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.
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.
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. This hormone imbalance can happen if a woman:
The most common symptoms of endometrial cancer include:
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.
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:
It’s common to feel scared, sad, or angry after finding out that you have endometrial cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area.
Learning about endometrial cancer:
Living with endometrial cancer:
Health Tools help you make wise health decisions or take action to improve your health.
|Actionsets are designed to help people take an active role in managing a health condition.|
|Cancer: Controlling Nausea and Vomiting From Chemotherapy|
Estrogen makes the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen—your progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what you know as menstrual bleeding.
When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. Over time, the endometrium cells can become cancerous.
The most common symptom of endometrial cancer is abnormal vaginal bleeding after menopause. "Abnormal" bleeding means unexpected bleeding. If you are taking hormone therapy after menopause, you can expect some bleeding. But if you have irregular bleeding, call your doctor.
Abnormal bleeding in women older than 35 who have not started menopause may also be a symptom of endometrial cancer, though this is less common. In rare cases, an unexplained abnormal vaginal discharge may be an early symptom.
Symptoms of more advanced endometrial cancer include:
Normally, the lining of the uterus (endometrium) builds up and then sheds every month. You know this shedding as menstrual bleeding. In most cases of endometrial cancer, the endometrium has built up, or thickened, and has stayed that way. This is called endometrial hyperplasia. From this "precancer" stage, 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. Some of this tissue mass passes out of the uterus through the cervix and vagina as part of abnormal bleeding. Abnormal bleeding occurs in 90% of postmenopausal women who have endometrial cancer.1
If endometrial cancer is not treated, it may spread from the uterus into deeper layers of the connective tissue around 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 stage and grade of your cancer is one of the most important factors in selecting the treatment option that is right for you. The long-term outcome (prognosis) depends on the stage of your cancer. The stage of you cancer will be determined by what your doctor finds at the time of surgery. The grade of your cancer is determined by how the cancer cells look under the microscope.
For more information, see the following topics:
The biggest risk factor for endometrial cancer is having too much estrogen and not enough progesterone. This is called "unopposed estrogen." (Your body makes progesterone. Man-made progesterone, as in birth control pills or hormone therapy, is called a progestin.)
Long-term exposure to unopposed estrogen may occur as a result of:
Other things that increase your risk include:
If you are taking tamoxifen for breast cancer, keep taking it as directed by your doctor. But be sure to have a pelvic exam each year. The risk of endometrial cancer 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.
Endometrial cancer has been linked to hereditary nonpolyposis colon cancer (HNPCC). In women, this cancer often starts in the uterus and ovaries before it grows in the colon. The American Cancer Society recommends that a woman with a family history of HNPCC talk to her doctor about annual screenings with endometrial biopsy, starting at age 35.4
There are some ways to help you lower your risk for endometrial cancer.
Schedule an appointment with your doctor if you have:
Symptoms of endometrial cancer can be mistaken for those of another condition, such as endometriosis.
If you are concerned about your symptoms or think you may have an increased risk for endometrial cancer, call and make an appointment with your doctor.
Watchful waiting is not appropriate if you have symptoms that do not go away.
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.
Most cases of endometrial cancer are diagnosed in an early stage. This is because women who have reached menopause usually see their doctors when they have vaginal bleeding. To check your symptoms, your doctor will perform a medical history and physical exam. The physical exam will include a pelvic exam 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) for examination under a microscope.
Additional tests may include:
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
Your doctor will determine the stage of your cancer at the time of your surgery. Other tests done before surgery may include:
An imaging test may be done before surgery to look for spread (metastasis) of cancer in the abdomen and pelvis. This helps with planning for treatment. Imaging tests include the following:
After endometrial cancer is confirmed, surgery is usually done to remove the uterus, cervix, ovaries, and fallopian tubes. This is called a hysterectomy with bilateral salpingo-oophorectomy. Sometimes the pelvic lymph nodes are also removed. The removed tissue is examined to find out the stage and grade of cancer.
There is no early detection test for endometrial cancer. If you have abnormal vaginal bleeding, schedule an appointment with your doctor for a medical evaluation. Unexpected bleeding, or more bleeding than normal, can be a symptom of endometrial cancer.
The American Cancer Society advises women who are nearing menopause to learn about the risks and symptoms of endometrial cancer.4
Endometrial cancer detected in its early stages can be cured with surgery and close follow-up. Treatment choices depend on where the cancer is and how much it has grown. Treatment may include one or more of the following:
After a diagnosis of endometrial cancer is confirmed, your doctor may recommend surgery to remove the uterus, ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). All tissues removed in surgery will be 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
Treatment for endometrial cancer depends on the size of the cancer, the extent of the cancer's growth, and how the cancer cells look under the microscope.
If you have recently been diagnosed with endometrial cancer, you may experience a wide variety of emotions in reaction to your diagnosis. There is no "normal" or "right" way to react to a diagnosis of cancer. But if your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services.
You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.
Most treatments for endometrial cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.
Your quality of life becomes a critical issue when you are considering your treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.
Use home treatment measures to help manage the side effects of treatment. For more information, see the Home Treatment section of this topic. Your doctor also may prescribe medicines to control nausea and vomiting.
If you are perimenopausal or 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. Estrogen normally prevents:
Some women with endometrial cancer may be interested in taking part in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to be in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of endometrial cancer.
After your initial treatment for endometrial cancer, it is important to receive follow-up care. Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.
Endometrial cancer may come back (recur). But this is not likely when the first cancer is caught 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
Cancer that comes back only in the pelvic area sometimes is treated with radiation therapy. This may stop the progress of cancer and may even cure it if it is only in the vagina. If cancer has spread to other parts of the body, radiation therapy often provides relief (palliation) from symptoms. Chemotherapy may also be used.
Progestin hormone therapy often is used to slow the growth of cancer that has recurred or spread. These hormone treatments can help 15 to 30 out of 100 women who have endometrial cancer that has spread to other organs (metastasized).2
Participation in clinical trials to test new treatments may be appropriate if cancer has spread to other parts of the body and hormonal therapy is ineffective in stopping the growth.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. 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. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:
Some risk factors for endometrial cancer are inherited, such as a family history of endometrial or colon cancer. But other risk factors are under your control. You can reduce your risk for endometrial cancer if you:
You have no risk for endometrial cancer if you have had your uterus removed (hysterectomy).
During medical treatment for any stage of endometrial cancer, you can use home treatment to help manage the side effects that may accompany endometrial cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.
Home treatment includes the following:
Other issues that may arise include:
Many women with endometrial cancer face emotional issues as a result of their disease or its treatment.
Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to talk with your doctor about any home treatment you use for pain.
Medicines, such as chemotherapy, may be given after surgery for endometrial cancer, depending on the stage and grade of the cancer and the risk for the cancer to spread (metastasis) or recur. Progestin hormone therapy may be used if your cancer has recurred or spread or you are unable to have surgery or radiation therapy.
Medicine treatment for endometrial cancer may include hormone therapy or chemotherapy.
Progestin hormone therapy. Examples include:
Chemotherapy, used alone or in combination. Examples include:
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 to remove the uterus (hysterectomy) is the most common treatment for endometrial cancer. The surgeon will also remove the fallopian tubes, ovaries, and often the pelvic lymph nodes, which are examined to find out the extent of the cancer and to help plan your treatment. If examination of tissue determines that more aggressive cancer still may be in the lymph system, a lymphadenectomy may be done to remove and examine additional lymph nodes. Surgery has the highest cure rate of all treatments for endometrial cancer.
Laparoscopic surgery is an option for treating your endometrial cancer. This surgery is done with a tiny camera and special instruments. The surgeon puts these tools through several small incisions (cuts) in the belly. Some surgeons do this surgery by guiding robotic arms that hold the surgery tools. This is called robot-assisted laparoscopy.
Most women have their ovaries removed after a diagnosis of endometrial cancer to make sure the cancer has not spread to the ovaries, to reduce the production of estrogen, and to slow cancer growth. And some women who have had endometrial cancer may be at greater risk of developing ovarian cancer.
You will not be able to become pregnant or continue to menstruate after a hysterectomy. If you have not yet gone through menopause, it will begin as soon as your ovaries are removed. For more information, see the topic Menopause and Perimenopause.
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.
Studies called clinical trials are being conducted to find ways to prevent, detect, diagnose, and treat endometrial cancer. Talk with your doctor to see whether clinical trials are available and whether you are a good candidate.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary 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. Complementary therapies are not meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
|American Cancer Society (ACS)|
The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.
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.
|National Cancer Institute (NCI)|
|6116 Executive Boulevard|
|Bethesda, MD 20892-8322|
|Web Address:||www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# 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.
|National Women's Health Information Center|
|8270 Willow Oaks Corporate Drive|
|Fairfax, VA 22031|
The National Women's Health Information Center (NWHIC) is a service of the U.S. Department of Health and Human Services Office on Women's Health. NWHIC provides women's health information to a variety of audiences, including consumers, health professionals, and researchers.
|Women's Cancer Network|
|Gynecologic Cancer Foundation|
|230 West Monroe|
|Chicago, IL 60606|
The Women's Cancer Network (WCN) is an interactive Web site developed by the Gynecologic Cancer Foundation. Their goal is to help women who have developed cancer. Links at this Web site offer information on different types of cancer, treatment options, ways to improve quality of life, genetics and hereditary cancer risks, and other background information, such as understanding test results.
- Chu CS, et al. (2008). Cancers of the uterine body. In VT DeVita et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1543–1563. Philadelphia: Lippincott Williams and Wilkins.
- National Cancer Institute (2010). Endometrial Cancer Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/healthprofessional.
- Mutch DG (2008). Uterine cancer. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 1002–1021. Philadelphia: Lippincott Williams and Wilkins.
- 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.
- 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 2009). Management of endometrial cancer. ACOG Practice Bulletin No. 65. Obstetrics and Gynecology, 106(2): 413–425.
- 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 (2008). Uterine Sarcoma PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/uterinesarcoma/HealthProfessional.
- National Cancer Institute (2010). Endometrial Cancer PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/Patient.
- National Cancer Institute (2010). Uterine Sarcoma PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/uterinesarcoma/Patient.
- National Comprehensive Cancer Network (2010). Uterine neoplasms. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Ross Berkowitz, MD - Obstetrics and Gynecology|
|Last Revised||November 29, 2010|
Last Revised: November 29, 2010
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.