Endometrial (Uterine) Cancer: The Basics
Endometrial cancer, also known as uterine cancer, happens when cells in the endometrium (inner lining of the uterus) grow out of control. As the number of cells grow, they form a tumor. Fibroids are classified as a tumor but are not cancerous. There are a few types of endometrial cancer:
- Endometrioid Adenocarcinoma (75% of all endometrial cancers).
- Papillary Serous Adenocarcinoma (10% of all endometrial cancers).
- Clear Cell Carcinoma (4% of all endometrial cancers).
- Mixed Adenocarcinoma is an endometrial cancer that has features of more than one subtype (10% of all endometrial cancers).
- Rare types, including mucinous adenocarcinoma and squamous cell adenocarcinoma (less than 1% of endometrial cancers).
Endometrial cancer that has spread from the endometrium to another part of the body is called metastatic cancer.
Risk factors include older age, high estrogen level (either naturally or from an outside source), obesity, diabetes, high blood pressure, hormone replacement therapy, family history of colon cancer or Lynch Syndrome (HNPCC), and diet high in animal fat and low in fruits and vegetables.
In women with no family history of endometrial cancer, there are no screening guidelines. Women who have Lynch Syndrome (HNPCC), a family member with Lynch Syndrome, or who have a strong family history of colon cancer, should get endometrial biopsies every year, starting at age 30-35.
Signs & Symptoms of Endometrial Cancer
The early and late stages of endometrial cancer can cause symptoms, like:
- Vaginal bleeding in post-menopausal women.
- Abnormal bleeding (in between periods/heavier or longer periods).
- Abnormal vaginal discharge (may smell bad).
- Pelvic or back pain.
- Pain with urination.
- Pain with sex.
- Blood in the urine or stool.
Keep in mind these symptoms are not specific to endometrial cancer and could be caused by another condition.
Diagnosis of Endometrial Cancer
The only way to know for sure if a tumor in the endometrium is cancer is to have a biopsy. This can be done in your provider’s office or in an operating room. Your provider will take a sample of cells to be looked at under a microscope. A pathology report goes over these results and is sent to your healthcare provider. This report is an important part of planning your treatment. You can ask for a copy of your report for your records.
A transvaginal ultrasound can also be used to help diagnose cancer. The thickness of the endometrium can be seen with ultrasound. If it appears too thick, cancer may be suspected and a biopsy is done to be sure.
Staging Endometrial Cancer
Surgery is required to stage endometrial cancer. In addition, your provider may order further testing such as a CT scan, MRI, chest X-ray, colonoscopy, barium enema or a blood test called CA-125, to determine if the extent of the cancer. Healthcare providers use two different staging systems for endometrial cancer; the FIGO system and the TNM system. These systems describe:
- The size and location of the tumor.
- Whether cancer cells are found in the lymph nodes.
- Whether cancer cells are found in other areas of the body.
Stages range from stage I to stage IV, with a higher stage describing a more advanced cancer.
- Surgery is often the treatment choice for endometrial cancer.
- Surgery is needed to stage the cancer and, at the same time, to remove as much of the cancer as possible.
- A surgeon may also perform a hysterectomy (removal of the uterus) and bilateral-salpingo-oopherectomy (removal of both ovaries and fallopian tubes) to make sure there are no cancer cells left behind. After this type of surgery, a woman can no longer have children. In younger women, this surgery is avoided if possible so that they may have the ability to have children in the future.
- In advanced cases of endometrial cancer, the surgeon may remove as much cancer as possible to relieve symptoms such as pain, rather than curing the cancer.
- Is often used to prevent recurrence (the cancer coming back).
- Is often used after surgery has been done.
- The two types of radiation used are external beam radiation and brachytherapy (a radioactive source is placed inside the vagina to deliver the radiation).
- In patients with advanced disease, radiation may be given with chemotherapy.
Chemotherapy and Hormonal Therapy
- Used in advanced stages or endometrial cancer that has come back after treatment (recurrent).
This article is a basic guide to endometrial cancer. You can learn more about your type of endometrial cancer and treatment by using the links below.
American Society of Clinical Oncology (ASCO). (2019). Uterine Cancer: Statistics. Retrieved from https://www.cancer.net/cancer-types/uterine-cancer/statistics.
Burke, W. M., Orr, J., Leitao, M., Salom, E., Gehrig, P., Olawaiye, A. B., ... & Shahin, F. A. (2014). Endometrial cancer: a review and current management strategies: part I. Gynecologic Oncology, 134(2), 385-392.
Burke, W. M., Orr, J., Leitao, M., Salom, E., Gehrig, P., Olawaiye, A. B., ... & SGO Clinical Practice Endometrial Cancer Working Group. (2014). Endometrial cancer: A review and current management strategies: Part II. Gynecologic oncology, 134(2), 393-402.
Carlson, M. J., Thiel, K. W., & Leslie, K. K. (2014). Past, present, and future of hormonal therapy in recurrent endometrial cancer. International Journal of Women's Health, 6, 429-435.
Carter, J.S. et.al. (2016) Endometrial (Uterine) Cancer Guidelines. Retrieved from https://emedicine.medscape.com/article/2500015-overview#a2.
Cormier, JN, Askew RL, Mungovan KS, Xing Y, Ross M, Armer JM. (2010) Lymphedema Beyond Breast Cancer. Cancer, 116(22):5138-49
Creutzberg, C. L., & Nout, R. A. (2011). The role of radiotherapy in endometrial cancer: current evidence and trends. Current Oncology Reports, 13(6), 472-478.
Dougan, M. M., Hankinson, S. E., Vivo, I. D., Tworoger, S. S., Glynn, R. J., & Michels, K. B. (2015). Prospective study of body size throughout the life?course and the incidence of endometrial cancer among premenopausal and postmenopausal women. International Journal of Cancer, 137(3), 625-637.
Frolova, A., Babb, S., Zantow, E., Powell, M. A., Thaker, P. H., Hagemann, A. R., & Mutch, D. G. (2015). Universal screening for Lynch syndrome in endometrial cancer results in increased acceptance of genetic counseling and testing. Gynecologic Oncology, 137, 37.
Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2012 Sep 12.
George, S., Serrano, C., Hensley, M. L., & Ray-Coquard, I. (2017). Soft tissue and uterine leiomyosarcoma. Journal of Clinical Oncology, 36(2), 144-150.
Kong, A., Johnson, N., Kitchener, H. C., & Lawrie, T. A. (2012). Adjuvant radiotherapy for stage I endometrial cancer. The Cochrane Library, DOI: 10.1002/14651858.CD003916.pub4
Johnson, N., Bryant, A., Miles, T., Hogberg, T., & Cornes, P. (2011). Adjuvant chemotherapy for endometrial cancer after hysterectomy. Cochrane Database Syst Rev, 10.
Mills, A. M., Liou, S., Ford, J. M., Berek, J. S., Pai, R. K., & Longacre, T. A. (2014). Lynch syndrome screening should be considered for all patients with newly diagnosed endometrial cancer. The American Journal of Surgical Pathology, 38(11), 1501.
Morice, P., Leary, A., Creutzberg, C., Abu-Rustum, N., & Darai, E. (2016). Endometrial cancer. The Lancet, 387(10023), 1094-1108.
National Comprehensive Cancer Network Practice Guidelines in Oncology http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (for healthcare professionals; registration required)
Nebgen, D. R., Lu, K. H., Rimes, S., Keeler, E., Broaddus, R., Munsell, M. F., & Lynch, P. M. (2014). Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome. Gynecologic Oncology, 135(1), 85-89.
Ricci, S., Stone, R. L., & Fader, A. N. (2017). Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecologic Oncology, 145(1), 208-216.
Roque, D. M., & Santin, A. D. (2013). Updates in therapy for uterine serous carcinoma. Current Opinion in Obstetrics and Gynecology, 25(1), 29-37.
Rungruang, B., & Olawaiye, A. B. (2012). Comprehensive surgical staging for endometrial cancer. Reviews in Obstetrics and Gynecology, 5(1), 28.
Signorelli, M., Lissoni, A. A., De Ponti, E., Grassi, T., Ponti, S., & Fruscio, R. (2015). Adjuvant sequential chemo and radiotherapy improves the oncological outcome in high risk endometrial cancer. Journal of Gynecologic Oncology, 26(4), 284-292.
Sorosky, J. I. (2012). Endometrial cancer. Obstetrics & Gynecology, 120(2, Part 1), 383-397.
Schwandt, A., Chen, W. C., Martra, F., Zola, P., DeBernardo, R., & Kunos, C. A. (2011). Chemotherapy plus radiation in advanced-stage endometrial cancer. International Journal of Gynecological Cancer, 21(9), 1622-1627.
SEER Stat Fact Sheets: Endometrial Cancer, National Cancer Institute, http://seer.cancer.gov/statfacts/html/corp.html
Sorbe, B., Horvath, G., Andersson, H., Boman, K., Lundgren, C., & Pettersson, B. (2012). External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma—a prospective randomized study. International Journal of Radiation Oncology* Biology* Physics, 82(3), 1249-1255.