Endometrial cancer starts in the layer of cells that form the lining of the womb, called the endometrium. It is a cancer of the womb, or uterus.
Most uterine cancers start as endometrial cancer. Another type of cancer, uterine sarcoma, starts in the muscles and tissues of the uterus. Endometrial cancer and uterine sarcoma usually have different treatments.
Uterine cancer is the most common gynecological cancer in the United States. In 2020, the National Cancer Institute estimate that there will have been approximately 65,620 diagnoses of endometrial cancer and 12,590 deaths from this disease in the U.S.
Endometrial cancer can also cause pain in the pelvic area, less commonly during sexual intercourse. Some people also experience pain when urinating or difficulty emptying the bladder.
As the cancer progresses, there may be:
- a feeling of a mass or heaviness in the pelvic area
- unintended weight loss
- pain in several parts of the body, including the legs, back, and pelvic area
It is important to rule out endometrial cancer if another condition is causing similar symptoms.
If tests detect cancer, the doctor will assess the grade of the tumor to see how rapidly the cells are dividing and how quickly the cancer is likely to grow.
A higher-grade tumor is more likely to grow quickly and spread to other parts of the body.
The best course of treatment depends, in part, on the stage, or how far the cancer has spread.
Doctors may use the following definitions when staging endometrial cancer:
- Stage 0: Cancerous cells remain where they started, on the surface of the inner lining of the uterus.
- Stage 1: The cancer has spread through the inner lining of the uterus to the endometrium and possibly to the myometrium — the middle layer of the uterine wall.
- Stage 2: The tumor has spread to the cervix.
- Stage 3: The tumor has spread through the uterus to nearby tissue, including the vagina or a lymph node.
- Stage 4: The cancer has spread to the bladder or an intestine, and possibly to other areas, such as the bones, liver, or lungs.
When endometrial cancer spreads from the endometrium to other parts of the body, doctors say that it has “metastasized.”
Below, find an interactive 3D map of the stages of endometrial cancer. Explore it using the mousepad or touchscreen.
The best approach to treatment depends on:
- the person’s age
- their overall health
- the grade and stage of the tumor
The options include surgery, radiation therapy, chemotherapy, targeted therapy, and hormone therapy. It is important for the doctor to describe all of these treatments in detail.
Surgery usually involves a hysterectomy, which is the removal of the uterus, the fallopian tubes, and the ovaries.
A person who has a hysterectomy before menopause will no longer menstruate and will not conceive.
After the surgery, a person may experience symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness.
Radiation therapy uses powerful beams to kill cancer cells. It damages their DNA so that they can no longer multiply.
If a person receives external radiation therapy, a machine directs radiation at their pelvis and other areas with cancer.
Brachytherapy, or internal radiation therapy, involves placing a small device that contains radiation into the vagina for a few minutes at a time.
Doctors may also use radiation therapy to:
- shrink a tumor before surgery, making it easier to remove
- eliminate any remaining cancer cells after surgery
- relieve symptoms and improve the quality of life, when it is not possible to remove the tumor
Side effects of radiation therapy can include:
- burns in the affected area
- hair loss
After the treatment has finished, the side effects usually resolve.
Chemotherapy uses medication to destroy cancer cells. Combined with radiotherapy, it can kill a tumor or remove any cells that remain after surgery.
It can also slow the progression of late-stage cancer and prolong life expectancy.
For people with endometrial cancer, doctors usually administer chemotherapy intravenously, with intervals between treatment sessions to allow the body to recover.
Possible side effects include a reduction in healthy blood cells. This can increase the risk of:
Anyone who experiences any of these should contact their doctor.
Chemotherapy can also cause:
- hair loss
- gastrointestinal problems
- a low appetite
- lip and mouth sores
Less commonly, it can cause:
- swelling in the legs and feet
- joint pain
- balance problems
- hearing difficulties
- a rash
- numbness and tingling in the hands and feet
These adverse effects typically go away after the treatment ends.
This type of treatment uses substances that target specific cancer cells.
They may do this by:
- producing antibodies that fight cancerous cells
- preventing the growth of blood vessels that supply a tumor
- blocking signals that tell cells to reproduce excessively
Unlike radiation therapy or chemotherapy, targeted treatments only affect cancerous cells, not healthy cells. For this reason, they are less likely to cause side effects throughout the body.
Some hormones encourage cancer cells to grow. Hormone therapy for cancer blocks or removes these hormones.
The main hormone involved in the treatment is progestin. Other options are tamoxifen (Nolvadex), an estrogen receptor modulator, luteinizing hormone-releasing hormone agonists, and aromatase inhibitors.
The side effects depend on the specific medication.
Doctors usually recommend hormone treatment for people with advanced endometrial cancer and also provide chemotherapy.
However, some researchers have suggested that it may be suitable for females with early stage cancer and low-grade tumors who wish to retain their fertility.
Doctors do not know what causes endometrial cancer.
Cancer occurs when genetic changes cause cells to start growing uncontrollably instead of dying at the expected stage of their life cycles.
Research into the cause of these genetic changes is ongoing, but health experts know that several factors may increase the risk of developing cancer.
People exposed to high levels of estrogen may have an increased risk of endometrial cancer.
The risk is greater for those who:
- have never been pregnant
- start menstruating before 12 years of age
- experience menopause after 55 years of age
Other factors include:
- using estrogen-only hormone therapy after menopause
- using Nolvadex to prevent or treat breast cancer
- having had previous radiation therapy to the pelvis
- having a family history of uterine cancer
- having polycystic ovary syndrome, or PCOS
- having diabetes, obesity, hypertension, or other aspects of metabolic syndrome
- having endometrial hyperplasia
It is important to recognize the early signs of endometrial cancer because prompt treatment can significantly improve the outlook.
Early signs include:
- vaginal bleeding between periods
- periods that are heavier than usual
- vaginal bleeding after menopause
- unusual vaginal discharge that is watery or tinged with blood
Anyone who has unusual discharge or periods should consult a doctor.
To diagnose this type of cancer, a physician will:
- review the symptoms
- ask about personal and family medical histories
- perform a pelvic examination
- request some tests, if they believe that it is necessary
The doctor will inspect and feel the cervix, uterus, vagina, and labia to detect any lumps or changes in shape or size.
With a transvaginal ultrasound, a doctor can assess the size and shape of the uterus and the texture and thickness of the endometrium and rule out other conditions.
To perform this scan, a healthcare professional inserts a transducer into the vagina and assesses the relayed images on a monitor.
Blood tests can also reveal the presence of cancerous cells.
Alternately, a doctor may use hysteroscopy, which involves inserting a thin scope into the vagina and uterus.
Or, they may take an aspiration biopsy, using a small, flexible tube to take sample cells for examination under a microscope.
To monitor the progress of endometrial cancer, a doctor may use:
The average 5-year survival rate for endometrial cancer overall is around 81.2%, according to the American Cancer Society. It is 95% if a doctor diagnoses the cancer at its earliest stage.
To reduce the risk, the National Cancer Institute recommend exercising regularly, having a healthful, balanced diet, and avoiding smoking.