About Endometrial Cancer
Endometrial cancer is a disease in which malignant (cancer) cells form in the tissues of the endometrium. Obesity and having metabolic syndrome may increase the risk of endometrial cancer.
This cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ in women where fetal development occurs.
This cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer.
This cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer.
Cancer can affect the uterus, the hollow, pear-shaped organ where a baby grows. The uterus is lined with a special tissue called the endometrium. When cancer grows in this lining, it is called endometrial cancer. Most cancers of the uterus are endometrial cancer..
If left untreated, endometrial cancer can spread to the bladder or rectum, or it can spread to the vagina, fallopian tubes, ovaries, and more distant organs. Fortunately, endometrial cancer grows slowly and, with regular checkups, is usually found before spreading very far.
This cancer is a disease in which malignant (cancer) cells form in the tissues of the endometrium. Obesity and having metabolic syndrome may increase the risk of endometrial cancer.
Taking tamoxifen for breast cancer or taking estrogen alone (without progesterone) can increase the risk of endometrial cancer. Signs and symptoms of endometrial cancer include unusual vaginal bleeding or pain in the pelvis. Tests that examine the endometrium are used to detect (find) and diagnose endometrial cancer. Certain factors affect prognosis (chance of recovery) and treatment options.
Types of Uterine Cancer
There are many different types of uterine cancer. Each type varies in the way it behaves and how it should be managed. For this reason, we often ask our specialists in pathology to review findings.
- Endometrioid adenocarcinoma: This type of uterine cancer forms in the glandular cells of the uterine lining. It accounts for as much as 75 percent of all uterine cancers. Endometrioid adenocarcinoma is commonly detected early and has a high cure rate.
- Serous adenocarcinoma: These tumors are more likely to spread to lymph nodes and other parts of the body. About 10 percent of uterine cancers diagnosed are of this type.
- Adenosquamous carcinoma: This rare form of uterine cancer has elements of both adenocarcinoma and carcinoma of the squamous cells that line the outer surface of the uterus.
- Carcinomasarcoma: This rare form of uterine cancer was previously thought to be a type of uterine sarcoma. However, it is now felt to be a uterine (endometrial) cancer. It has elements of both adenocarcinoma and sarcoma. These tumors have a high risk of spreading to the lymph nodes and other parts of the body.
Every year, more than 1,300 women with some form of gynecologic cancer come to Memorial Sloan Kettering Cancer Center for treatment, including nearly 300 women with uterine cancer. We tailor our comprehensive care to each woman’s specific needs.
We take a multidisciplinary team approach to diagnosing and treating uterine cancer, and our results with surgery for women with advanced-stage or recurrent disease are among the best in the world. Many women choose minimally invasive operations that enable them to go home the same or the following day and offer such benefits as decreased pain and relatively fast recovery.
Our innovative approach to identifying and removing only the necessary lymph nodes during surgery is an option that many women with early-stage uterine cancer select. For women whose cancers are more advanced and require additional treatments following surgery, our medical oncologists are investigating chemotherapy regimens using novel drugs and drug combinations available through our clinical trials.
Our Fertility Preservation experts can often guide women to options that help preserve fertility before undergoing treatment.
Signs and symptoms of endometrial cancer may include:
- Vaginal bleeding after menopause
- Bleeding between periods
- An abnormal, watery or blood-tinged discharge from your vagina
- Pelvic pain
Most women with endometrial cancer have early symptoms. The most common symptom of endometrial cancer is abnormal uterine bleeding. For women who are premenopausal, this includes irregular menstrual bleeding, spotting, and bleeding between menstrual periods. For women who are postmenopausal, any bleeding is abnormal. Symptoms of advanced endometrial cancer include abdominal or pelvic pain, bloating, feeling full quickly when eating, and changes in bowel or bladder habits.
If a woman is having abnormal vaginal bleeding or other symptoms, the evaluation starts with a detailed interview. A health-care provider asks questions about the woman’s symptoms, her medical history and any current conditions, her family’s medical history, her menstrual and pregnancy history, and her habits and lifestyle. This information helps the health-care provider determine the cause of the symptoms. The interview is followed by a physical examination, including a pelvic examination.
If a health-care provider suspects uterine cancer, he or she might refer the woman to a specialist in cancers of the female genital tract (gynecologic oncologist).
No blood or imaging studies can confirm the diagnosis of endometrial carcinoma. Lab tests may be performed after endometrial cancer is diagnosed to ensure that a woman is able to undergo treatment and also to monitor treatment progress.
Routine blood tests: Tests of blood chemistry, liver and kidney functions, and blood cell counts are done to check a woman’s overall health and her ability to tolerate surgery and other therapy.
In many instances, imaging studies are not necessary but if performed may include the following:
Vaginal (transvaginal) ultrasound: Ultrasound is a technique that uses sound waves to take a picture of the internal organs. Ultrasound is the same technique used to look at a fetus in the uterus. To perform a vaginal (transvaginal) ultrasound, a small device called a transducer is inserted into the vagina. The device emits sound waves, which bounce off the pelvic organs and transmit a picture to a video monitor. Often, the examiner moves the transducer around slightly to get a better picture. A vaginal (transvaginal) ultrasound is safe and painless.
Hysterosonogram is similar to vaginal (transvaginal) ultrasound, but a saline (saltwater) solution is first injected into the uterus to extend the uterine walls. This procedure can improve the picture in some cases and show the uterus in greater detail.
Ultrasound often can reveal a uterine tumor, but the findings are not always conclusive. Other imaging tests may be needed and might include the following:
A CT scan of the pelvis would be the usual choice of a follow-up imaging test. A CT scan is like an X-ray film but shows greater detail in two dimensions. PET imaging using a radioactive isotope may be done with a CT scan to further enhance sensitivity of the test.
- An MRI of the pelvis is another choice of a follow-up imaging test. An MRI shows great detail in three dimensions.
- A chest X-ray may be needed if metastasis to the lungs is suspected.
- A bone scan may be needed if metastasis to the bones is suspected.
There are no screening tests to detect endometrial cancer in women with no symptoms. If you are postmenopausal, any abnormal bleeding needs to be checked. You may first have a transvaginal ultrasound exam. During this exam, the thickness of the endometrium and the size of the uterus are measured. A thickened endometrium (more than 4 mm) means that more testing is needed.
The standard way that endometrial cancer is diagnosed is with an endometrial biopsy. In this procedure, a sample of the endometrium is removed and looked at under a microscope. This test may be performed in your gynecologist’s office.
Another way the endometrium can be sampled is with dilation and curettage (D&C). A lighted instrument with a camera called a hysteroscope may be used to help guide this procedure. Anesthesia is given to make you more comfortable.
If you are premenopausal, your gynecologist will consider your signs and symptoms, age, and other medical factors to decide whether a biopsy is needed. An ultrasound exam is not helpful if you are premenopausal in diagnosing endometrial cancer.
Endometrial cancer usually is treated with surgery. During surgery, the cervix and uterus are removed (total hysterectomy), as well as both ovaries and fallopian tubes (salpingo-oophorectomy). Lymph nodes and other tissue may be removed and tested to find out if they contain cancer.
After surgery, the stage of disease is determined. Staging helps your doctor decide if additional treatment, such as chemotherapy or radiation therapy, is needed. Stages of cancer range from I to IV. Stage IV is the most advanced. The stage of cancer affects the treatment and outcome.
Hormone therapy used to treat endometrial cancer
Treatment with progestin is an option for women who want to have more children or for women who cannot have surgery because of other medical reasons. This option usually is only recommended for women who
- have slower-growing cancer that has not reached the muscle layer of the uterus
- do not have cancer outside of the uterus
- are in general good health and are able to take progestin
- understand that information about future outcomes is limited
For some women, it may be possible to keep the ovaries at the time of surgery. Keeping your ovaries means that you may be able to use your own eggs for in vitro fertilization. This choice is not for everyone and is best made in consultation with your health care team.
Causes and Risk Factors
The exact cause of endometrial carcinoma remains unknown, although several risk factors have been identified. Possessing one of these risk factors does not mean that a woman will develop endometrial cancer but rather that her risk of developing endometrial cancer is higher than that of another woman without the risk factor. Risk factors for endometrial cancer include the following:
Obesity: Women who are more than 50 pounds over ideal weight have a 10-times greater risk of developing endometrial cancer than women of ideal weight. Body fat contains an enzyme which converts other hormones to estrogen, and women with excess fat have a higher level of estrogen than women without excess fat. The higher level of estrogen is believed to increase the risk of endometrial cancer.
Women who have never been pregnant have a two-to three-times higher risk than women who have been pregnant. Early puberty: Women who begin their periods before 12 years of age are at an increased risk. Early puberty increases the number of years that the endometrium is exposed to estrogen.
Women who go through menopause after 52 years of age are at a higher risk of developing endometrial cancer than women who go through menopause earlier in life. Like early puberty, late menopause increases the number of years that the endometrium is exposed to estrogen.
Treatment with unopposed estrogen:
The risk of developing endometrial cancer is increased by several times in women who take estrogen replacement therapy without added progesterone.
High level of estrogen:
Women who have a high level of unopposed estrogen in the body are also at an increased risk. Several different conditions, such as polycystic ovarian syndrome, can cause a woman to have a high unopposed estrogen level. Treatment with tamoxifen: Women who have been treated with tamoxifen, a drug used to prevent and treat breast cancer, have an increased risk of developing endometrial cancer.
Cancers of the breast, ovary, and colon are linked with an increased risk of endometrial cancer. Family history: Women who have a close relative with endometrial cancer have an increased risk of the disease.
The use of combination oral contraceptives (birth control pills) decreases the risk of developing endometrial cancer. Women who use oral contraceptives at some time have half the risk of developing endometrial cancer as women who have never used oral contraceptives. This protection occurs in women who have used oral contraceptives for at least 12 months.
The protection continues for at least 10 years after oral contraceptive use. The protection is most notable for women who have never been pregnant.
Talk to your doctor about the risks of hormone therapy after menopause. If you’re considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you’ve undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer.
Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, such as a possible increase in the risk of breast cancer, so weigh the benefits and risks with your doctor.
Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor.
Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day. Exercise most days of the week. Exercise may reduce your risk of endometrial cancer. Add physical activity into your daily routine. Try to exercise 30 minutes most days of the week. If you can exercise more, that’s even better.1 250