Endometrial cancer

 

Alternative Names

Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma - endometrium; Adenocarcinoma - uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer

Definition

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).

Causes

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
  • Obesity
  • 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:

Symptoms

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
  • Thin white or clear vaginal discharge after menopause

Exams and Tests

During the early stages of disease, a pelvic exam is often normal. As the cancer becomes more advanced, there may be changes in the size, shape, or feel of the uterus or surrounding structures.

Tests that may be done include:

  • Endometrial biopsy
  • Dilation and curettage (D and C)
  • Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
  • 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

Treatment options include surgery, radiation therapy, and chemotherapy.

Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. The doctor may also recommend removing 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.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Endometrial cancer is usually diagnosed at an early stage.

If the cancer has not spread, 95% of women are alive after five years. If the cancer has spread to distant organs, about 25% of women are still alive after five years.

Possible Complications

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:

  • Bleeding or spotting after intercourse or douching
  • Bleeding lasting longer than 7 days
  • Periods that occur every 21 days or sooner
  • Bleeding or spotting after 1 year or more of no bleeding after menopause
  • New discharge after menopause has begun
  • Pelvic pain or cramping that does not go away

Prevention

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 or women who have taken tamoxifen for more than 2 years. Frequent pelvic exams, Pap smears and endometrial biopsy may be considered in some cases.

The risk of endometrial cancer is reduced by:

  • Maintaining a normal weight
  • Using birth control pills for over a year

References

Boggess JF, Kilgore JE. Uterine cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 88.

Leslie KK, Thiel KW, Goodheart MJ, et al. Endometrial cancer. Obstet Gynecol Clin N Am. 2012; 39:255–268.

National Cancer Institute: PDQ Endometrial Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified: 06/14/2013. Accessed March 5, 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Uterine Neoplasms. Version 1.2014. Accessed March 5, 2014.

Review Date: 2/24/2014
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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