Endometrial Cancer

Cancer occurs when cells in the body change and start growing out of control. Cancer cells can form lumps of tissue called tumors. Cancer that starts in the lining of the uterus is called endometrial cancer.

The uterus is part of the female reproductive system. It's the organ that holds the baby when a woman is pregnant. The endometrium is the inside lining of the uterus. Each month, from puberty to menopause, the lining grows and thickens to prepare for pregnancy. This thickened lining helps to nourish a growing baby. If a woman doesn’t become pregnant, the lining of the uterus is shed. This is her period.

The endometrium is the most common place in the uterus for cancer to start. It's the most common type of gynecologic cancer (cancer in the female reproductive system). Cancer can destroy tissue in the uterus. Cancer cells may also spread to nearby organs and other parts of the body. When cancer spreads, it is called metastasis. In general, the more cancer spreads, the harder it is to treat.

Endometrial cancer often causes abnormal vaginal bleeding which may cause a woman to seek medical care. In these cases, endometrial cancer is often found when it is small and has not spread (metastasized). This is when the cancer is easiest to treat and cure.

The main symptom of endometrial cancer is unusual vaginal bleeding. This occurs in almost all women with endometrial cancer. The bleeding may include:

• Changes in the kind of bleeding during periods, such as a very long period or heavy bleeding.

• Bleeding between periods.

• Any vaginal bleeding after menopause.

For most women, abnormal vaginal bleeding is the only symptom they have. Other symptoms may include:

• Non-bloody vaginal discharge. 

• Pain when urinating.

• Pain during sex.

• Pain, pressure, or a lump in the pelvic area or lower belly (lower abdomen).

• Losing weight without trying

Early detection means checking for a health problem before a person has symptoms. This can sometimes find diseases like cancer early, which can lead to early treatment. This may improve the chance that treatment will work.

Screening tests are procedures to check for disease. There are no routine tests used to screen for endometrial cancer, but if your healthcare provider thinks you are at higher than average risk, he or she can check for endometrial cancer in these ways: 

• Transvaginal ultrasound. For this test, a wand-like probe is put into your vagina to create images of your uterus. The probe sends out sound waves that echo off the walls of your uterus. A computer translates these sound waves into an image on a screen. The inside of your uterus and changes in the thickness of the lining can be seen. An ultrasound can be used to see a biopsy is needed.

• Pelvic ultrasound. For this test, a probe is moved over the skin of your lower belly to get images of your uterus. A gel is put on your skin to slide the probe and get good images. Your bladder needs to be full for this test.

Endometrial sampling. Taking a sample of the cells from the lining of the uterus can be done in several ways. An endometrial biopsy uses a thin flexible tube that’s put through your vagina and cervix and into your uterus. Cells are then removed through this tube. A hysteroscopy lets your doctor see inside your uterus. It’s done with a small telescope-like tool. The tool is inserted through your cervix. Polyps or other abnormal tissues can also be removed. If more cells are needed, a procedure called a dilation and curettage (D&C) is done after you are given drugs to help you relax and sleep. A special tool is inserted through the opened (dilated) cervix. The lining of the uterus is removed. The sampled cells are checked under a microscope for cancer.

Screening tests aren’t advised for women who are at average risk for cancer. Your healthcare provider may advise screening in these cases: 

• You have or may have a gene for hereditary nonpolyposis colon cancer (HNPCC). You may have this gene if HNPCC runs in your family. Or you may have this gene if colon, ovarian, or uterine cancers run in your family. The HNPCC gene puts you at a higher than average risk for endometrial cancer.

• You have known risk factors and are going through menopause.

• You have precancerous changes (hyperplasia) in the cells inside your uterus that may turn into cancer.

If you are at high risk for endometrial cancer, talk with your healthcare provider about an endometrial biopsy. He or she may advise you to have biopsies after menopause as well. 

If you are at risk for HNPCC, talk to your doctor about extra testing for endometrial cancer at a younger age.

If your healthcare provider thinks you might have endometrial cancer, you will need certain exams and tests to be sure. Endometrial cancer is cancer that starts in the lining of the uterus (endometrium). Diagnosing endometrial cancer starts with your healthcare provider asking you questions. He or she will ask about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam. This will include a pelvic exam.

Diagnosis may be done by a gynecologist. Or you may see a gynecologic oncologist. These healthcare providers specialize in treating cancers and other diseases of the female reproductive organs.

You may have one or more of the following tests:

• Transvaginal ultrasound (ultrasonography).

• Endometrial biopsy.

• Dilation and curettage (D&C).

An ultrasound test uses sound waves to create images on a computer screen. It’s done with a small wand called a transducer that’s placed in the vagina. The test creates pictures of the uterus. Ultrasound can show tumors and can be used to measure the thickness of the endometrium. The healthcare provider may do a biopsy if the endometrium looks too thick.

Sometimes a small tube is used to fill the uterus with salt water before doing the ultrasound. This may be called a hysterosonogram or a saline infusion sonogram. The saline helps the healthcare provider get a better image of any changes in the lining of the uterus.

A biopsy is when small pieces of tissue are taken and looked at with a microscope. A biopsy is the only way to confirm cancer. An endometrial tissue sample is collected by using a small flexible tube that is put into the uterus. Suction is used to pull out the tissue. The tissue sample is examined to see if there are cancer cells or other abnormal cells in it. This biopsy is often done in a healthcare provider’s office. It may also be done during a D&C.

Your healthcare provider may recommend a D&C if an endometrial biopsy is not possible or more information is needed. This is a minor surgery in which the cervix is opened (dilated). The cervical canal and uterine lining are then scraped with a spoon-shaped tool called a curette. A pathologist looks at the tissue for cancer cells. Sometimes your healthcare provider will use a thin, telescope-like tube to look into the uterus at the same time. This is called a hysteroscopy.

When your healthcare provider has the results of your tests, he or she will talk with you about the next steps. Your provider will talk with you about other tests you may need if endometrial cancer is found. This may include repeating the biopsy or more tests. Make sure you understand the results and what follow-up you need.

You and your healthcare provider will discuss your treatment options. These may include:

• Surgery to remove the uterus (hysterectomy). Sometimes the fallopian tubes and ovaries are also removed.

• Radiation therapy. This uses directed rays of high-energy to kill cancer cells.

• Chemotherapy. This uses strong medicine to kill cancer cells.

• Hormone therapy. This treatment affects hormone levels and may help slow the growth of cancer cells. It may be used in some cases to avoid hysterectomy and allow a woman to get pregnant in the future.

• Biologic therapy (immunotherapy). This uses medicines that act like your body's own immune system to fight cancer.  At this time, these treatments are only available in clinical trials.

Risk factors for endometrial cancer include:

• Diabetes.

• Diet high in animal fats.

• Not being physically active.

• Family history of endometrial cancer.

• Family history of colon cancer (hereditary nonpolyposis colon cancer).

• Personal history of breast cancer.

• Personal history of ovarian cancer.

• Prior radiation therapy to the pelvis.

• Personal history of atypical endometrial hyperplasia.

• Older age.

Most of the risk factors linked to endometrial cancer come from too much exposure to the hormone estrogen. Estrogen and progesterone are the two main types of female hormones. The balance between these two hormones change every month during your menstrual cycle. These two hormones need to be in the right balance for your uterus to be healthy. Risk factors that can affect this hormone balance and can increase your risk for endometrial cancer include:

• Obesity.

• Late menopause.

• Starting monthly periods before age 12.

• Inability to become pregnant (infertility).

• Not giving birth to any children.

• Taking tamoxifen to prevent or treat breast cancer.

• Use of estrogen replacement therapy (ERT) to treat menopause symptoms.

• Personal history of polycystic ovary syndrome (PCOS).

• Personal history of a type of ovarian tumor that produces estrogen, such as granulosa cell tumor.

Talk with your healthcare provider about your risk factors for endometrial cancer and what you can do about them. For instance, you may be able to lower your risk in areas you can control, such as diet and exercise. In fact, you can make some general lifestyle changes to reduce your endometrial cancer risk:  

• Eat a healthy diet and stay at a healthy weight. Limit the fat in your diet. Eat a moderate amount of a variety of foods. Get regular physical activity. If you have diabetes, work with your healthcare team to manage your condition. Your plan may include diet, exercise, and medicine. These steps will all help keep your weight within a healthy range.

• Monitor and treat endometrial hyperplasia. If you have precancerous changes of the endometrium, talk to your doctor. You may need screening tests to check on the changes. Or you may need treatment.

• Review your hormone therapy strategy. If you've gone through menopause and use estrogen therapy to help deal with the changes in your body, use the lowest dose possible for the shortest amount of time. Talk with your doctor about taking progesterone along with estrogen.This is called combination therapy. Using just estrogen without progesterone can lead to endometrial cancer if you still have your uterus. If your symptoms of menopause have gone away or gotten better, you may be able to reduce or stop hormone therapy.

Tell your healthcare provider if you have any unusual bleeding from the vagina. Tell him or her if you have any bleeding at all after menopause.

Some women develop endometrial cancer while they are going through menopause. During this time, periods may get heavier or lighter. This may not be a symptom of menopause. Make sure to tell your healthcare provider about any change in vaginal bleeding during this time.

Some of these symptoms may be caused by other health problems. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.