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Endometrial (Uterine) Cancer

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?

Endometrial cancer in its early stages can be cured. The main treatment is surgery to remove the uterus plus the cervix, ovaries, and fallopian tubes. This is called a hysterectomy with bilateral salpingo-oophorectomy. The doctor may also remove pelvic and aortic lymph nodes to see if the cancer has spread.

A woman whose cancer has spread may also have 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 counsellor can really help. Ask your doctor about support groups. Or call the Canadian Cancer Society (1-888-939-3333) or visit its website at www.cancer.ca.

Frequently Asked Questions

Learning about endometrial cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with endometrial cancer:

End-of-life decisions:

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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. This can happen when a woman:

  • Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
  • Takes estrogen without taking a progestin.
  • Is taking tamoxifen.
  • Has polycystic ovary syndrome.
  • Starts her period before age 12 or starts menopause after age 55.

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 are rarely signs 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, 9 out of 10 have vaginal bleeding.1

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.2

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 endometrial cancer is having too much estrogen and not enough progesterone. (Your body makes progesterone. Man-made progesterone, as in birth control pills or hormone therapy, is called a progestin.)

Risk from long-term exposure to too much estrogen can be from:

  • 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, a breast cancer treatment that acts like estrogen in the uterus.3
  • Polycystic ovary syndrome.
  • Starting your menstrual cycle before age 12 or starting menopause after age 55.

Other things that increase your risk include:

  • Being older than 50. Endometrial cancer is most common in women older than 50.
  • Having a history of breast, ovarian, or colon cancer.
  • Having endometrial hyperplasia.
  • Having type 2 diabetes.
  • Having high blood pressure.
  • Having previous radiation therapy to the pelvis.

When To Call a Doctor

See your doctor if you have:

Who to see

Your family doctor or general practitioner can evaluate your symptoms and your risk for endometrial cancer.

You may be referred to doctors who can manage your cancer treatment, such as:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Tests to find cancer

To check your symptoms, your doctor will ask about your medical history and do a physical examination. This will include a pelvic examination and Pap test.

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. One type of hyperplasia, atypical adenomatous hyperplasia, progresses to cancer in about 1 out of 3 women.1

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 Canadian Cancer Society advises women who have an increased risk of endometrial cancer to talk with their doctor about a personal plan for testing.4

  • Women are advised to report to their doctors any unexpected bleeding or spotting or unusual vaginal discharge.
  • Women at risk for hereditary non-polyposis colon cancer (HNPCC) are advised to talk to their doctors about screening.4 Having an HNPCC risk also means a high risk of getting ovarian and uterine cancer. High-risk women who have no pregnancy plans can avoid these cancers by having the uterus, fallopian tubes, and ovaries removed.5

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.6

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:

Clinical trials

Studies called clinical trials can be an option for women who don't want or aren't cured by standard treatments.

Side effects of treatment

Your quality of life is a critical issue when you are considering your treatment options. Be sure to discuss side effects and your personal preferences with your doctors when they recommend treatment.

  • Your surgeon and oncologist will explain the possible side effects of your surgery. If you're still in your childbearing years, a hysterectomy means that pregnancy will no longer be possible.
  • Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
  • Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, anemia, or infections.

For information about how to manage side effects, see Home Treatment.

Follow-up treatment

Endometrial cancer may come back (recur). But this isn't likely when the first cancer is found early and is low-risk. Of those cancers that do come back, nearly all do so within 3 years of the first diagnosis. This is why regular follow-up is extremely important after initial treatment.1 Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.

You can find more information about endometrial cancer online at the:

  • Canadian Cancer Society website at www.cancer.ca.
  • U.S. National Cancer Institute website at www.cancer.gov.

Coping with emotions

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.

If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment centre may offer counselling services. And a local chapter of the Canadian Cancer Society can help you find a support group.

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.

Supportive care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Hospice palliative care can improve your quality of life by helping you to manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

For some people with advanced-stage cancer, a time comes when treatment to cure 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 this isn't the end of treatment. It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for hospice palliative care.

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.
  • Breast-feed 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 acts like estrogen in the uterus.3 This 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 examination 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 to your doctor. You might be able to use another medicine, instead of tamoxifen, for 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 fibre 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:

Medicines to help with side effects

Click here to view an Actionset. 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. These medicines include serotonin antagonists, phenothiazines, and aprepitant.

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, 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

  • Hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy)
  • Lymphadenectomy (removal of lymph nodes)

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).

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.

Clinical trials

Studies called clinical trials are being conducted to find ways to prevent, detect, diagnose, and treat endometrial cancer. Talk with your doctor to see if clinical trials are available and to find out if you are a good candidate.

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

Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org
 

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.


Canadian Cancer Society
55 St. Clair Avenue West
Suite 300
Toronto, ON  M4V 2Y7
Phone: (416) 961-7223
Fax: (416) 961-4189
Email: ccs@cancer.ca
Web Address: www.cancer.ca
 

The Canadian Cancer Society (CCS) is a national, community-based organization that provides information about cancer prevention, care, and treatment. The CCS also provides funding for cancer research.


Cancer.Net
Phone: 1-888-651-3038
(571) 483-1780
Fax: (571) 366-9537
Email: contactus@cancer.net
Web Address: www.cancer.net
 

Cancer.Net is the information website of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.


U.S. National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


Women's Cancer Network
Gynecologic Cancer Foundation
230 West Monroe
Suite 2528
Chicago, IL 60606
Phone: 1-800-444-4441 or (312) 578-1439
Fax: (312) 578-9769
Email: info@foundationforwomenscancer.org
Web Address: www.foundationforwomenscancer.org
 

The Foundation for Women's Cancer has a mission to increase awareness of cancers specific to women, to support research, and to provide information for women who are diagnosed with gynecologic cancers. Their website links to in-depth resources on reproductive cancer, prevention for cervical cancer, and updates on the National Race to End Women's Cancer.


References

Citations

  1. Ramirez PT, et al. (2011). Cancers of the uterine body. In VT DeVita Jr. et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1345–1362. Philadelphia: Lippincott Williams and Wilkins.
  2. National Cancer Institute (2012). Endometrial Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional.
  3. Mutch DG (2003). Uterine Cancer. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., chap. 54, pp. 951–969. Philadelphia: Lippincott Williams and Wilkins.
  4. Canadian Cancer Society (2011). Uterine cancer overview. Canadian Cancer Encyclopedia. Available online: http://info.cancer.ca/cce-ecc/default.aspx?Lang=E&toc=53#Early_detection.
  5. 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.
  6. American Joint Committee on Cancer (2010). Corpus uteri. In AJCC Cancer Staging Manual, 7th ed., pp. 403–418. New York: Springer.

Other Works Consulted

  • American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.
  • 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.
  • Brand A, et al. (2000). Diagnosis of endometrial cancer in women with abnormal vaginal bleeding. SOGC Clinical Practice Guideline. Journal of Obstetrics and Gynaecology Canada, 22(1): 102–104.
  • 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 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

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Ross Berkowitz, MD - Obstetrics and Gynecology
Last Revised November 13, 2012

Last Revised: November 13, 2012

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Ross Berkowitz, MD - Obstetrics and Gynecology

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