Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).
Endometrial cancer is the most common type of uterine cancer. The exact cause of endometrial cancer is unknown. An increased level of estrogen may play a role. Estrogen helps stimulate the buildup of the lining of the uterus. This can lead to overgrowth of the endometrium and cancer.
Most cases of endometrial cancer occur between the ages of 60 and 70. A few cases may occur before age 40.
The following factors related to your hormones increase your risk of endometrial cancer:
- Estrogen replacement therapy without the use of progesterone
- History of endometrial polyps
- Infrequent periods
- Never being pregnant
- Polycystic ovary syndrome (PCOS)
- Starting menstruation at an early age (before age 12)
- Starting menopause after age 50
- Tamoxifen, a drug used for breast cancer treatment
Women with the following conditions also seem to be at a higher risk of endometrial cancer:
- Colon or breast cancer
- Gallbladder disease
- High blood pressure
Symptoms of endometrial cancer include:
- Abnormal bleeding from the vagina, including bleeding between periods or spotting/bleeding after menopause
- Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
- Lower abdominal pain or pelvic cramping
Exams and Tests
During the early stages of disease, a pelvic exam is often normal.
- In advanced stages, there may be changes in the size, shape, or feel of the uterus or surrounding structures.
- Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
Based on your symptoms and other findings, other tests may be needed. Some can be done in your health care provider’s office. Others may be done at a hospital or surgical center:
- Endometrial biopsy: Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). It is looked at under a microscope.
- Hysteroscopy: A thin telescope-like device is inserted through the vagina and the opening of the cervix. It lets the provider view the inside of the uterus.
- Ultrasound: Sound waves are used to make a picture of the pelvic organs. The ultrasound may be performed abdominally or vaginally.
- Sonohysterography: Fluid is placed in the uterus through a thin tube, while vaginal ultrasound images are made of the uterus.
- Magnetic resonance imaging (MRI): In this imaging test, powerful magnets are used to create images of internal organs.
If cancer is found, imaging tests may be done to see if the cancer has spread to other parts of the body. This is called staging.
Stages of endometrial cancer are:
- Stage 1: The cancer is only in the uterus.
- Stage 2: The cancer is in the uterus and cervix.
- Stage 3: The cancer has spread outside of the uterus, but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
- Stage 4: The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Cancer is also described as grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive. Aggressive means that the cancer grows and spreads quickly.
Treatment options include:
- Radiation therapy
Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. The doctor may also remove the tubes and ovaries.
Surgery combined with radiation therapy is another treatment option. It is often used for women with:
- Stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3
- Stage 2 disease
Chemotherapy or hormonal therapy may be considered in some cases, most often for those with stage 3 and 4 disease.
Endometrial cancer is usually diagnosed at an early stage.
If the cancer has not spread, 95% of women are alive after 5 years. If the cancer has spread to distant organs, about 25% of women are still alive after 5 years.
Complications may include any of the following:
- Anemia due to blood loss (before diagnosis)
- Perforation (hole) of the uterus, which may occur during a D and C or endometrial biopsy
- Problems from surgery, radiation, and chemotherapy
When to Contact a Medical Professional
Call for an appointment with your health care provider if you have any of the following:
- Any bleeding or spotting that occurs after the onset of menopause
- Bleeding or spotting after intercourse or douching
- Bleeding lasting longer than 7 days
- Periods that occur every 21 days or sooner
- New discharge after menopause has begun
- Pelvic pain or cramping that does not go away
There is no effective screening test for endometrial (uterine) cancer.
Women with risk factors for endometrial cancer should be followed closely by their doctors. This includes women who are taking:
- Estrogen replacement therapy without progesterone therapy
- Tamoxifen for more than 2 years
Frequent pelvic exams, Pap smears, vaginal ultrasounds, and endometrial biopsy may be considered in some cases.
The risk for endometrial cancer is reduced by:
- Maintaining a normal weight
- Using birth control pills for over a year