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).
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.
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.
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.
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.
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.
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.
Endometrial cancer is a cancerous growth of the endometrium (lining of the uterus). It is the most common uterine cancer.
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 abnormal 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). The cells are examined under a microscope to see if any appear to be abnormal or cancerous.
- 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. Tissue can also be removed for analysis during the exam.
- Ultrasound: Sound waves are used to make a picture of the pelvic organs. The ultrasound may be performed abdominally or vaginally. An ultrasound can determine if the lining of the uterus appears abnormal or thickened.
- Sonohysterography: Fluid is placed in the uterus through a thin tube, while vaginal ultrasound images are made of the uterus. This procedure can be done to determine presence of any abnormal uterine mass which may be an indication of cancer.
- 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 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.
The female reproductive system is a very complex system. And as with any system, occasionally, things go wrong. When treatments and therapies can't fix an issue, sometimes surgery is required. Surgery to remove a woman's uterus or womb, a major component of this system, is called hysterectomy. Let's talk about this procedure. There are many reasons a woman may need a hysterectomy cancer of the uterus, usually endometrial cancer; cancer of the cervix; childbirth complications, such as uncontrolled bleeding; other long-term vaginal bleeding problems; long-term pelvic pain. Other reasons include severe endometriosis, including growths outside the uterus; slipping of the uterus into the vagina and perhaps tumors in the uterus, such as uterine fibroids. During a hysterectomy, your doctor may remove the entire uterus or just part of it. The fallopian tubes, which connect the ovaries to the uterus, and the ovaries themselves may also be removed. There are several different ways to perform a hysterectomy. It may be done through a surgical cut in either the belly or vagina. It may be done using laparoscopy, using a camera and smaller incisions, or it may be performed using robotic surgery. Your doctor will help you decide which type of procedure is best for you. After surgery, you will receive pain medications to relieve discomfort. You may also have a tube, called a catheter, inserted into your bladder for a day or two to pass urine. You will be asked to get up and move around as soon as possible after surgery; this helps prevent blood clots from forming in your legs and speeds up recovery. How long you stay in the hospital depends on the type of hysterectomy. If you have a robot-assisted hysterectomy, you will likely go home the next day. Most women who have a hysterectomy, however, will stay in the hospital for 2 to 3 days, maybe even longer if you have a hysterectomy due to cancer. Recovery may take anywhere from 2 to 6 weeks, depending on the type of hysterectomy you have. A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor, then, may recommend estrogen replacement therapy. There is some good news. Removing the problematic organs should keep you from having problems in this area again.
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
Contact your provider for an appointment 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
- Irregular menstrual cycles that occur twice per month
- 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
Armstrong DK. Gynecologic cancers. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 189.
Boggess JF, Kilgore JE, Tran A-Q. Uterine cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 85.
Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387(10023):1094-1108. PMID: 26354523
National Cancer Institute website. Endometrial cancer treatment (PDQ)-health professional version.
National Comprehensive Cancer Network website. NCCN guidelines for patients: uterine cancer, endometrial carcinoma, uterine sarcoma. Version 3.2021.
Version Info
Last reviewed on: 1/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
