Uterine/endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).
Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a role. Estrogen is a hormone that helps stimulate the buildup of the lining of the uterus. Studies have shown that high levels of estrogen in animals result in excessive endometrial growth and cancer.
Most cases of uterine cancer occur between the ages of 60 and 70 years, but a few cases may occur in women younger than 40 years of age.
- Uterine and Endometrial Cancer Diagnosis
- Uterine and Endometrial Cancer Risks and Prevention
- Uterine and Endometrial Cancer Treatment
Symptoms of Uterine Cancer
- Abnormal uterine bleeding and/or abnormal menstrual periods
- Bleeding between normal periods, before menopause
- Vaginal bleeding or spotting after menopause
- Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
- Lower abdominal pain or pelvic cramping
- Thin white or clear vaginal discharge after menopause
Uterine or Endometrial Cancer Diagnosis
When all cases of uterine cancer are considered, the five-year survival rate is 96 percent. Survival rates are even higher when the disease is discovered and treated in its earliest stage.
A yearly pelvic examination and Pap smear are the first line of defense against uterine cancer. They allow a physician to detect and monitor any changes in the endometrial lining.
Tests that may be done at MedStar Health include:
- Endometrial aspiration or biopsy
- Dilation and curettage (D and C )
- Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body.
Uterine or Endometrial Cancer Prevention
All women should have regular pelvic exams beginning at the onset of sexual activity (or at the age of 21 if not sexually active) to help detect signs of infection of abnormal development.
Women should have a Pap smears beginning three years after becoming sexually active.
Women with any risk factors for endometrial cancer should be followed more closely by their doctors. Frequent pelvic examinations and screening tests such as a Pap smear and endometrial biopsy should be considered.
Women who are taking estrogen replacement therapy should have regular pelvic examinations and Pap smears.
Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.
What Increases the Risk of Endometrial Cancer?
- Estrogen replacement therapy without the use of progesterone
- History of endometrial polyps or other benign growths of the uterine lining
- Infertility (inability to become pregnant)
- Tamoxifen, a drug for breast cancer treatment
- Never being pregnant
- Starting menstruation at an early age (before age 12)
- Starting menopause after age 50
- Personal or family history of colon, ovarian or breast cancer
- Hypertension (high blood pressure)
- Polycystic ovarian disease
Uterine or Endometrial Cancer Treatment
The treatment for uterine cancer depends on the patient and the stage of the disease. A personalized treatment plan will be developed by your specialist. At MedStar Health, treatment may include surgery, chemotherapy and/or radiation.
- Adjuvant radiation therapy - this treatment option is used to destroy any cancer that remains after the initial surgery. The decision will be based on findings from surgery, if they suggest a likelihood of the cancer coming back (recurring).
- Adjuvant chemotherapy - the decision to use this treatment depends on findings from surgery that suggest a likelihood of recurrence.
Radiation Oncology for Uterine and Endometrial Cancer
Radiation therapy alone is the best treatment for certain types of cancer and some benign (non-cancerous) diseases. Other types of cancer may require radiation therapy to be delivered along with other therapeutic agents such as chemotherapy or hormone therapy. Radiation therapy can be used to shrink tumors prior to surgical removal, or after surgery to destroy tumor cells that may exist microscopically in the surgical area. Radiation therapy may be used to cure disease, control disease, or control the symptoms of disease (such as pain).
Surgery for Uterine Cancer and Endometrial Cancer
In order to manage uterine cancers, doctors often recommend a total hysterectomy (complete removal of uterus and cervix) with lymph node dissection. Your doctor will probably recommend removal of the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy).
This procedure can be performed either through an open abdominal incision, or via minimally invasive techniques such as laparoscopy or robotic assisted procedures. The advantage of robotic and other minimally invasive procedures is that they allow you to treat the cancer with minimal blood loss, less pain, shorter hospital stay, and faster return to work and other normal activities.
Following surgery, additional treatment with radiation and/or chemotherapy may be suggested. The decision will be based on findings from the tissue removed at surgery, which may show that the cancer is likely to recur or has already spread beyond the uterus.
Staging of Uterine Cancer
This is based on findings at the time of surgery.
Stages of uterine cancer, from least to most aggressive:
- The cancer is only in the uterus.
- The cancer is in the uterus and cervix.
- The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
- The cancer has spread to the inner surface of the bowel, bladder, abdomen or other organs.
Doctors describe cancer cells as Grades I, II or III. Grade 1 is the least aggressive, and Grade III is the most aggressive.
The five-year survival rate for endometrial cancer that has not spread is 95 percent. If the cancer has spread to distant organs, the five-year survival rate is considerably lower.