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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?

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 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.

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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.

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 should you call your 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:

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.

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 post-menopausal 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 Canadian Cancer Society advises women who have an increased risk of endometrial cancer to talk with their doctors about a personal plan for testing.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:

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

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.

Hospice palliative 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 who have 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. Hospice palliative care providers will work to help manage pain and other symptoms 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.

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.
  • 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 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 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 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 carboplatin, cisplatin, and doxorubicin.

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

  • 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 child-bearing 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.

References

Citations

  1. National Cancer Institute (2012). Endometrial Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional.
  2. Canadian Cancer Society (2012). Uterine cancer overview. Canadian Cancer Encyclopedia. Available online: http://info.cancer.ca/cce-ecc/default.aspx?Lang=E&toc=53#Early_detection.
  3. 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.
  4. 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

Credits

Current as of: April 29, 2020

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology
E. Gregory Thompson MD - Internal Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Ross Berkowitz MD - Obstetrics and Gynecology