What Is Endometrial Cancer?

Endometrial cancer, the most common type of uterine cancer, starts in the cells of the endometrium—the lining of the uterus that is built up and then shed each month in menstruating females who are not pregnant.

The disease is more common after menopause. It's typically curable, and factors such as the stage and effect of hormones on the tumor can determine individual prognosis.

Endometrial Cancer Symptoms

The most common symptom of endometrial cancer is unusual vaginal bleeding that occurs between periods or a year or more after menopause. If you have unusual discharge or abnormal bleeding that's not related to your period, it's important to have it evaluated by your healthcare provider.

Other symptoms include pain during sexual intercourse or an abnormal discharge that's watery or bloody. In later stages of the disease, you may experience pelvic pain, weight loss, and you might feel a mass in your pelvis.

Causes

There are a number of different types of endometrial cancer, such as adenocarcinoma (the most common), squamous cell carcinoma, carcinosarcoma, small cell carcinoma, undifferentiated carcinoma, clear-cell carcinoma, and transitional carcinoma.

Risk factors for developing endometrial cancer include:

• Obesity
• Being past menopause
• Menstruation that began before age 12
• Never having been pregnant
• High estrogen levels; changes in the balance of your hormones
• Use of hormone replacement therapy with estrogen
• Polycystic ovarian syndrome (PCOS)
• Diabetes
• A personal or family history of breast or ovarian cancer
• Hereditary cancer syndromes such as Lynch syndrome (hereditary nonpolyposis colorectal cancer or HNPCC)

Endometrial cancer occurs when normal cells mutate and multiply. As they accumulate, a tumor begins to form. The abnormal cells can spread to other parts of the body.

Diagnosis

The earlier endometrial cancer is detected, the better the outcome. Endometrial cancer is often diagnosed at an early stage due to abnormal bleeding.

Your healthcare provider can find abnormalities in your uterus and cervix during a pelvic exam or a pelvic or transvaginal ultrasound. You may also have a hysteroscopy, a diagnostic test in which a flexible, lighted tube is inserted into your uterus so your healthcare provider can visualize the structures inside.

There are two procedures that can be used to definitively diagnose endometrial cancer:

• During an endometrial biopsy, the healthcare provider will remove a few cells of the endometrium so they can be examined with a microscope for abnormalities of cell shape, structure, or growth.
• During a surgical procedure called a dilation and curettage (D&C), which usually requires general anesthesia, the cervix is dilated and endometrial cells are extracted for microscopic examination.

Endometrial Cancer Healthcare Provider Discussion Guide

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If a cancer diagnosis is made, your healthcare provider will probably order more tests to determine if cancer has spread outside of your uterus. These tests can include a computerized tomography (CT) scan, chest X-ray, positron emission tomography (PET) scan, and blood tests. The results of these tests will determine the staging of your cancer:

• Stage 0: Also referred to as carcinoma-in-situ. Cancer cells are found on the endometrium's surface layer and have not grown into other cell layers.
• Stage I: The cancer is only present in the uterus.
• Stage II: The cancer is present in the uterus and cervix.
• Stage III: Cancer has spread beyond the uterus, and may be in the pelvic lymph nodes, fallopian tubes, and ovarian ligaments, but hasn't gotten outside the pelvic area.
• Stage IV: Cancer has spread outside the pelvic area, possibly to the bladder, rectum, or other areas.

Treatment

If you're diagnosed with endometrial cancer, you and your healthcare providers will need to discuss the best treatments options for you based on the stage of your cancer, your symptoms, and any other health issues you have.

Treatments include:

• Surgery: Your healthcare provider may recommend a hysterectomy, which is the surgical removal of the uterus. If your cancer has spread, you may also need surgical removal of other organs, such as your fallopian tubes, ovaries, part of your vagina, or lymph nodes. Before or after surgery, you may also need chemotherapy or radiation treatment to prevent your cancer from spreading.
• Radiation: This type of therapy involves exposing cancer cells to high-energy radiation. Radiation can be delivered externally by a machine that directs radiation to the cancer tissue or with seeds, needles, or catheters that are placed internally for direct contact with the cancerous tissue.
• Chemotherapy: This type of treatment involves medications that kill the cancer cells. It can be taken are taken by mouth or intravenously, Sometimes chemotherapy can be placed into a body cavity to more directly target a tumor.
• Hormone therapy: If your cancer responds to hormonal stimulation, there are medications that can help prevent further cancer growth. These may include medications to increase the amount of progesterone in your body or medications to decrease the amount of estrogen.
• Immunotherapy: Your immune system might not attack cancer because the cancer cells produce proteins that essentially blind immune system cells. Immunotherapy interferes with that process. Immunotherapy might be considered if the cancer is advanced and other treatments haven't helped.

Prevention

You can't completely prevent endometrial cancer, but you can lower your risk of developing it by staying active, maintaining a healthy weight, eating a balanced diet, talking to your healthcare provider about hormonal therapy, and making sure you get treated for any endometrial issues (such as irregular bleeding) that you're having.

It usually takes years for endometrial cancer to develop, and it often comes after lesser endometrial problems have started. If you have abnormal bleeding, be sure to see your healthcare provider.

Taking birth control pills for at least a year may lower the risk of endometrial cancer. Using an intrauterine device (IUD) that doesn't contain hormones also may lower the risk, though there isn't research about the effects of IUDs that release hormones. Talk to your healthcare provider about the risks and benefits of using either of these types of contraception.

A Word From Verywell

The most common symptom of endometrial cancer is abnormal bleeding. This means that many cases are caught in the early stages and the overall prognosis for this type of cancer is good. If you've been diagnosed, it's important to become your own advocate when it comes to your care. Ask your healthcare provider lots of questions. Consider getting a second opinion. Take time to relax and unwind. Enlist the help of your family and friends, if needed. Educate yourself and your loved ones about what to expect. Most importantly, take one day at a time.