Endometrial Cancer

Endometrial cancer starts in endometrial cells that line the inside of the uterus. The most common symptom is abnormal vaginal bleeding. Treatment may include surgery, radiation and chemotherapy.

Endometrial Cancer Overview

Reviewed: February 9, 2015
Updated: 
Recent estimates from the American Cancer Society show that each year in the United States, over 45,000 women will be diagnosed with some form cancer of the uterus. About 95% of all uterine cancer is cancer of the endometrial lining called endometrial cancer. Most women - 96 percent – who have endometrial cancer that hasn’t spread beyond the uterus will be alive in five years. Yet, over 8,000 of these women will die from the disease. It is the third most common gynecologic cancer behind cervical and ovarian cancers.
 
Endometrial cancers are usually carcinomas that start in endometrial cells that line the inside of the uterus.  These cells provide the optimal environment of a fertilized egg to implant in the uterus after conception.  The uterus expels this layer of the endometrium during a woman's menstrual cycle. 
 
Most endometrial cancers occur in post-menopausal women between the ages of 60 to 70. This is likely due to increased exposure to estrogen during a woman's lifetime. But, there are certain types that can occur in younger women around age 40.
 
While there is no known single cause of endometrial cancer, several risk factors have been identified. These risk factors include estrogen replacement therapy without progesterone, a history of endometrial polyps (benign growths), diabetes, infertility ,as well as never being pregnant, obesity, polycystic ovary syndrome (PCOS), starting menopause after 50, an early menarche (first menstrual period before age 12), and exposure to the anti-breast cancer drug tamoxifen. Other risk factors include a high intake of animal fats in the diet, hypertension, and heavy daily intake of alcohol. Women who have had breast or ovarian cancer are also at an increased risk.
 
Symptoms of endometrial cancer usually begin with abnormal vaginal bleeding. Any vaginal bleeding in women who have already gone through menopause is abnormal. Pre-menopausal women may experience abnormal or heavy menstrual bleeding, usually between menstrual periods.  Postmenopausal women may also experience a clear, thin white vaginal discharge as well. Lower abdominal pain and pelvic cramping are also common.
 
Usually, women are not routinely screened for endometrial cancer, as the disease is highly curable in the early stages. As the disease advances, some women may notice a change in the size or shape of her uterus, along with the above mentioned symptoms. Diagnosis is typically started with endometrial curettage, which provides a sample of the endometrium for pathologic diagnosis. hysteroscopy allows visualization inside the uterus, which can aid in biopsy and identifying lesions. A newer method called TruTest can sample the entire lining of the uterus and is less painful than biopsy.
 
Treatment usually begins with a total abdominal hysterectomy. A surgeon will remove the entire uterus, the ovaries and fallopian tubes. The surgeon will then take a look inside the abdomen to take samples of abdominal fluid and inspect the lymph nodes for signs of metastasis. Radiation therapy is usually given to women whose disease has a high likelihood of returning or has spread into the abdomen. Chemotherapy is usually not given unless a woman has advanced disease.
 
For women whose disease has not spread beyond the uterus, the survival rate is very high, up to 96% in some instances. Unfortunately, the survival rate drops considerably as the disease moves to other organs. The best way to reduce the risk of endometrial cancer is to live a healthy lifestyle. Avoid obesity, heavy alcohol intake, high fat diets and have regular Pap smears and pelvic examinations as recommended by a gynecologist.

Endometrial Cancer Symptoms

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The most common symptom of endometrial cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.

Common symptoms of endometrial cancer include:

  • Abnormal vaginal bleeding, spotting or discharge
  • Pain or difficulty when emptying the bladder
  • Pain during sex
  • Pain in the pelvic area

These symptoms may be caused by endometrial cancer or by other health problems. Contact your doctor if you have any of these symptoms.

Endometrial Cancer Causes

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The exact cause of endometrial cancer is unknown. Why one woman develops it and another does not is also unknown.
 
We do know that women with certain risk factors may be more likely than others to develop endometrial cancer. A risk factor is something that may increase the chance of getting a disease.
 
These are the most common risk factors for endometrial cancer:
  • Obesity. Women who are obese have a greater chance of developing endometrial cancer.
  • Reproductive and menstrual history. Women are at increased risk of endometrial cancer if any of the following holds true for them:
  • History of taking estrogen alone: The risk of endometrial cancer is higher among women who used estrogen without progesterone as menopausal hormone therapy for many years.
  • History of taking tamoxifen: Women who took the drug tamoxifen to prevent or treat breast cancer are at increased risk of endometrial cancer.
  • Family health history. Women with a mother, sister or daughter with endometrial cancer are at increased risk of developing the disease.
 
Many women who get endometrial cancer have none of these risk factors, and many women who have known risk factors don’t develop the disease.

Endometrial Cancer Diagnosis

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If you have symptoms that suggest endometrial cancer, your doctor will try to find out what’s causing the problems.

You may have a physical exam and blood tests, along with one or more of the following tests:

  • Pelvic exam: Your doctor checks your uterus, vagina,and nearby tissues for any lumps or changes in shape or size.
  • Ultrasound: An ultrasound device uses sound waves to take pictures of your uterus and nearby tissues. The picture can show a endometrial tumor.
  • Biopsy: A sample of tissue from the suspicious area or lump is removed so it can be examined for cancer.

If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal endometrial tissue. The grade may suggest how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster and be more likely to spread than those with lower grades. Doctors use tumor grade along with other factors to suggest treatment options.

Living With Endometrial Cancer

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Every cancer diagnosis is different, just like every person diagnosed with cancer is different. Cancer knows no barriers to race, age, or social group. Yet there is one thing that each person diagnosed with cancer will have in common: help with fighting and beating the disease.
 
Life with cancer is different for everyone. Cancer can be a short chapter in some people's lives and a complete life change for others. Cancer diagnoses can change relationships, your routines, your work and home life. One thing is certain, no one person’s experience will be exactly the same. Yet there are plenty of resources to learn about what life was like for other people. You can find out what they did to achieve balance, maintain their health and personal life, keep peace of mind, and enjoy their lives with or after cancer.
 
Your experience with cancer will depend on the type of cancer you have, your choices of treatment and the lifestyle you lead. Be sure to speak with your doctor about the side effects of your disease and the treatments you choose. Your doctor will be able to consult with you on realistic lifestyle expectations.
 
Financial Help
 
Unfortunately, cancer treatment can be costly, even if a patient has comprehensive health insurance. For patients who do not have health insurance, the cost of treatment may seem insurmountable. Fortunately many pharmaceutical companies offer cost assistance to help make treatment more affordable. The National Comprehensive Cancer Network has compiled a Virtual Reimbursement Room where patients can find information for accessing financial help with their treatment cost.

Endometrial Cancer Treatments

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Treatment options for people with endometrial cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.

Surgery

Surgery is the most common treatment for women with endometrial cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.

The surgeon usually removes the uterus cervix, and nearby tissues. The nearby tissues may include:

  • Ovaries
  • Fallopian tubes
  • Nearby lymph nodes
  • Part of the vagina

Radiation Therapy

Radiation therapy is an option for women with all stages of endometrial cancer. It may be used before or after surgery. For women who can’t have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.

Doctors use two types of radiation therapy to treat endometrial cancer. Some women receive both types:

  • External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer.
  • Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat endometrial cancer that has an increased risk of returning after treatment. For example, endometrial cancer that is a high grade or is Stage II, III, or IV may be more likely to return.

Chemotherapy may be given to women whose endometrial cancer can’t be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.

Chemotherapy for endometrial cancer is usually given by vein (intravenous). It’s usually given in cycles. Each cycle has a treatment period followed by a rest period.

The time it takes to heal after surgery is different for each woman. After a hysterectomy, most women go home in a couple days, but some women leave the hospital the same day. You’ll probably return to your normal activities within 4 to 8 weeks after surgery.

Endometrial Cancer Other Treatments

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Clinical Trials

The search for a cure for cancer is an ongoing, constant battle. Clinical trials are the basis upon which new treatments and medications are proven to help the fight against cancer, or if researchers should pursue another tactic. The advancement of medicine depends on willing and able cancer patients to volunteer for experimental treatments so that future generations will have proven and effective cures. Not every patient with cancer will be eligible for a clinical trial, as the scientific method needs specific patients with specific types of cancers. However, patients who are selected for trials may benefit from being at the cutting edge of new research, and gain time they otherwise might not have had.

The National Cancer Institute at the National Institutes of Health has a comprehensive database of over 10,000 ongoing clinical trials that both help advance medicine and help patients.

Medications:
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