Endometrial 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.
Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus..
Endometrial 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.
Symptoms
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
• Pain during intercourse
Causes
Doctors don’t know what causes endometrial cancer. What’s known is that something occurs to create a genetic mutation within cells in the endometrium — the lining of the uterus.
The genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don’t die at a set time. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).
Risk factors
Factors that increase the risk of endometrial cancer include:
• Changes in the balance of female hormones in the body. Your ovaries make two main female hormones — estrogen and progesterone. Fluctuations in the balance of these hormones cause changes in your endometrium.
A disease or condition that increases the amount of estrogen, but not the level of progesterone, in your body can increase your risk of endometrial cancer. Examples include irregular ovulation patterns, such as can occur in women with polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen but not progesterone increases the risk of endometrial cancer.
A rare type of ovarian tumor that secretes estrogen also can increase the risk of endometrial cancer.
• More years of menstruation. Starting menstruation at an early age — before age 12 — or beginning menopause later increases the risk of endometrial cancer. The more periods you’ve had, the more exposure your endometrium has had to estrogen.
• Never having been pregnant. Women who have never been pregnant have a higher risk of endometrial cancer than do women who have had at least one pregnancy.
• Older age. As you get older, your risk of endometrial cancer increases. The majority of endometrial cancer occurs in older women who have undergone menopause.
• Obesity. Being obese increases your risk of endometrial cancer. This may occur because excess body fat alters your body’s balance of hormones.
• Hormone therapy for breast cancer. Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing endometrial cancer. If you’re taking tamoxifen, discuss this risk with your doctor. For most women, the benefits of tamoxifen outweigh the small risk of endometrial cancer.
• An inherited colon cancer syndrome. Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer. HNPCC occurs because of a gene mutation passed from parents to children. If a family member has been diagnosed with HNPCC, discuss your risk of the genetic syndrome with your doctor. If you’ve been diagnosed with HNPCC, ask your doctor what cancer screening tests you should undergo.
Complications
Endometrial cancer can spread to other parts of your body, making it more difficult to treat successfully. Endometrial cancer that spreads (metastasizes) most often travels to the lungs.
Diagnosing endometrial cancer
Tests and procedures used to diagnose endometrial cancer include:
• Pelvic examination. During a pelvic exam, your doctor carefully inspects the outer portion of your genitals (vulva), and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can view your vagina and cervix for abnormalities.
• Using sound waves to create a picture of your uterus. Your doctor may recommend a transvaginal ultrasound to look at the thickness and texture of the endometrium and help rule out other conditions. In this procedure, a wand-like device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining.
• Using a scope to examine your endometrium. During a hysteroscopy, your doctor inserts a thin, flexible, lighted tube (hysteroscope) through your vagina and cervix into your uterus. A lens on the hysteroscope allows your doctor to examine the inside of your uterus and the endometrium.
• Removing a sample of tissue for testing. To get a sample of cells from inside your uterus, you’ll likely undergo an endometrial biopsy. This involves removing tissue from your uterine lining for laboratory analysis. Endometrial biopsy may be done in your doctor’s office and usually doesn’t require anesthesia.
• Performing surgery to remove tissue for testing. If enough tissue can’t be obtained during a biopsy or if the biopsy results are unclear, you’ll likely need to undergo a procedure called dilation and curettage (D&C). During D&C, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells.
If endometrial cancer is found, you’ll likely be referred to a doctor who specializes in treating cancers involving the female reproductive system (gynecologic oncologist).
Treatments and drugs
Your options for treating your endometrial cancer will depend on the characteristics of your cancer, such as the stage, your general health and your preferences.
Surgery
Surgery to remove the uterus is recommended for most women with endometrial cancer. Most women with endometrial cancer undergo a procedure to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to have children in the future. Also, once your ovaries are removed, you’ll experience menopause, if you haven’t already.
Radiation
Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.
Radiation therapy can involve:
• Radiation from a machine outside your body. Called external beam radiation, during this procedure you lie on a table while a machine directs radiation to specific points on your body.
• Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.
Hormone therapy
Hormone therapy involves taking medications that affect hormone levels in the body. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus. Options include:
• Medications to increase the amount of progesterone in your body.
• Medications to reduce the amount of estrogen in your body.
Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination.
Prevention
To reduce your risk of endometrial cancer, you may wish to:
• Talk to your doctor about the risks of hormone therapy after menopause. If you’re considering hormone replacement therapy to help control menopause symptoms.
• Consider taking birth control pills.
• Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight.
• Exercise most days of the week. Exercise may reduce your risk of endometrial cancer.
