What Is Endometrial Cancer?
Endometrial cancer is a type of uterine cancer that starts in the inner lining of the uterus. This lining is called the endometrium.
According to the National Cancer Institute, approximately 3 in 100 women will be diagnosed with uterine cancer at some point in their lives. More than 80 percent of people with uterine cancer survive for five years or longer after receiving the diagnosis.
If you have endometrial cancer, early diagnosis and treatment increases your chances of remission.
The most common symptom of endometrial cancer is abnormal vaginal bleeding. This can include:
- changes in the length or heaviness of menstrual periods
- vaginal bleeding or spotting between menstrual periods
- vaginal bleeding after menopause
Other potential symptoms of endometrial cancer include:
If you experience any of these symptoms, make an appointment with your doctor. These symptoms aren’t necessarily a sign of serious condition, but it’s important to get them checked out.
Abnormal vaginal bleeding is often caused by menopause or other non-cancerous conditions. But in some cases, it’s a sign of endometrial cancer or other types of gynecological cancer.
Your doctor can help you identify the cause of your symptoms and recommend appropriate treatment, if needed.
Over time, endometrial cancer can potentially spread from the uterus to other parts of the body.
The cancer is classified into four stages based on how much it has grown or spread:
- Stage 1: The cancer is only present in the uterus.
- Stage 2: The cancer is present in the uterus and cervix.
- Stage 3: The cancer has spread outside the uterus, but not as far as the rectum or bladder. It might be present in the fallopian tubes, ovaries, vagina, and/or nearby lymph nodes.
- Stage 4: The cancer has spread beyond the pelvic area. It might be present in the bladder, rectum, and/or distant tissues and organs.
When a person is diagnosed with endometrial cancer, the stage of the cancer affects what treatment options are available and the long-term outlook. Endometrial cancer is easier to treat in the early stages of the condition.
If you develop symptoms that might be endometrial cancer, make an appointment with your primary care doctor or gynecologist. A gynecologist is a special type of doctor that focuses on the female reproductive system.
Your doctor will ask you about your symptoms and medical history. They will perform a pelvic exam to look and feel for abnormalities in your uterus and other reproductive organs. To check for tumors or other abnormalities, they may order a transvaginal ultrasound exam.
An ultrasound exam is a type of imaging test that uses sound waves to create pictures of the inside of your body. To perform a transvaginal ultrasound, your doctor or other healthcare professional will insert an ultrasound probe into your vagina. This probe will transmit images onto a monitor.
If your doctor detects abnormalities during the ultrasound exam, they may order one or more of the following tests to collect a sample of tissue for testing:
- Endometrial biopsy: In this test, your doctor inserts a thin flexible tube through your cervix into your uterus. They apply suction to remove a small piece of tissue from your endometrium through the tube.
- Hysteroscopy: In this procedure, your doctor inserts a thin flexible tube with a fiber-optic camera through your cervix into your uterus. They use this endoscope to visually examine your endometrium and biopsy samples of abnormalities.
- Dilation and curettage (D&C): If the results of a biopsy are unclear, your doctor might collect another sample of endometrial tissue using D&C. To do so, they dilate your cervix and use a special tool to scrape tissue from your endometrium.
After collecting a sample of tissue from your endometrium, your doctor will send it to a laboratory for testing. A laboratory professional will examine the sample under a microscope to learn if it contains cancer cells.
There are several treatment options available for endometrial cancer. Your doctor’s recommended treatment plan will depend on the subtype and stage of the cancer, as well as your overall health and personal preferences.
There are potential benefits and risks associated with each treatment option. Your doctor can help you understand the potential benefits and risks of each approach.
Endometrial cancer is often treated with a type of surgery known as hysterectomy.
During hysterectomy, a surgeon removes the uterus. They might also remove the ovaries and fallopian tubes, in a procedure known as a bilateral salpingo-oophorectomy (BSO). Hysterectomy and BSO are typically performed during the same operation.
To learn if the cancer has spread, the surgeon will also remove nearby lymph nodes. This is known as lymph node dissection or lymphadenectomy.
If the cancer has spread to other areas of the body, the surgeon might recommend additional surgeries.
Radiation therapy uses high-energy beams to kill cancer cells.
There are two main types of radiation therapy used to treat endometrial cancer:
- External beam radiation therapy: An external machine focuses beams of radiation on the uterus from outside your body.
- Internal radiation therapy: Radioactive materials are placed inside the body, in the vagina or uterus. This is also known as brachytherapy.
Your doctor might recommend one or both types of radiation therapy after surgery. This can help kill cancer cells that might remain after surgery.
In rare cases, they might recommend radiation therapy before surgery. This can help shrink tumors to make them easier to remove.
If you can’t have surgery due to other medical conditions or poor overall health, your doctor might recommend radiation therapy as your main treatment.
Chemotherapy involves the use of drugs to kill cancer cells. Some types of chemotherapy treatment involve one drug, while others involve a combination of drugs. Depending on the type of chemotherapy that you receive, the drugs might be in pill form or given through an intravenous (IV) line.
Your doctor might recommend chemotherapy for endometrial cancer that has spread to other parts of the body. They might also recommend this treatment approach for endometrial cancer that has returned after past treatment.
Hormone therapy involves the use of hormones or hormone-blocking drugs to change the body’s hormone levels. This can help slow the growth of endometrial cancer cells.
Your doctor might recommend hormone therapy for stage III or stage IV endometrial cancer. They might also recommend it for endometrial cancer that has returned after treatment.
Hormone therapy is often combined with chemotherapy.
If you’re having trouble coping emotionally with your cancer diagnosis or treatment, let your doctor know. It’s common for people to have difficulty managing the emotional and mental effects of living with cancer.
Your doctor may refer you to an in-person or online support group for people with cancer. You might find it comforting to connect with others who are going through similar experiences as you.
Your doctor might also refer you to a mental health specialist for counseling. One-on-one or group therapy might help you manage the psychological and social effects of living with cancer.
The risk of endometrial cancer increases with age. Most cases of endometrial cancer are diagnosed between the ages of 45 and 74 years old, reports the National Cancer Institute.
Several other risk factors may also raise the risk of endometrial cancer, including:
- changes in sex hormone levels
- certain medical conditions
- family history of cancer
Estrogen and progesterone are female sex hormones that affect the health of your endometrium. If the balance of these hormones shifts towards increased estrogen levels, it raises your risk of developing endometrial cancer.
Certain aspects of your medical history can affect your sex hormone levels and risk of endometrial cancer, including:
- Years of menstruation: The more menstrual periods that you’ve had in your life, the more exposure your body has had to estrogen. If you got your first period before you were 12 years old or you went through menopause late in life, you may be at increased risk of endometrial cancer.
- History of pregnancy: During pregnancy, the balance of hormones shifts towards progesterone.If you’ve never been pregnant, your chances of developing endometrial cancer are heightened.
- Polycystic ovarian syndrome (PCOS): In this hormonal disorder, estrogen levels are high and progesterone levels are unusually low. If you have a history of PCOS, your chances of getting endometrial cancer are increased.
- Granulosa cell tumors: Granulosa cell tumors are a type of ovarian tumor that release estrogen. If you’ve had one of these tumors, it raises your risk of endometrial cancer.
Some types of medication can also change the balance of estrogen and progesterone in your body, including:
- Estrogen replacement therapy (ERT): ERT is sometimes used to treat symptoms of menopause. Unlike other types of hormone replacement therapy (HRT) that combine estrogen and progesterone (progestin), ERT uses estrogen alone and raises your risk of endometrial cancer.
- Tamoxifan: This drug is used to help prevent and treat certain types of breast cancer. It can act like estrogen in your uterus and raise endometrial cancer risk.
- Oral contraceptives (birth control pills): Taking birth control pills reduces your risk of endometrial cancer. The longer you take them, the lower your risk of endometrial cancer.
Medications that raise your risk of endometrial cancer may lower your risk of some other conditions. Conversely, drugs that lower your risk of endometrial cancer may raise your risk of some conditions.
Your doctor can help you weigh the potential benefits and risks of taking different medications, including ERT, tamoxifan, or birth control pills.
Endometrial hyperplasia is a non-cancerous condition, in which your endometrium becomes unusually thick. In some cases, it goes away on its own. In other cases, it may be treated with HRT or surgery.
If left untreated, endometrial hyperplasia sometimes develops into endometrial cancer.
The most common symptom of endometrial hyperplasia is abnormal vaginal bleeding.
According to the American Cancer Society, women who are overweight (BMI 25 to 29.9) are twice as likely to develop endometrial cancer as women who aren’t overweight. Those with obesity (BMI > 30) are more than three times as likely to develop this type of cancer.
This might reflect the effects that body fat has on estrogen levels. Fat tissue can convert some other types of hormones (androgens) into estrogen. This can raise the level of estrogen in the body, increasing the risk of endometrial cancer.
However, the nature of this link is uncertain. Type 2 diabetes is more common in people who are overweight or who have obesity, which is also a risk factor for endometrial cancer. The high rate of obesity in people with type 2 diabetes might account for the increased risk of endometrial cancer.
History of cancer
You’re more likely to develop endometrial cancer if other members of your family have had it.
You’re also at increased risk of endometrial cancer if you have a family history of Lynch syndrome. This condition is caused by mutations in one or more of the genes that repair certain mistakes in cell development.
If you have the genetic mutations associated with Lynch syndrome, it greatly increases your risk of certain types of cancer, including colon cancer and endometrial cancer. According to a review published in the journal Genes, 40 to 60 percent of women with Lynch syndrome develop endometrial cancer.
If you’ve had breast cancer or ovarian cancer in the past, that may also raise your risk of endometrial cancer. Some of the risk factors for these cancers are the same. Radiation therapy on your pelvis can also heighten your chances of developing endometrial cancer.
In most cases, the exact cause of endometrial cancer is unknown. However, experts believe that changes in the level of estrogen and progesterone in the body often play a part.
When the levels of those sex hormones fluctuate, it affects your endometrium. When the balance shifts towards increased levels of estrogen, it causes endometrial cells to divide and multiply.
If certain genetic changes occur in endometrial cells, they become cancer. Those cancer cells rapidly grow and proliferate to form a tumor.
Scientists are still studying the changes that cause normal endometrial cells to become cancer cells.
The American Cancer Society reports that most cases of endometrial cancer are adenocarcinomas. Adenocarcinomas are cancers that develop from glandular tissue. The most common form of adenocarcinoma is endometrioid cancer.
Less common forms of endometrial cancer include:
- uterine carcinosarcoma (CS)
- squamous cell carcinoma
- small cell carcinoma
- transitional carcinoma
- serous carcinoma
The different kinds of endometrial cancer are classified into two main types:
- Type 1 tend to be relatively slow growing and don’t spread quickly to other tissues.
- Type 2 tend to be more aggressive and are more likely to spread outside the uterus.
Type 1 endometrial cancers are more common than type 2. They are also easier to treat.
Some strategies may help you lower your risk of developing endometrial cancer:
- Manage your weight: If you’re overweight or obese, losing weight and maintaining the weight loss might lower your risk of endometrial cancer. More research is needed to learn how weight loss affects the risk of endometrial cancer.
- Get regular exercise: Regular physical activity has been linked to lower risk of endometrial cancer. It also has many other health benefits.
- Seek treatment for abnormal vaginal bleeding: If you develop abnormal vaginal bleeding, make an appointment with your doctor. If the bleeding is caused by endometrial hyperplasia, ask your doctor about treatment options.
- Consider the pros and cons of hormone therapy: If you’re thinking about using HRT, ask your doctor about the potential benefits and risks of using estrogen alone versus a combination of estrogen and progesterone (progestin). They can help you weigh each option.
- Ask your doctor about the potential benefits of contraceptives: Birth control pills and intrauterine devices (IUDs) have been linked to reduced risk of endometrial cancer. Your doctor can help you learn about the potential benefits and risks of using these contraceptives.
- Let your doctor know if you have a history of Lynch syndrome: If your family has a history of Lynch syndrome, your doctor might recommend genetic testing. If you have Lynch syndrome, they might encourage you to consider having your uterus, ovaries, and fallopian tubes removed to prevent cancer from developing in those organs.
If you have symptoms that could be a sign of endometrial cancer or another gynecological condition, make an appointment with your doctor. Early diagnosis and treatment may help improve your long-term outlook.