Endometrial (Uterine) Cancer: The Basics
Endometrial cancer, also known as uterine cancer, develops when cells in the endometrium (inner lining of the uterus) grow out of control. As the number of cells grow, they form into 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 annual endometrial biopsies, starting at age 30-35.
Signs & Symptoms of Endometrial Cancer
The early and late stages of endometrial cancer can cause symptoms, including:
- 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 sexual intercourse.
- 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 cancerous 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 examined under a microscope. A pathology report summarizes these results and is sent to your healthcare provider. This report is an important part of planning your treatment. You can request 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.
- The typical treatment for endometrial cancer is surgery.
- A surgical procedure 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 ensure no cancer cells are left behind. After this type of surgery, a woman can no longer have children and therefore, in younger women, other treatments may be used when possible.
- 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.
- 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.
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National Comprehensive Cancer Network Practice Guidelines in Oncology http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf (for healthcare professionals; registration required)
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