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Types of Cancer > Gynecologic Cancers > Endometrial and Uterine Cancer > Overview
Endometrial Cancer: The Basics
Christopher Dolinsky, MD
Affiliation:
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 29, 2008
How can I prevent endometrial cancer?
Unfortunately, there aren't very good screening methods for endometrial cancer, so preventing it is a particularly important challenge. If you are a woman without a family history/genetic syndrome, there are some things which are under your control and which can reduce the risk of endometrial cancer Birth control (like OCPs - oral contraceptive pills, or depo-provera) that stop ovulation/menstruation can reduce the risk of developing both endometrial and ovarian cancer. Multiple studies have demonstrated that OCPs reduce a woman's risk for developing endometrial cancer; the longer a woman takes them, the more they help in this regard. Combined hormone replacement therapy with both an estrogen and a progesterone component also appears to decrease the risk of endometrial cancer. However, both birth control and combined hormone replacement have several side effects so consult with your physician to see if they are right for your specific situation. Exercise also appears to reduce the risk of developing endometrial cancer.
While a diet high in animal fats has been implicated in endometrial cancer, a diet rich in fruits and vegetables may have a small preventive effect. It has been suggested that diets high in naturally occurring phytoestrogens (which are prevalent in soy products) and fatty fishes may decrease your risk, but further studies need to be performed before these particular nutritional recommendations can be made regarding endometrial cancer prevention.
Women who are carriers of Lynch Syndrome, the above mentioned genetic syndrome, face different decisions. They generally need to have more rigorous screening done for endometrial cancer, and some of them may elect to have their uterus's removed when they are still healthy (called a prophylactic hysterectomy). This should only be done when a woman is finished having children, and it can eliminate the possibility that a woman will contract endometrial cancer. Before a woman decides to do this, she should have genetic testing and a significant amount of counseling from a physician who has experience with genetic diseases. Another time that some women will be offered a prophylactic hysterectomy is if they are done having children, have already gone through menopause, and are taking estrogens as a part of hormone replacement therapy. Discuss your options with your doctors to best sort out the different methods of preventing endometrial cancer in your particular case.
What screening tests are available?
Patients who are diagnosed with early endometrial cancers tend to respond to treatment better than patients with more advanced cancers, so it is beneficial to detect endometrial cancers as early as possible. Luckily, many endometrial cancers are found at early stages, because early endometrial cancers often cause vaginal bleeding (which is very abnormal in post-menopausal women). When post-menopausal women experience vaginal bleeding, they are often worried enough to see their physicians who can then use more invasive tests to look for endometrial cancers. Remember, all postmenopausal vaginal bleeding should be brought to a physician’s attention as soon as possible. The amount of bleeding does not correlate with the risk of cancer, so even a small amount of bleeding should be investigated. Additionally, pre-menopausal woman, who have risk factors for endometrial cancer (such as tamoxifen or estrogen replacement therapy use,) who have bleeding between menstruations, should also be evaluated by a physician.
Right now, there aren't any endometrial cancer screening recommendations for the general population (women without hereditary cancer syndromes) because there aren't any effective screening tests available. Women should get annual pelvic exams for cervical and ovarian cancer screening, but endometrial cancer is not routinely screened for in the general population.
Women with a strong family history and many risk factors or who have a proven hereditary cancer syndrome may need to get rigorous screening for endometrial cancer. Currently, the American Cancer Society recommends that women, who have Lynch Syndrome (HNPCC) or, who have a family member with Lynch Syndrome, or, who have a strong family history of colon cancer (even with negative genetic testing), get annual endometrial biopsies starting at age 35. Endometrial biopsies can be done in your doctor's office. They are often the first step a doctor takes when a post-menopausal patient has vaginal bleeding. However, only women with a very high risk for getting endometrial cancer, (like patients with a genetic syndrome), should be screened in this manner. Talk to your doctor about your endometrial cancer risk, and whether or not you need to be screened.
What are the signs of endometrial cancer?
Luckily, the early stages of endometrial cancer can cause symptoms. When a post-menopausal woman has vaginal bleeding (present in 90% of women at the time of diagnosis with endometrial cancer), the first thing that needs to be looked into is the possibility of endometrial cancer. However, some of the other symptoms are occasionally non-specific, and don't always point toward a diagnosis of endometrial cancer. As a tumor grows in size, it can produce a variety of problems including:
- vaginal bleeding (in a post-menopausal woman)
- abnormal bleeding (including bleeding in between periods, or heavier/longer lasting menstrual bleeding)
- abnormal vaginal discharge (may be foul smelling)
- pelvic or back pain
- pain on urination
- pain on sexual intercourse
- blood in the stool or urine
All of these symptoms are non-specific, and could represent a variety of different conditions; however, your doctor needs to see you if you develop any of these problems.