Cancer of the uterine endometrium, also known as endometrial cancer, is a type of cancer that starts in the inner lining of your uterus. This lining is called the endometrium.
The exact cause of endometrial cancer is unknown. Some experts suspect that high levels of estrogen might be responsible for this disease. Progesterone and estrogen are female sex hormones produced in the ovaries. When the balance of these two hormones changes, the endometrium can change. Research has shown that increased estrogen without corresponding increased progesterone can thicken the endometrium and potentially increase the likelihood of cancer. According to the National Institutes of Health, animals with higher estrogen levels had more endometrial growth and greater incidents of cancer (NIH).
What scientists know for sure is that cancer begins when a genetic mutation causes normal cells in your endometrium to become abnormal. These cells then multiply rapidly and form a tumor. In advanced cases, cancer cells metastasize or spread to other parts of the body.
Age & Menopause
Most cases of endometrial cancer occur in women who are between 60 and 70 years old. If you fall into this age range or have already gone through menopause, some other factors can further raise your risk. These include:
- treating menopause symptoms with hormone replacement therapy that contains estrogen but not the other female hormone known as progesterone
- going through menopause at a later age since this means that your body has been exposed to estrogen over a longer period of time
Exposure to Estrogen
If you got your first period before you were 12, this increases your risk of having endometrial cancer because of the increased exposure to higher estrogen levels. Your exposure to estrogen is also greater if you’re infertile or have never been pregnant
Certain conditions or diseases lead to changes that affect the balance between the estrogen and progesterone levels in your body. These changes can result in the thickening of the uterine lining and a subsequent increased risk for cell abnormality and cancer.
Hormonal risk factors include:
- polycystic ovarian syndrome
- endometrial polyps or other benign growths in the endometrium
- hormone therapy with tamoxifen for breast cancer, although the risk is small
- ovarian tumors that release estrogen, although these are rare
Inherited Colon Cancer Syndrome
If you’ve inherited hereditary nonpolyposis colorectal cancer (HNPCC), your risk of developing endometrial cancer is higher than normal.
You should make an appointment with your doctor if you have any symptoms associated with endometrial cancer. However, keep in mind that these symptoms can also be caused by several other noncancerous conditions.
The most common symptom is unusual vaginal bleeding or spotting. This symptom often occurs as a normal part of the menopause process, but should still be brought up to your doctor as a precaution.
Other symptoms include:
- thin clear or whitish discharge if you’ve been through menopause
- bleeding in between periods or having periods that last longer than usual
- heavy bleeding, bleeding that lasts a long time, or frequent bleeding if you’re over 40
- lower abdominal or pelvic pain
- painful intercourse
Your doctor might run urine or blood tests and give you a physical exam to check your overall health. Other tests might include:
- a pelvic exam to check your uterus, vagina, rectum, and bladder for abnormalities such as lumps
- a Pap test to check for atypical cells from your cervix and the upper part of your vagina
- a transvaginal ultrasound that uses high-frequency sound waves to create a picture of your uterus; your doctor will be looking for abnormal thickness
- a biopsy that involves your doctor removing a tissue sample from your endometrium
After your diagnosis, the next step is to figure out how far your cancer has advanced.
The tests that are commonly used for endometrial cancer staging are blood tests, chest X-rays, and computerized tomography (CT) scans. CT scans show a cross-sectional view of your body taken from several X-rays. In some cases, your doctor might not be able to find out what stage your cancer is at until after you’ve had surgery for it.
The stages are:
- Stage I: cancer is only in your uterus
- Stage II: cancer is in your uterus and cervix
- Stage III: cancer is also found outside your uterus and possibly in your pelvic lymph nodes but not in your bladder or rectum
- Stage IV: cancer has spread outside your pelvic area and might be in your rectum, bladder, and other parts of your body
According to the National Institutes of Health (NIH), the survival rate after one year is around 92 percent in people who are diagnosed early. The NIH also states that the survival rate after five years is around 95 percent when the cancer hasn’t spread and 23 percent if it has (NIH).
There are several ways to treat endometrial cancer. Your treatment options depend on which stage of cancer you have, your overall health, and your personal preferences.
Most women with this cancer have a hysterectomy, which removes the entire uterus. Another common procedure is a salpingo-oophorectomy, which involves removing the ovaries and fallopian tubes. Having surgery also gives your doctor a chance to check around your uterus to see if the cancer has spread.
This type of treatment uses high-energy beams to destroy cancer cells. The radiation can come from a machine or from a device placed inside your vagina. Your doctor might suggest radiation therapy if your cancer has a higher risk of coming back after surgery. You can also use this as your sole form of treatment if you’re unable to have surgery.
Chemotherapy drugs contain chemicals that destroy cancer cells. They can be taken in pill form or through your veins from an intravenous line. Some treatment plans involve one drug, while others involve two or more drugs. This form of treatment might be recommended for more advanced stages of cancer.
This type of treatment uses medications to change your hormone levels. Your doctor might recommend this if you have a more advanced stage of cancer. Some medications increase your progesterone levels, which can help prevent cancer cells from growing rapidly. Other medications lower your estrogen levels, to decrease the growth of cancer cells.
If you’re having trouble dealing with your diagnosis, look for a support group in your area. Being around others who share similar concerns can be a source of comfort. You should also find out as much as you can about your condition. This will help you feel more in control of the treatment process. Don’t be afraid to ask your doctor questions or seek a second opinion on treatment options.
Pelvic Exams and Pap Smears
See your gynecologist for regular pelvic exams and Pap smears, especially if you are undergoing estrogen replacement therapy. These tests can help your doctor find signs of abnormalities. If you have any risk factors for endometrial cancer, let your doctor know. Your doctor might want to see you more often for pelvic exams and Pap smears.
Taking oral birth control pills for at least one year might lower your risk of having endometrial cancer. (Mayo Clinic) This is because they balance estrogen and progesterone levels. The preventative effects can last for several years after taking the pills. Ask your doctor about potential side effects before taking them.