as those with obesity, diabetes, or hypertension, those who have never given birth, those receiving estrogen therapy (without progesterone), those using Tamoxifen, PCOS patients, and those with a family history of certain cancers (uterine, ovarian, colon – Lynch syndrome) are at higher risk.

A definitive diagnosis is made through pathological examination of a tissue sample (biopsy) taken from the uterine lining (endometrium). The biopsy is usually performed in the office with a Pipelle cannula or with hysteroscopy.

Staging is the process of determining how far the cancer has spread in the body (whether it is confined to the uterus or has spread to other organs or lymph nodes). It is usually performed during surgery. It is critically important for determining the treatment plan (whether additional treatment is needed after surgery) and the prognosis (course) of the disease.

The main treatment for uterine cancer, especially in the early stages, is surgery (removal of the uterus, tubes, and ovaries, along with staging). In patients who cannot undergo surgery or in cases of very advanced-stage disease, radiotherapy or other treatments may take priority.

The standard approach, especially in postmenopausal patients, is to also remove the ovaries (BSO), both to reduce the risk of cancer spread and because some cancer types are estrogen-sensitive. In very young, early-stage patients, ovarian preservation may rarely be considered, but this decision must be made carefully by the oncology team.

Depending on the stage, type, and grade of the cancer, additional treatments such as radiotherapy (radiation therapy), chemotherapy, hormone therapy, targeted therapies, or immunotherapy may be needed after surgery, or sometimes instead of surgery. The treatment decision is made by a multidisciplinary team.

The chance of success largely depends on the stage of the cancer at the time of diagnosis. For cancers caught at an early stage (Stage I), treatment success and 5-year survival rates are very high (over 90%). As the stage advances, the chance of success decreases. This is why early diagnosis is so important.

If you have suspicious symptoms such as abnormal bleeding, you can make an appointment with Prof. Dr. Nuray Bozkurt at her clinic in Ankara by calling 0538 983 18 78. Prof. Dr. Bozkurt will perform the necessary initial evaluation and diagnostic tests (ultrasound, biopsy), and if a diagnosis is made, she will refer you to expert Gynecologic Oncology and other oncology units in Ankara for the most accurate and up-to-date treatment.

You can get in touch to learn more about the diagnosis and treatment process.

Contact

Uterine Cancer Treatment: A Personalized and Multidisciplinary Approach

Uterine cancer (endometrial cancer) is the most common gynecological cancer in women, arising from the uncontrolled proliferation of cells lining the inner layer of the uterus. Because it produces symptoms early on (such as abnormal bleeding), the disease is generally caught at an early stage, allowing for a high rate of treatment success.

In Ankara, Prof. Dr. Nuray Bozkurt develops a comprehensive treatment plan for uterine cancer based on the disease’s stage, cell type, and the patient’s general health status. The primary goal of treatment is to completely remove the cancerous tissue and minimize the risk of recurrence. The process usually begins with surgical intervention and, if needed, is supported by additional treatments (radiotherapy, chemotherapy).

Surgical Treatment: The Cornerstone of Treatment and Staging

For almost every patient diagnosed with uterine cancer, the first and most important step is surgical intervention. This operation both treats the disease and enables definitive “staging,” which determines the subsequent steps.

Hysterectomy and Bilateral Salpingo-Oophorectomy The standard surgical procedure involves removal of the uterus (hysterectomy) along with the ovaries and tubes (bilateral salpingo-oophorectomy). Removing these organs, which have the potential to harbor spreading cancer cells, is critical to the success of treatment.

Lymph Node Sampling and Sentinel Lymph Node To check the pathways of cancer spread, examination of the lymph nodes around the uterus may be necessary. Today, instead of removing all lymph nodes, the “Sentinel Lymph Node” technique — which identifies the first lymph node with a potential for cancer spread — is being successfully applied. This method significantly reduces the risk of side effects such as leg swelling (lymphedema).

Laparoscopic and Robotic Surgery (Minimally Invasive Method)

Today, if the patient’s general condition allows, uterine cancer surgeries are performed without large incisions, using laparoscopic or robotic surgery methods. Choosing a minimally invasive approach minimizes wound-healing problems, particularly in individuals with additional conditions such as obesity or diabetes, which are common in the uterine cancer risk group.

In operations performed with this method, the surgeon can examine the tumor area and lymphatic pathways in much greater detail thanks to high-resolution cameras. Compared with open surgery, patients experience much less pain, have a lower risk of infection, and return to their social lives more quickly.

Additional Treatments (Adjuvant Therapy): Radiotherapy and Chemotherapy

After surgery, the pathology report is carefully examined. How deeply the cancer has invaded the uterus, the aggressiveness of the cells, and whether it has spread to the lymph nodes are checked. Based on these results, additional treatments are decided upon to eliminate the risk of disease recurrence:

Radiotherapy (Radiation Therapy): Applied to reduce the risk of regional recurrence. It may be given as “brachytherapy,” applied only to the vaginal cuff area, or as external beam radiation applied to the entire pelvic region. Chemotherapy (Drug Therapy): If the cancer shows a tendency to spread outside the uterus, or if the cell type is high-risk, this is applied to clear possible cancer cells in other parts of the body. Hormone Therapy: In certain cases, particularly in patients who are not suitable for surgery or radiotherapy, or in cases of recurrence, this is used to slow the growth of cancer cells.

Fertility Preservation in Young Patients

Although uterine cancer is generally seen in the postmenopausal period, it can sometimes be diagnosed in young women who have not yet had children. At this point, Umut Bey, as a communications specialist, considers how this delicate balance is conveyed on the website to be very important, because the standard treatment for uterine cancer is removal of the uterus.

However, if the cancer is confined only to the uterine lining (early stage) and the cell type is not aggressive, the uterus can be preserved and a chance at pregnancy can be given through close follow-up and intensive progesterone (hormone) therapy. After having a baby, the definitive surgical procedure is usually then performed.

Follow-Up Process and Check-Ups After Treatment

After uterine cancer treatment is completed, a regular follow-up process begins to keep the disease under control and detect any possible recurrence early. The follow-up plan generally proceeds as follows:

Check-Up Frequency: During the first two years, check-ups are usually performed every 3-4 months. After the second year, depending on risk status, check-ups continue every 6 months, and after the fifth year, annually.
Examination and Tests: A detailed pelvic examination is performed at each check-up. When deemed necessary, imaging methods such as chest X-ray, computed tomography (CT), or MRI, as well as blood tests for tumor markers, are used.

The most important part of the follow-up process is that the patient monitors changes in her body and consults her doctor without waiting for the scheduled appointment if she experiences vaginal bleeding, weight loss, or persistent pain.

Success Rates in Uterine Cancer Treatment

Uterine cancer is one of the gynecological cancers with the highest treatment success rate. When diagnosed early (stage 1), the full recovery rate with surgical intervention is over 90%. The main factors affecting success are as follows:

  • Disease Stage: The cancer remaining confined only to the uterus maximizes treatment success.

  • Cell Type: While some cell types progress more slowly, others can be more aggressive; the treatment plan is shaped accordingly.

  • Patient’s General Health: Controlling existing conditions such as diabetes or obesity speeds up the recovery process.

Uterine Cancer Treatment and Appointments in Ankara

In the fight against uterine cancer, an experienced surgical team and advanced technology form the foundation of treatment success. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt provides comprehensive services for the diagnosis of uterine cancer, its surgical treatment using minimally invasive methods (laparoscopy), and long-term follow-up.

If you have abnormal bleeding, or if you would like a second opinion on an existing diagnosis, it is vital that you seek expert support.

Appointments and Detailed Information: 0312 284 00 12