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Endometrial cancer

Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma - endometrium; Adenocarcinoma - uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer

 

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).

Causes

 

Endometrial cancer is the most common type of uterine cancer. The exact cause of endometrial cancer is not known. An increased level of estrogen hormone may play a role. This stimulates the buildup of the lining of the uterus. This can lead to overgrowth of the endometrium and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70. A few cases may occur before age 40.

The following factors related to your hormones increase your risk for endometrial cancer:

  • Estrogen replacement therapy without the use of progesterone
  • History of endometrial polyps
  • Infrequent periods
  • Never being pregnant
  • Obesity
  • Diabetes
  • Polycystic ovary syndrome (PCOS)
  • Starting menstruation at an early age (before age 12)
  • Starting menopause after age 50
  • Tamoxifen, a drug used for breast cancer treatment

Women with the following conditions also seem to be at a higher risk for endometrial cancer:

  • Colon or breast cancer
  • Gallbladder disease
  • High blood pressure

 

Symptoms

 

Symptoms of endometrial cancer include:

  • Abnormal bleeding from the vagina, including bleeding between periods or spotting/bleeding after menopause
  • Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
  • Lower abdominal pain or pelvic cramping

 

Exams and Tests

 

During the early stages of disease, a pelvic exam is often normal.

  • In advanced stages, there may be changes in the size, shape, or feel of the uterus or surrounding structures.
  • Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)

Based on your symptoms and other findings, other tests may be needed. Some can be done in your health care provider's office. Others may be done at a hospital or surgical center:

  • Endometrial biopsy: Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). It is looked at under a microscope.
  • Hysteroscopy: A thin telescope-like device is inserted through the vagina and the opening of the cervix. It lets the provider view the inside of the uterus.
  • Ultrasound: Sound waves are used to make a picture of the pelvic organs. The ultrasound may be performed abdominally or vaginally.
  • Sonohysterography: Fluid is placed in the uterus through a thin tube, while vaginal ultrasound images are made of the uterus.
  • Magnetic resonance imaging (MRI): In this imaging test, powerful magnets are used to create images of internal organs.

If cancer is found, imaging tests may be done to see if the cancer has spread to other parts of the body. This is called staging.

Stages of endometrial cancer are:

  • Stage 1: The cancer is only in the uterus.
  • Stage 2: The cancer is in the uterus and cervix.
  • Stage 3: The cancer has spread outside of the uterus, but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
  • Stage 4: The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

Cancer is also described as grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive. Aggressive means that the cancer grows and spreads quickly.

 

Treatment

 

Treatment options include:

  • Surgery
  • Radiation therapy
  • Chemotherapy

Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. The doctor may also remove the tubes and ovaries.

Surgery combined with radiation therapy is another treatment option. It is often used for women with:

  • Stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3
  • Stage 2 disease

Chemotherapy or hormonal therapy may be considered in some cases, most often for those with stage 3 and 4 disease.

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

 

Outlook (Prognosis)

 

Endometrial cancer is usually diagnosed at an early stage.

If the cancer has not spread, 95% of women are alive after 5 years. If the cancer has spread to distant organs, about 25% of women are still alive after 5 years.

 

Possible Complications

 

Complications may include any of the following:

  • Anemia due to blood loss (before diagnosis)
  • Perforation (hole) of the uterus, which may occur during a D and C or endometrial biopsy
  • Problems from surgery, radiation, and chemotherapy

 

When to Contact a Medical Professional

 

Call for an appointment with your provider if you have any of the following:

  • Any bleeding or spotting that occurs after the onset of menopause
  • Bleeding or spotting after intercourse or douching
  • Bleeding lasting longer than 7 days
  • Periods that occur every 21 days or sooner
  • New discharge after menopause has begun
  • Pelvic pain or cramping that does not go away

 

Prevention

 

There is no effective screening test for endometrial (uterine) cancer.

Women with risk factors for endometrial cancer should be followed closely by their doctors. This includes women who are taking:

  • Estrogen replacement therapy without progesterone therapy
  • Tamoxifen for more than 2 years

Frequent pelvic exams, Pap smears, vaginal ultrasounds, and endometrial biopsy may be considered in some cases.

The risk for endometrial cancer is reduced by:

  • Maintaining a normal weight
  • Using birth control pills for over a year

 

 

References

Boggess JF, Kilgore JE. Uterine cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 88.

Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387(10023):1094-1108. PMID: 26354523 www.ncbi.nlm.nih.gov/pubmed/26354523.

National Cancer Institute website. Endometrial cancer treatment treatment (PDQ) – health professional version. www.cancer.gov/types/uterine/hp/endometrial-treatment-pdq. Updated January 19, 2018. Accessed February 9, 2018.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): uterine neoplasms. Version 1. 2018. www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Updated October 13, 2017. Accessed March 28, 2018.

Silasi D-A, Azodi M. Cancer of the endometrium. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier Saunders; 2018:1084-1086.

Text only

 
  • Pelvic laparoscopy

    Pelvic laparoscopy - illustration

    Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

    Pelvic laparoscopy

    illustration

  • Female reproductive anatomy

    Female reproductive anatomy - illustration

    External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

    Female reproductive anatomy

    illustration

  • D and C

    D and C - illustration

    D and C (dilatation and curettage) is a procedure in which the vaginal canal is held open with a speculum and the cervix is dilated with a metal rod. A curette is then passed through the cervical canal into the uterine cavity where endometrial tissue is scraped away and collected for examination.

    D and C

    illustration

  • Endometrial biopsy

    Endometrial biopsy - illustration

    The mucosal lining of the cavity of the uterus is called the endometrium. It is this lining which undergoes changes over the course of the monthly menstrual cycle, sloughes off and becomes part of the menses. A biopsy of the endometrium is used to check for disease or problems of fertility.

    Endometrial biopsy

    illustration

  • Hysterectomy

    Hysterectomy - illustration

    Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.

    Hysterectomy

    illustration

  • Uterus

    Uterus - illustration

    The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

    Uterus

    illustration

  • Endometrial cancer

    Endometrial cancer - illustration

    Endometrial cancer is a cancerous growth of the endometrium (lining of the uterus). It is the most common uterine cancer.

    Endometrial cancer

    illustration

    • Pelvic laparoscopy

      Pelvic laparoscopy - illustration

      Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

      Pelvic laparoscopy

      illustration

    • Female reproductive anatomy

      Female reproductive anatomy - illustration

      External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

      Female reproductive anatomy

      illustration

    • D and C

      D and C - illustration

      D and C (dilatation and curettage) is a procedure in which the vaginal canal is held open with a speculum and the cervix is dilated with a metal rod. A curette is then passed through the cervical canal into the uterine cavity where endometrial tissue is scraped away and collected for examination.

      D and C

      illustration

    • Endometrial biopsy

      Endometrial biopsy - illustration

      The mucosal lining of the cavity of the uterus is called the endometrium. It is this lining which undergoes changes over the course of the monthly menstrual cycle, sloughes off and becomes part of the menses. A biopsy of the endometrium is used to check for disease or problems of fertility.

      Endometrial biopsy

      illustration

    • Hysterectomy

      Hysterectomy - illustration

      Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.

      Hysterectomy

      illustration

    • Uterus

      Uterus - illustration

      The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

      Uterus

      illustration

    • Endometrial cancer

      Endometrial cancer - illustration

      Endometrial cancer is a cancerous growth of the endometrium (lining of the uterus). It is the most common uterine cancer.

      Endometrial cancer

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Endometrial cancer

           
             

            Review Date: 1/14/2018

            Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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