Endometrial cancer starts in the layer of cells that form the lining of the uterus, called the endometrium. Endometrial cancer can also be called cancer of the womb or cancer of the uterus.
Most uterine cancers are endometrial cancer. In another type of cancer, uterine sarcoma, the malignancy starts in the muscles around the womb. Endometrial cancer and uterine sarcoma are usually treated differently.
Uterine cancer is the fourth most common cancer in women in the U.S.
It normally affects women aged over 55 years.
Contents of this article:
Signs and symptoms of endometrial cancer
Endometrial cancer starts in the lining of the womb and can spread from there.
Signs and symptoms of endometrial cancer include:
- Vaginal bleeding between menstrual periods
- Periods that are heavier than usual
- Vaginal bleeding in post-menopausal women
- Abnormal vaginal discharge, which may be watery or tinged with blood.
Less common is pain in the pelvic area or during sexual intercourse.
As the disease progresses, there may be fatigue, nausea and pain in the legs, back, and pelvic area.
Some women also experience pain when urinating, while others have difficulties when emptying their bladder.
Risk factors for endometrial cancer
A major factor in endometrial cancer is an increased exposure to high levels of estrogen. Women who have never been pregnant, who start menstruating before the age of 12 years, or who undergo late menopause, after 55 years, are more at risk.
Hormone replacement therapy (HRT), specifically estrogen-only, as used by women following a hysterectomy, also contributes. Polycystic ovarian syndrome (PCOS) is also a risk factor, because it raises estrogen levels.
Other factors include:
- Endometrial hyperplasia, or abnormal overgrowth or thickening of the lining of the uterus
- Use of Tamoxifen to prevent or treat breast cancer
- Radiation therapy to the pelvis
- A family history of uterine cancer
- A previous diagnosis of ovarian or breast cancer.
Acrylamide, a carcinogenic compound found in cooked, particularly burned, carbohydrate-rich food has been linked to endometrial and ovarian cancer in post-menopausal women.
Diagnosing endometrial cancer
A physician will review the symptoms and the patient's medical and family history, and will carry out a pelvic examination.
This involves inspecting and feeling the cervix, uterus, vagina, and labia to detect any lumps or changes in shape or size.
A transvaginal ultrasound (TVU) scan can determine the size and shape of the uterus, and the texture and thickness of the endometrium, to rule out other conditions. A transducer is inserted into the vagina, and sound waves create a video image of the uterus on a monitor.
Blood tests may reveal cancerous cells.
A biopsy involves taking a sample of tissue or cells for examination under a microscope. This could be a hysteroscopy, in which a thin telescope is inserted into the vagina and the uterus, or an aspiration biopsy, using a small, flexible tube to take sample cells.
If cancer is detected, the "grade" of the tumor will then be assessed, 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 to metastasize, or spread to other parts of the body.
Removing the uterus surgically or hysterectomy can reveal the scale of the cancer in the uterus.
Staging endometrial cancer
Treatment will depend on the stage, or how far the cancer has spread.
The following stages may be used:
- Stage 0: Cancerous cells remain where they started, on the surface of the inner lining of the uterus.
- Stage I: The cancer has spread through the inner lining of the uterus to the endometrium, and possibly to the myometrium.
- Stage II: The tumor has spread to the cervix.
- Stage III: The tumor has spread through the uterus to nearby tissue, including the vagina or a lymph node.
- Stage IV: The cancer has spread to the bladder or intestine, and possibly to other areas, such as bones, liver, or lungs.
When endometrial cancer spreads from the endometrium to other parts of the body, and when a new tumor formed in, say, the lung, that new tumor is not lung cancer. It is known as metastasized endometrial cancer.
Treatment for endometrial cancer
Treatment depends on the patient's age and general health, and the grade and stage of the tumor. A physician will discuss options and possible adverse effects with the patient.
Overall, the options include surgery, radiation therapy, chemotherapy, and hormone therapy.
Treatment for endometrial cancer is normally a hysterectomy, or the surgical removal of the uterus, together with the fallopian tubes and the ovaries.This normally involves a 2-day hospital stay, but resuming normal activities can take from 4 to 8 weeks.
A premenopausal woman will no longer menstruate after surgery, and she will not be able to conceive. There may be symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness.
Radiation therapy uses powerful beams to kill cancer cells, and it damages their DNA so that they can no longer multiply.
In external beam radiation (EBRT), a beam is directed at the pelvis and other areas with cancer. There may be up to five sessions each week for several weeks. A session lasts about 15 minutes.
Brachytherapy, or internal radiation therapy, uses small devices filled with radiation, such as wires, a cylinder, or small seeds. These are placed inside the vagina for a few minutes, and then removed, after which the patient goes home. The therapy is repeated two or more times over several weeks. Removing the device removes the radiation from the body.
Neo-adjuvant radiotherapy shrinks the tumor before surgery, making it easier to remove.
Adjuvant radiotherapy is applied after surgery to eliminate any remaining cancer cells.
Chemotherapy uses medication to destroy cancer cells. Combined with radiotherapy, it can remove the remains of a tumor.
Chemotherapy can destroy cancer cells and prolong life.
In late-stage cancer, chemotherapy can slow progression and prolong life.
Both radiotherapy and chemotherapy can help to relieve symptoms in patients with advanced cancer.
For endometrial cancer, chemotherapy is usually administered intravenously in cycles of treatment and a rest period. The cycle is repeated several times, depending on the stage and the treatment goals.
Possible adverse effects include a reduction in healthy blood cells, leaving the patient prone to bruising, bleeding, anemia, fatigue, and increased risk of infection. If these symptoms occur, the patient should seek medical advice.
Other effects include hair loss and gastrointestinal problems, including nausea, vomiting, diarrhea, and poor appetite. There may be lip and mouth sores.
These problems typically go away after treatment is completed.
Less common effects include swollen legs and feet, joint pain, balance problems, hearing difficulties, skin rash, and numbness and tingling in the hands and feet.
Hormone therapy may help patients with advanced endometrial cancer.
Women with very early stage cancer and low-grade tumors, who wish to become pregnant, may opt for hormone therapy rather than surgery.
This is not standard treatment, and it needs close monitoring. If there is complete cancer remission after 6 months of hormonal therapy, they will be encouraged to conceive and give birth, and then to have surgery after childbirth.
Hormone therapy for endometrial cancer includes giving progestin, to help shrink the tumor and control symptoms, and reduction of estrogen levels, making it harder for the cancer cells to grow.
Side effects include weight gain, mild muscle cramps, and mild nausea.
Prognosis for endometrial cancer
The 5-year survival rate for endometrial cancer overall is around 81.7 percent, according to the American Cancer Society, and 95.4 percent or higher for those diagnosed at the earliest stage.
The National Cancer Institute recommends avoiding smoking, doing exercise and having healthy diet to reduce the risk.