Topic Overview
Is this topic for you?
This topic provides
information about cancer of the lining of the uterus (endometrium).
It does not cover cancer in the muscle of the uterus, which is called uterine sarcoma. This topic focuses on type I endometrial cancer, which is the most common kind of uterine cancer.
What is endometrial cancer?
Endometrial cancer is the
growth of abnormal cells in the lining of the uterus. The lining is called the
endometrium. Endometrial cancer is also called cancer of the uterus, or uterine
cancer.
Endometrial cancer usually occurs in women older than 50.
The good news is that it is usually cured when it is found early. And most of
the time, the cancer is found in its earliest stage, before it has spread
outside the uterus.
What causes endometrial cancer?
The most common
cause of type I endometrial cancer is having too much of the hormone
estrogen compared to the hormone
progesterone in the body. This hormone imbalance
causes the lining of the uterus to get thicker and thicker. If the lining
builds up and stays that way, then cancer cells can start to grow.
Women who have this
hormone imbalance over time may be more likely to get endometrial cancer after age 50.
What are the symptoms?
The most common symptoms include:
- Bleeding or vaginal discharge not related to your period (menstruation).
- Pain during sex.
- Pelvic pain.
How is endometrial cancer diagnosed?
Endometrial
cancer is usually diagnosed with a
biopsy. In this test, the doctor removes a small
sample of the lining of the uterus to look for cancer cells.
How is it treated?
The main treatment for endometrial cancer is surgery to remove the uterus plus
the
cervix,
ovaries, and
fallopian tubes. This is
called a hysterectomy with bilateral salpingo-oophorectomy. Other treatments include radiation therapy, hormone therapy, or chemotherapy.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
Frequently Asked Questions
Learning about endometrial cancer: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with endometrial cancer: | |
Supportive care: | |
Cause
The main cause of most
type I endometrial cancer is too much of the hormone
estrogen compared to the hormone
progesterone in the body. This hormone imbalance
causes the lining of the uterus to get thicker and thicker. If the lining
builds up and stays that way, then cancer cells can start to grow.
Symptoms
Unexpected vaginal bleeding after
menopause is the most common symptom of
endometrial cancer.
If you are
taking
hormone therapy after menopause, you can expect some
bleeding. But if you have irregular bleeding, call your doctor.
Before menopause, abnormal bleeding or vaginal discharge is not as likely to be a sign of endometrial cancer. They are usually signs of other conditions, such as hormone changes.
Symptoms of more advanced
endometrial cancer include:
- Pain in the pelvic area.
- A pelvic
lump.
- Weight loss.
Symptoms of
endometrial cancer can be mistaken for those of
another condition, such as
endometriosis.
What Happens
Normally, the lining of the
uterus (endometrium) builds up and then sheds with each menstrual cycle. This shedding is menstrual bleeding, or a menstrual period.
But in most cases of
endometrial cancer, the endometrium has built up and has not shed and thinned. The lining has remained thick. This is called
endometrial hyperplasia. This is a "precancer" stage,
and the cells can grow quickly and out of control. These fast-growing cells are
cancer cells.
As the cancerous cells multiply, they form a mass
of tissue, which can cause vaginal bleeding. Especially after menopause, this abnormal bleeding is a reason to call your doctor. Of women who have endometrial cancer after menopause, most have vaginal bleeding.
If endometrial cancer isn't treated, it may spread outside of the uterus. As it progresses, it
may spread to the
pelvic lymph nodes and other pelvic organs. Advanced-stage cancer may spread to
lymph nodes and on to the lungs, liver, bones, brain, and vagina.footnote 1
The
long-term outcome (prognosis) depends on the stage and grade of
your cancer.
What Increases Your Risk
A risk factor for endometrial cancer is something that increases your chance of getting it. But it doesn't mean that you will definitely get it. And many people who get endometrial cancer don't have any risk factors.
The biggest risk factor for most endometrial cancers is related to the hormone estrogen. Estrogen is not a risk factor for endometrial cancer when it is balanced with another hormone, progesterone. But when estrogen is not kept in balance with progesterone, it can cause problems that raise a woman's risk for this cancer.
Risk factors for endometrial cancer include:
- Being
obese. Fat cells make extra estrogen, but the body
doesn't make extra progesterone to balance it out.
- Taking estrogen without taking a progestin.
- Taking tamoxifen. Tamoxifen reduces your risk for breast cancer but can increase your risk for endometrial cancer.
- Polycystic ovary syndrome. This can cause you to produce too much estrogen and not enough progesterone.
- Having naturally high levels of estrogen. This can cause women to start their periods before age 12 and delay menopause until after they are 52.
Other things that increase your risk include:
- Being older than 50. Endometrial cancer is most
common in women older than 50.
- Inheriting some kinds of genes, such as those for Lynch syndrome.
- Having
endometrial hyperplasia.
- Having
type 2 diabetes.
- Never having been pregnant.
- Having previous radiation
therapy to the pelvis.
When To Call a Doctor
See your doctor if you have:
Who to see
Health professionals who can evaluate your symptoms
and your risk for endometrial cancer include:
Doctors who can manage your cancer treatment
include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Tests to find cancer
To check your symptoms, your doctor will ask about your
medical history and do a physical exam. This
will include a
pelvic exam.
An
endometrial biopsy is needed to confirm a diagnosis of
endometrial cancer. A biopsy removes a small sample of the lining of the uterus
(endometrium) to be looked at under a microscope.
Other tests
may include:
- A
transvaginal pelvic ultrasound. This uses sound waves
to create images of the uterus. The images can show how thick the endometrium
is. A thick endometrium can be a sign of cancer in
postmenopausal women. Ultrasound also can help show
whether cancer has grown into the uterine muscle.
- A
hysteroscopy. This allows your doctor to view the
inside of the uterus and get an endometrial tissue sample.
- Dilation and curettage (D&C). This test is done to
get a sample of tissue from the inside of the uterus. It may be
done at the same time as a hysteroscopy.
Testing for endometrial cancer may show that you have
endometrial hyperplasia. This is not cancer but may
develop into cancer.
Tests to see if the cancer has spread
If cancer is found, surgery is done to find out how much the cancer has grown (stage and grade) and to treat it at the same time.
Before surgery, an imaging test may be done to see if cancer has spread to the abdomen and pelvis. This helps with
planning for treatment. Imaging tests may include a CT scan or an MRI.
Other tests done before surgery may include:
Early detection
There is no routine screening test for endometrial cancer. The American Cancer Society advises women who are nearing menopause to learn
about the risks and symptoms of endometrial cancer.footnote 2
- Women are advised to report to their doctors
any unexpected bleeding or spotting or unusual vaginal
discharge.
- Women at risk for
Lynch syndrome are
advised to get checked every year starting at age 35. Having this risk also means a high risk of getting ovarian and/or
uterine cancer.
High-risk women who have no pregnancy plans can avoid these
cancers by having the uterus, fallopian tubes, and ovaries removed.footnote 3
Treatment Overview
Endometrial cancer found in its early stages can often be cured with surgery and close
follow-up. Treatment choices depend on where the cancer is and how much it has
grown.
Types of treatment
After testing shows that you have
endometrial cancer, your doctor may
recommend surgery to remove the uterus, ovaries, and fallopian tubes. All tissues removed in surgery are examined to find out the
stage and grade of the cancer.
Lymph nodes near the uterus may be examined to find out if cancer has spread
outside of the uterus.
You may get more than one type of treatment for
endometrial cancer. This depends on the size of the cancer and how the cancer cells look under the microscope. Treatments include:
Additional information about endometrial cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/pdq/treatment/endometrial/Patient.
Clinical trials
Studies called clinical trials can be an option for women who don't want or aren't cured by
standard treatments. Talk with your doctor
to see if clinical trials are available and to find out if you are a good
candidate.
Follow-up treatment
Endometrial cancer may come back (recur), so regular followup after your initial treatment is very important. Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.
Most of the time when endometrial cancer comes back after treatment, a woman will have symptoms. These include:footnote 4
- Bleeding from the vagina, bladder, or rectum.
- Decreased appetite.
- Weight loss.
- Pain in your belly, hip, or back.
- Cough.
- Shortness of breath.
- Swelling in your belly or legs.
If you have any of these symptoms, see your doctor right away and don't wait for your next scheduled appointment.
Sexual problems and body changes
Your feelings about your body and your sexuality may
change after treatment for cancer. It may help to talk openly with your partner about your
feelings. Your
doctor may be able to refer you to groups that can offer support and
information.
Having cancer treatments such as radiation therapy or a hysterectomy may affect your ability to have or enjoy sex. If you do have sexual problems, talk with your doctor about treatment, information, or a group for support.
If you
have not yet reached
menopause, your menstrual period will end immediately
after most treatments for endometrial cancer. If your uterus and ovaries have
been removed or have had radiation therapy, your body will have a decrease in
estrogen. This may cause:
- Menopausal symptoms, such as
hot flashes, changes in mood, vaginal dryness, and atrophy (shrinking) of pelvic tissues. Talk with your doctor about how to manage your
symptoms if they bother you. To learn more, see the topic
Menopause and Perimenopause.
- An increased risk of heart disease and changes in your bones, such as osteoporosis.
Palliative care
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see
the topic
Palliative Care.
End-of-life care
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see
the topics:
Prevention
You cannot control some things that put you at risk for endometrial cancer, such as a family
history of endometrial or
colon cancer.
But you can make personal choices that lower your risk of endometrial cancer.
- Strive for a healthy body
weight. The body's fat cells make estrogen. For
more information on controlling your weight, see the topic
Weight Management.
- Breastfeed if you are
able. This decreases ovulation and estrogen activity.
- Get treatment for abnormal or unexpected bleeding. (Endometrial hyperplasia, which may develop into endometrial cancer, is one cause of
abnormal bleeding.) Heavy menstrual periods, bleeding between periods, and
bleeding after menopause are symptoms of hyperplasia.
- Exercise
regularly. It may help control your weight and may reduce
estrogen levels.
- Eat a diet that is low in animal fats and high in fruits and vegetables.
You have no risk for endometrial cancer if you have had
your uterus removed (hysterectomy).
If you take tamoxifen
Tamoxifen is a breast cancer treatment that lowers your risk for having breast cancer come back (recur). But taking tamoxifen can raise your risk of getting endometrial cancer.
If you are taking tamoxifen, keep taking it as directed by your doctor. But be sure to
have a pelvic exam each year. The risk of endometrial cancer from tamoxifen is less than the risk of getting breast cancer again.
If you
are worried about endometrial cancer risk, talk with your doctor. You might be
able to use another medicine, instead of tamoxifen, to reduce your risk for recurrent breast
cancer.
Home Treatment
During treatment for endometrial cancer, you can do things at home to help manage your side effects and symptoms. If your doctor has given you instructions or medicines to
treat these problems, be sure to also use them.
In general, healthy habits such
as eating a balanced diet and getting enough sleep and exercise can help
control your symptoms.
You can try home treatments:
- For
nausea or vomiting, such as ginger or peppermint tea, gum, or candy.
- For
diarrhea, such as taking small, frequent sips of water and bites of salty crackers.
- For constipation, such as plenty of water and fiber in your diet. Do not use a laxative without first talking to
your doctor.
Other issues that can be treated at home include:
- Sleep problems. If you have trouble sleeping, try having
a regular bedtime and getting exercise daily.
- Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
- Hair loss. Hair loss may be unavoidable. But using
mild shampoos and avoiding damaging hair products will reduce irritation of
your scalp.
- Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.
Handling the stress of having cancer
Having cancer can be very stressful. And it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
- Get the support you need. Spend time with people who care about you. Let them help you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
- Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.
Medications
Medicines, such as
chemotherapy or progestin hormone therapy, may be given after surgery for
endometrial cancer. Your treatment depends on the
stage and grade of the cancer and the risk for the cancer to spread
or come back.
Medicine choices
Progestin hormone therapy may be used if your cancer has
come back or spread or you are unable to have surgery or radiation
therapy. Or it may be done if you are a young woman with early-stage cancer and you want the option of becoming pregnant in the future.
Chemotherapy is used alone or in combination. Examples
include:
- Carboplatin.
- Cisplatin.
- Doxorubicin.
- Paclitaxel.
Medicines to help with side effects
Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe medicines to help relieve nausea.
Surgery
Surgery to remove the uterus (hysterectomy) is
the most common treatment for
endometrial cancer. Surgery has the highest cure
rate of all treatments for endometrial cancer.
Along with the uterus (and cervix), the surgeon also removes the
fallopian tubes, ovaries, and often the
pelvic lymph nodes. Everything is then examined to find out the extent of the cancer and
to help plan your treatment. If there are signs that more
aggressive cancer still may be in the lymph system, more lymph nodes may be removed.
Surgery choices
What to think about
Most women have their ovaries removed after a
diagnosis of endometrial cancer. This is to make sure the cancer has not spread to the
ovaries, to reduce the production of
estrogen, and to slow cancer growth.
If you're still in your childbearing years, a hysterectomy means that pregnancy will no
longer be possible and that your menstrual periods will end. The hormonal changes of menopause will begin as soon as your ovaries are
removed. For more information, see the topic
Menopause and Perimenopause.
Other Treatment
Radiation therapy
Radiation therapy
may be used to treat
endometrial cancer. Radiation may be given internally by placing radioactive substances in the vagina (vaginal radiation). Or it may be given externally by delivering radiation from an
outside source (pelvic radiation).
Radiation therapy may also be used for endometrial cancer that has come back. If the cancer has come back only in the vagina, radiation can sometimes cure the cancer. Radiation also may be used to control symptoms and increase comfort.
If you need to have radiation, your doctor will plan the most effective treatment for you based on the stage and grade of your cancer.
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of these therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
Other Places To Get Help
Organizations
American Cancer Society (ACS)
250 Williams Street NW
Atlanta, GA 30303
www.cancer.org
National Cancer Institute (U.S.)
www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)
References
Citations
- National Cancer Institute (2012). Endometrial Cancer Treatment (PDQ)-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional.
- Smith RA, et al. (2010). Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians, 60: 99-119.
- Schmeler KM, et al. (2006). Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. New England Journal of Medicine, 354(3): 261-269.
- National Comprehensive Cancer Network (2012). Uterine neoplasms. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Other Works Consulted
- American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
- American College of Obstetricians and Gynecologists (2005, reaffirmed 2011). Management of endometrial cancer. ACOG Practice Bulletin No. 65. Obstetrics and Gynecology, 106(2): 413-425.
- Dowdy SC, et al. (2012). Uterine cancer. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 1250-1303. Philadelphia: Lippincott Williams and Wilkins.
- McMeekin DS, et al. (2009). Corpus: Epithelial tumors. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., chap. 23, pp. 683-732. Philadelphia: Lippincott Williams and Wilkins.
- National Cancer Institute (2012). Endometrial Cancer Treatment (PDQ)-Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional
- National Cancer Institute (2012). Endometrial Cancer Treatment (PDQ)-Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/Patient.
- National Comprehensive Cancer Network (2012). Uterine neoplasms. NCCN Clinical Practice Guidelines in Oncology, version 3. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerRoss Berkowitz, MD - Obstetrics and Gynecology