Uterine cancer, which also includes endometrial cancer, starts when cells in the lining of the uterus get changes in their DNA. These changes cause the cells to grow out of control and not die when they should as part of the body’s normal life cycle.
Some of these factors can be changed, and new ways to prevent cancer are being studied in clinical trials.
A risk factor is anything that increases a person’s chances of getting cancer. It can be a behaviour, substance or condition. Some risk factors are easy to change, such as smoking or not being physically active. Others are harder to control, such as age or whether a family member has had cancer.
Most women diagnosed with uterine cancer are over the age of 50. The disease occurs most often in Caucasian women and is rare in other parts of the world. The number of menstrual cycles a woman has had and the amount of time since her first period increase her chance of developing uterine cancer. Women who have never been pregnant or have reached menopause at an older age are also more likely to develop the disease.
Researchers are not sure what causes most types of uterine cancer. But they do know that most types of endometrial cancer are associated with an imbalance between estrogen and progesterone. Some types of tumours are linked to a lack of progesterone, while others are associated with too much estrogen. Some women’s bodies produce too much estrogen, especially after they reach menopause. Other tumours are linked to a hormonal imbalance caused by certain medicines or by the use of hormone replacement therapy.
Having one or more risk factors doesn’t mean a woman will get uterine cancer. Many people who have uterine cancer did not have any known risk factors. In some families, a specific genetic disorder may increase the chances of developing the disease. Women who have had other types of cancer, such as breast or ovarian cancer, are at increased risk of having endometrial cancer. The radiation used to treat some of these other cancers can cause cells in the uterus to grow out of control and form a tumour.
Several different ways to prevent cancer are being studied in clinical trials. Some of these include avoiding risk factors, such as smoking or being overweight, and increasing protective factors, such as exercising regularly. There is also hope that someday soon, doctors will be able to predict which women are at risk of getting uterine cancer and offer them preventive treatment.
There is no screening test for endometrial cancer, but doctors recommend that women of average risk see their health care provider if they have unusual vaginal bleeding or pain in the pelvis. They may also want to schedule regular pelvic exams, Pap smears and vaginal ultrasounds.
Most cases of endometrial cancer occur in post-menopausal women. It affects mainly the tissue that lines the uterus, or womb. The most common type of the cancer is adenocarcinoma, which begins in glandular cells in the tissue that lines the uterus. This type of cancer tends to spread quickly.
Other types of endometrial cancer are atypical hyperplasia and complex atypical hyperplasia, which are precancerous conditions that may turn into endometrial cancer if it is not treated. Women with a history of Lynch syndrome (an inherited genetic mutation that increases the chances of developing colon, bowel and stomach cancers) have a higher risk of having these types of precancerous conditions.
The most serious symptoms of endometrial cancer are abdominal or pelvic pain, and abnormal vaginal bleeding that does not correspond with menstruation. This can be very painful and may lead to bowel blockage or septicemia, which is life-threatening.
There are also less serious symptoms, such as frequent or heavy vaginal bleeding that does not correspond to menstruation. These are not as dangerous as the more serious symptoms and can often be managed by a doctor with medicine.
Other signs of endometrial cancer are an enlarged uterus, which can be felt by a doctor during a pelvic exam, and a thick, brown or foul-smelling vaginal discharge that is not typical of menstruation. It can be difficult for a doctor to diagnose endometrial cancer because it usually starts outside the lining of the uterus.
The only way to confirm the diagnosis of endometrial cancer is to do a biopsy of the tissue. A gynecologist can perform this procedure in their clinic, where they will insert a thin tube into the cervix and collect a small sample of the uterine lining for analysis under the microscope. They may also offer you some pain relief medicine before the biopsy to make it more comfortable.
The first step in diagnosis is for your doctor to review your medical history and symptoms, and do a pelvic exam. Your doctor may also ask about other family members who have had uterine cancer or who have died from endometrial cancer. Some women at increased risk for uterine cancer can reduce their risk by changing their lifestyle habits or getting regular screening tests.
A specialized form of ultrasound is the best test to look at the lining of the uterus (the endometrium) for signs of endometrial cancer. This test uses a small wand, called a transducer, that sends out sound waves and picks up echoes. A computer then translates these echoes into pictures of the uterus and fallopian tubes.
If the lining of your uterus looks abnormal, a sample of the tissue can be taken with a procedure called an endometrial biopsy. During this procedure, your doctor will use a tool to remove a small piece of the lining of your uterus and send it for testing by Siteman pathologists. The biopsy usually takes less than 5 minutes.
Your doctor will also do blood tests and a pelvic CT scan to check for other problems. For most women, the earliest sign of endometrial cancer is postmenopausal bleeding that gets lighter and further apart over time. For perimenopausal or premenopausal women, the bleeding may be more subtle, and doctors will do other tests to find out what is causing it.
After the lab tests come back, your doctor will assign your uterine cancer a stage. The lower the stage, the more likely it is to be treated successfully. Your doctor may also talk with you about the cancer’s “grade.” This is a number that tells how normal or abnormal your cancer cells look under a microscope.
Some types of uterine cancer, especially those that start in the lining of the uterus, are hormone-sensitive. This means that the cancer depends on the body’s natural hormones oestrogen and progesterone to grow. Your doctor may prescribe hormonal therapy to treat these cancers, or, if you have already had surgery and want to have children in the future, they might recommend an implant, such as a hormone-releasing IUD.
Cancer is a disease that occurs when cells in the body grow out of control and form malignant (cancerous) tissue. Usually, cancer starts in the inner lining of the uterus called the endometrium. It can also start in other tissues or spread from other parts of the body to the uterus, fallopian tubes and ovaries.
When a person is diagnosed with cancer, they are usually treated by a team of health professionals, including medical doctors and gynecologists, or gynecologic oncologists. The team may also include nurses, psychologists and social workers.
The first treatment goal is to remove any tumors from the uterus, cervix and fallopian tubes. This is called a hysterectomy. If the cancer has not spread, surgery is often enough to cure the person. If the cancer has spread, additional treatments are needed.
During surgery, your doctor will also remove any lymph nodes that are near the uterus. Lymph nodes are small, bean-shaped organs that are part of the lymphatic system. There are lymph nodes in your neck, armpits, groin and abdomen. Your doctor will check your lymph nodes for signs of cancer, such as red or white blood cells, in the fluid that drains from them. If your doctor suspects that the cancer has spread beyond the uterus, they will recommend removal of more lymph nodes in the pelvic area, called lymphadenectomy.
If the cancer has spread, treatment may involve surgery and radiation therapy or chemotherapy. Chemotherapy is a combination of drugs that destroys cancer cells and prevents them from growing. It is used in most cases of advanced endometrial cancer. The most common chemotherapy for a woman with stage III or IV endometrial cancer is carboplatin and paclitaxel. Other types of chemotherapy are also being studied in clinical trials.
Recurrent endometrial cancer is cancer that returns to the uterus or other parts of the body after it has been treated. Recurrent cancer can occur in the same place as the original cancer or it can spread to other parts of the body, such as the lung and the pelvic lymph nodes.
Endometrial Cancer symptoms include abnormal vaginal bleeding or discharge. It’s important to see your doctor if you have these signs.
Your doctor will want to find out how far the cancer has spread. This is called staging.
Women who start menstruating early or go through menopause at an older age are at higher risk of endometrial cancer. Certain genes can also increase your risk for the disease.
Pain or discomfort anywhere in your belly area, between your chest and pelvis. This may feel like a regular stomachache or could be localized in one spot. If your symptoms are persistent or don’t go away, talk to your GP. Your doctor will ask you about your symptoms and your family history. They’ll also do a physical exam. This includes feeling for any lumps or changes in the shape of your uterus or cervix. They may refer you to a specialist in the female reproductive system, called a gynecologist or gynecologic oncologist.
The diagnosis of endometrial cancer is made by a combination of medical and surgical tests. The first test is an internal pelvic exam, including a vaginal ultrasound. The gynecologist will also check your cervix for any signs of cancer. If they think you have endometrial cancer, you may need a biopsy. A small sample of your endometrium will be collected with a thin tube that’s inserted into your uterus through the cervix. This can be painful, but you might take numbing medicine (like ibuprofen) before the procedure to help reduce the pain.
Other tests include a Pap test or cervical biopsy. This is used to check for abnormal cells in the cervix and to show how the lining of your uterus is forming. The Pap test doesn’t detect endometrial cancer, but it can show other reasons for bleeding or abnormal cells, such as inflammation or infection.
Your doctor will use information from the test and procedures to assign your cancer a stage. The lower the stage number, the less likely it is that the cancer has spread to other parts of your body.
If your cancer is in the early stages, you might only need surgery to remove your endometrium and uterus. If it’s in the later stages, you might need chemotherapy or hormone therapy to control your cancer. Sometimes immunotherapy is added to the treatment plan. This is a type of medicine that helps your immune system find and kill the cancer cells. This treatment can be used with other treatments or on its own.
Abnormal vaginal bleeding is a common early symptom. It can be a sign of Endometrial Cancer, or it may happen for other reasons, including changes in your periods or menstrual bleeding after menopause. If you have abnormal vaginal bleeding, it is important to see your doctor right away.
Often, doctors will find that the bleeding isn’t due to cancer. They will use other tests to find out what is causing the problem. These tests might include a pelvic ultrasound or bloodwork. They might also do a procedure called endometrial sampling (biopsy). This involves inserting a small tube into your uterus. Your doctor will scrape a sample of the lining of your uterus (endometrium) to check for cancer cells.
The biopsy can be painful. The doctors will give you medicine to help make it more comfortable. The doctor will send the tissue to a lab to check for cancer cells. If they find cancer, the doctor will talk with you about your treatment options.
It isn’t clear what causes the lining of your uterus to change and grow faster than normal. This might cause the cells to develop into a cancer tumor and spread to other parts of your body.
In some cases, the cancer uses hormones to grow and spread. Hormones are made in your body by the ovaries and are natural substances that control many of your body functions, including reproduction. Cancer cells can get the hormones they need to grow and spread from your ovaries or from other parts of your body, such as your pelvic organs.
If the cancer has spread to other tissues, you might need surgery and other treatments. These might include a hysterectomy (removing your uterus and cervix) or other surgeries to remove your fallopian tubes (a salpingectomy) and your ovaries (an oophorectomy). Sometimes, doctors put cancer-suppressing hormones into your body. They might also give you chemotherapy drugs to destroy cancer cells and prevent them from growing or spreading. The cancer-suppressing hormones might be given as pills or, if the cancer is in an early stage, they might be given through a tube placed in your abdomen.
The uterus is a pear-shaped organ above the pelvis. It has a cavity called the uterine lining (endometrium). Cancer cells sometimes form in this tissue. They can also form in the lower part of the uterus, which is called the cervix. Cancer in the cervix is called cervical cancer.
Abnormal vaginal bleeding is the most common sign of endometrial cancer. This includes heavy, irregular menstrual periods and bleeding between periods. It also can include blood in the vaginal discharge, which may be pink and watery or thick and brown and foul smelling. The symptom occurs in nine out of 10 women with endometrial cancer. It usually happens in postmenopausal women, though it can happen in premenopausal women as well. The first time any woman experiences this symptom, she should see her doctor.
If the doctor thinks there is a chance that the patient has endometrial cancer, she will order an ultrasound or magnetic resonance imaging scan of the pelvis. This will give the doctor a clearer picture of the area and help rule out other health problems.
The doctor also will take a sample of the endometrium to test for cancer. She may do this through a surgical procedure called dilatation and curettage. This is done in a gynaecologist’s office or in a hospital. The tissue is then sent to a laboratory for testing.
Once the diagnosis is made, the doctor will decide what treatment to recommend. The type of treatment depends on the stage of the cancer and whether it has spread.
Stage 1 cancers are low risk and don’t spread to other parts of the body. The doctor may suggest surgery to remove the endometrium, uterus and cervix, as well as the fallopian tubes (a salpingectomy) and, in most cases, the ovaries (an oophorectomy).
In stage 2, cancer has grown into the tissues around the uterus but has not spread outside the pelvis. This is the most common stage of endometrial cancer. Cancer in stages 3 and 4 has spread outside the pelvis and into other tissues and organs, including the bladder and ovaries. It is harder to treat cancer that has spread.
When cancer cells grow in the uterus, they can sometimes spread to other areas of the pelvis and abdomen, where they are called metastases. When this happens, it may cause symptoms such as pain in the pelvic area or loss of weight without trying. Some types of metastases can also affect the lungs and other organs.
In the case of endometrial cancer, metastases usually develop in the tissues lining the peritoneum or pelvic lymph nodes. They can also spread to other parts of the body, including the brain, bones, and liver. Symptoms like these can occur in early or advanced stages of the disease.
Unlike most other cancers, endometrial cancer typically only forms in the tissues that line the uterus. The cervix, at the bottom of the uterus, is not affected by endometrial cancer and does not form into a tumor.
For many women, the first symptom of endometrial cancer is abnormal vaginal bleeding or discharge. This can be bloody or non-bloody, and can often be mistaken for regular menstrual cramps. However, even if the bleeding or discharge is not bright red and does not contain clots, it should still be brought to the attention of a doctor, as this can indicate that the cancer has spread beyond the uterus into other areas.
Abnormal vaginal bleeding and discharge is not only a common symptom of endometrial cancer, but it can also be a sign of uterine polyps or other less serious conditions. It’s important to get any unusual vaginal bleeding or discharge checked out by a doctor, since delays in seeking treatment can lead the cancer to progress and decrease the chance of it being successfully treated.
The most common risk factor for endometrial cancer is age. Most people who get this type of cancer are over 60, although it can occur in women who are much younger. Some other risk factors include:
Being overweight can increase your chances of developing this type of cancer, especially if you are overweight at the time that you first start experiencing abnormal vaginal bleeding or discharge. The reason for this is that fat cells can convert androstenedione to estrogen at a faster rate than when the body does not have any excess fat cells.
The cancer can spread to other parts of the body. To find out how far the cancer has spread, doctors do tests. This process is called staging.
In general, surgery is the first treatment for endometrial cancer. It may involve a total abdominal hysterectomy or a vaginal hysterectomy. Chemotherapy with paclitaxel, doxorubicin, and either carboplatin or cisplatin is often used in combination with the surgery.
The cancer cells in a person’s endometrium can grow until they spread outside the uterus. At that point, they can’t be treated with surgery alone. Your health care team will use tests and procedures to find out the stage of your endometrial cancer. This information helps your doctor plan your treatment.
Whether you have stage I, II, III, or IV cancer, it’s important to follow up with your gynaecologist regularly. This may help catch a recurrence early, when it’s easier to treat.
A recurrence of endometrial cancer can be local (in the pelvis) or distant (in other parts of the body). You might need surgery, radiation, or both. Your doctor might also give you hormone therapy or chemo, depending on the type of cancer and its stage.
People with stage I and II endometrial cancer usually have the best chance of survival, because the cancer hasn’t spread beyond the uterus. They’re often treated with surgery, followed by chemo and radiation to reduce the risk of the cancer returning in the pelvis (called locoregional recurrence).
Your health care team might recommend a combination of drugs called chemo for people with stage III and IV endometrial cancer. These drugs might include paclitaxel, doxorubicin, and either carboplatin or cisplatin. Some women with stage IV endometrial cancer might benefit from other medicines, such as targeted therapy and immunotherapy. You might also be able to take part in a clinical trial of new treatments.
Most people with cancer worry about how their treatment will affect them, their family, and their future. Talking openly with your healthcare team can help ease these worries. You might also find it helpful to bring a support person with you to your appointments, especially when you have questions. A friend or family member can help you understand your options, take notes, and offer emotional support.
Surgical removal of the uterus is usually considered in all stages of endometrial cancer. This procedure is called hysterectomy. The surgery removes the uterus, fallopian tubes and both ovaries, as well as any disease that extends beyond the lining of the uterus. It also may remove any lymph nodes that are visible. Radiation therapy may be given after the surgery, to eliminate any cancer cells that remain in the pelvic region or lymph nodes.
If enough tissue isn’t removed during a biopsy, or if the results of the biopsy are unclear, you may have to have a procedure that scrapes the lining of your uterus with a small tube inserted through your cervix (dilation and curettage, or D&C). Your doctor will then look at this tissue under a microscope. This procedure can be done on an outpatient basis, in a doctor’s office or at a hospital. You will be sedated for this procedure.
You can expect to have a similar operation for stage III endometrial cancer. In this case, the uterus and both fallopian tubes are removed as well as any tumors that extend beyond the lining of your uterus. Any lymph nodes in the pelvis and para-aortic region that are seen on the X-ray may be removed as well. Radiation therapy to eliminate any cancer cells that remain in the body or lymph nodes after surgery is common for both stages.
Some women with low-grade endometrial cancers who don’t have a high risk of spread might benefit from hormone therapy after surgery. This treatment lowers the levels of estrogen and progesterone in your body, which can cause the cancer to shrink. However, high-grade endometrial cancers and those without estrogen or progesterone receptors are unlikely to respond to hormone therapy.
It is important to follow up with your doctor regularly. Your doctor will want to know if your cancer has recurred or if it has spread to other areas of your body. Your doctor can check for recurrence using blood tests, physical exams and imaging tests. These can include X-rays, computed tomography (CT) scans and ultrasounds.
In addition to evaluating your symptoms and performing a pelvic exam, your doctor may also order blood tests and imaging studies to help diagnose endometrial cancer. These tests will look for cancer cells in your blood and tissues around the uterus. They will also tell your doctor how far the cancer has spread, which is called staging.
Almost all cases of stage I endometrial cancer (also known as serous, clear cell, and carcinosarcoma) can be treated with surgery alone. Your surgeon will remove your uterus, fallopian tubes, and ovaries (a total hysterectomy with bilateral salpingo-oophorectomy or TH/BSO). Lymph nodes from the pelvis and aorta will be removed, as well, to check for the presence of cancer cells in these glands (pelvic and para-aortic lymph node dissection or LND). Pelvic washings will also be done.
Some cases of stage II endometrial cancer can be treated with radiation therapy alone or in combination with chemotherapy. Your doctor will decide how much radiation to use, depending on how large your tumor is and if it has spread. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing. It can be given outside your body from a machine, called external radiation, or it can come from radioactive material placed inside your uterus, called implant radiation.
Your doctor will consider your age and overall health, as well as your desire to have children, when choosing the best treatment for you. Your doctor will also use the results of your biopsy and other tests to assign a stage to your endometrial cancer. The stage will help your doctor know if the cancer is likely to return after surgery or spread to other parts of your body.
Adding molecular subtype (POLEmut, MMRd or MSI, TP53, and HER2/neu overexpression) to your staging evaluation can improve prediction of prognosis and inform adjuvant therapy decisions. Molecular subtype assignment can be performed during your initial biopsy, or it can be done on a sample from a hysterectomy specimen. When possible, neoadjuvant chemotherapy should be considered prior to surgery for patients with intermediate-/high-risk histology (serous or undifferentiated). This approach has been associated with better outcomes compared to primary surgical cytoreduction in previous studies.
Women with endometrial cancer that has spread (metastasized) beyond the uterus have a much lower chance of survival. For these women, treatment may include combinations of chemotherapy drugs. For some women, immunotherapy may also be a part of the treatment plan. Immunotherapy uses drugs to help the body’s own immune system better recognize and fight cancer cells. It works by blocking the proteins that cancer cells use to hide from the immune system.
Your health care team will take into account your age, overall health and your wishes, including whether you want to have children, when deciding on a treatment plan for you. The type and stage of your cancer will also influence your treatment options.
The PDQ cancer information summary for your disease helps you and your doctor understand the treatment options for your condition. This summary explains the possible side effects of different treatments, and how they might affect you. It also gives you tips on how to manage them.
PDQ is produced by the National Cancer Institute (NCI) and is edited by gynecologic oncology experts. It is reviewed regularly and updated as needed. This information is not a substitute for talking with your doctor.
Your doctor will give you 24-hour contact numbers to call for advice if you have any problems while receiving treatment. These numbers should be written down and saved somewhere safe, so you can get in touch with your doctor at any time of day or night.
If your cancer is in the early stages, and hasn’t spread beyond the uterus, you may be able to have surgery to remove just the uterus and fallopian tubes (hysterectomy). This will reduce the chances that your cancer will return. For some women, the cancer can recur in the ovaries or elsewhere in the pelvis, and this may require additional surgery, radiation or drugs to stop it from spreading further.
For women with advanced or recurrent endometrial cancer, combination therapy with drugs such as paclitaxel, doxorubicin and either cisplatin or carboplatin has been shown to improve the chance of living longer. The results of two recent trials showed that adding a drug called pembrolizumab or dostarlimab to standard chemotherapy improved how long people lived without their cancer getting worse, a measure known as progression-free survival.
