Endometrial cancer

Definition

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).

Alternative Names

Endometrial adenocarcinoma; Uterine adenocarcinoma; Uterine cancer; Adenocarcinoma - endometrium; Adenocarcinoma - uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer

Causes, incidence, and risk factors

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 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 endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

The following increase your risk of endometrial cancer:

• Diabetes
• Estrogen replacement therapy without the use of progesterone
• History of endometrial polyps 
• Infertility (inability to become pregnant)
• Infrequent periods
• Tamoxifen, a drug for breast cancer treatment
• Never being pregnant
• Obesity
• Polycystic ovarian syndrome (PCOS)
• Starting menstruation at an early age (before age 12)
• Starting menopause after age 50

Associated conditions include the following:

• Colon or breast cancer
• Gallbladder disease
• High blood pressure
• Polycystic ovarian disease

Symptoms

• Abnormal bleeding from the vagina, including bleeding between periods or spotting/bleeding 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

Signs and tests

A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.

Tests that may be done 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 if the cancer has spread to other parts of the body. This is called staging.

Stages of endometrial cancer:

1. The cancer is only in the uterus.
2. The cancer is in the uterus and cervix.
3. 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).
4. The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

Cancer is also described as Grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive.

Treatment

Treatment options involve surgery, radiation therapy, and chemotherapy.

Removal of the uterus (hysterectomy) may be done in women with the early stage 1 uterine cancer. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.

Total robotic or abdominal hysterectomy is recommended over vaginal hysterectomy. A vaginal hysterectomy does not allow the surgeon to look inside the abdominal area or remove tissue for a biopsy.

Surgery combined with radiation therapy is often used to treat women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with stage 2 disease.

Chemotherapy or hormonal therapy may be considered in some cases, especially for those with stage 3 and 4 disease.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 92%.

The 5-year survival rate for endometrial cancer that has not spread is 95%. If the cancer has spread to distant organs, the 5-year survival rate drops to 23%.

Complications

Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy.

There can also be complications from hysterectomy, radiation, and chemotherapy.

Calling your health care provider

Call for an appointment with your health care provider if you have abnormal vaginal bleeding or any other symptoms of endometrial cancer.

Any of the following symptoms should be reported immediately to the doctor:

• Bleeding or spotting after intercourse or douching
• Bleeding lasting longer than 7 days
• Periods that occur every 21 days or sooner
• Bleeding or spotting after 1 year or more of no bleeding after menopause

Prevention

There is no effective screening test for endometrial (uterine) cancer. Women with any risk factors for endometrial cancer should be followed closely by their doctors. Frequent pelvic examinations and screening tests such as a Pap smear and endometrial biopsy may be considered in some cases.

Use of birth control pills for over a year reduces the risk of endometrial cancer. Women who are taking estrogen replacement therapy without progesterone therapy or who have taken tamoxifen for more than 2 years have an increased risk of endometrial cancer and should have regular pelvic examinations and Pap smears.

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References

American Cancer Society. Cancer Facts and Figures 2009. Atlanta, Ga: American Cancer Society; 2009.

Park CK, Apte S, Acs G, Harris EER. Cancer of the endometrium. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 92.

Lu K, Slomovitz BM. Neoplastic diseases of the uterus: Endometrial hyperplasia, endometrial carcinoma, sarcoma: Diagnosis and management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 32.

Hernandez E, American College of Obstericians and Gynecologists. ACOG practice bulletin number 65: management of endometrial cancer. Obstet Gynecol. 2006;107(4):952.

In: Goldman L,Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 205.