The good news is that the majority of patients presenting with a uterine cancer that has not spread far afield are cured by the above methods.
Recurrence is problematic. Depending upon prior therapy and the nature of the recurrence, patients may be treated with curative or palliative intent. Treatment options for locally recurrent disease include radiotherapy, surgery, hormone therapy, and chemotherapy.
Surgical management is best reserved for the rare woman who has an isolated vaginal recurrence in a previously irradiated field and who is a good surgical candidate (both medically and surgically). In other cases of recurrence, cure is less likely.
Palliative radiotherapy may be recommended to ease discomfort where the relapse is in the pelvis and the patient has not had previous radiotherapy. For relapses outside the pelvis or those patients presenting with stage 4 of the disease, then occasionally, progestogen therapy (e.g. medroxyprogesterone) may give some worthwhile remissions and will be prescribed in most cases at least for a trial period.
Cytotoxic chemotherapy has had a poor track record in this disease, but recently some better drug combinationos are available; these are administered as a carefully audited trial, assessing foresponse and tolerance as the therapy proceeds.
Interestingly, some (around 10%) of patients presenting with stage 4 of the disease live five years.