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Endometrial cancer

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

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

Causes

Endometrial cancer is the most common type of uterine cancer. The exact cause of endometrial cancer is unknown. An increased level of estrogen may play a role. Estrogen helps stimulate the buildup of the lining of the uterus. This can lead to overgrowth of the endometrium and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70. A few cases may occur before age 40.

The following factors related to your hormones increase your risk of endometrial cancer:

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

Women with the following conditions also seem to be at a higher risk of endometrial cancer:

  • Colon or breast cancer
  • Diabetes
  • Gallbladder disease
  • High blood pressure

Symptoms

Symptoms of endometrial cancer include:

  • 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

Exams and Tests

During the early stages of disease, a pelvic exam is often normal. As the cancer becomes more advanced, there may be changes in the size, shape, or feel of the uterus or surrounding structures.

Tests that may be done include:

  • Endometrial 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, imaging tests may be done to see if the cancer has spread to other parts of the body. This is called staging.

Stages of endometrial cancer are:

  • Stage 1: The cancer is only in the uterus.
  • Stage 2: The cancer is in the uterus and cervix.
  • Stage 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).
  • Stage 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. Aggressive means that the cancer grows and spreads quickly.

Treatment

Treatment options include surgery, radiation therapy, and chemotherapy.

Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. The doctor may also recommend removing the tubes and ovaries.

Surgery combined with radiation therapy is another treatment option. It is often used for 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.
  • Stage 2 disease.

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

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Endometrial cancer is usually diagnosed at an early stage.

If the cancer has not spread, 95% of women are alive after 5 years. If the cancer has spread to distant organs, about 25% of women are still alive after 5 years.

Possible Complications

Complications may include any of the following:

  • Anemia due to blood loss (before diagnosis)
  • Perforation (hole) of the uterus, which may occur during a D and C or endometrial biopsy
  • Problems from surgery, radiation, and chemotherapy

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have any of the following:

  • 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
  • New discharge after menopause has begun
  • Pelvic pain or cramping that does not go away

Prevention

There is no effective screening test for endometrial (uterine) cancer.

Women with risk factors for endometrial cancer should be followed closely by their doctors. This includes women who are taking estrogen replacement therapy without progesterone therapy or women who have taken tamoxifen for more than 2 years. Frequent pelvic exams, Pap smears and endometrial biopsy may be considered in some cases.

The risk of endometrial cancer is reduced by:

  • Maintaining a normal weight
  • Using birth control pills for over a year

References

Boggess JF, Kilgore JE. Uterine cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 88.

Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387(10023):1094-1108. PMID: 26354523 www.ncbi.nlm.nih.gov/pubmed/26354523.

National Cancer Institute: PDQ endometrial cancer treatment. Bethesda, MD: National Cancer Institute. Updated February 2, 2016. www.cancer.gov/types/uterine/hp/endometrial-treatment-pdq. Accessed April 11, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): uterine neoplasms. Version 2. 2016. www.nccn.org/professionals/physician_gls/pdf/uterine.pdf. Accessed April 11, 2016.

    • Pelvic laparoscopy

      Pelvic laparoscopy - illustration

      Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

      Pelvic laparoscopy

      illustration

    • Female reproductive anatomy

      Female reproductive anatomy - illustration

      External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

      Female reproductive anatomy

      illustration

    • D and C

      D and C - illustration

      D and C (dilatation and curettage) is a procedure in which the vaginal canal is held open with a speculum and the cervix is dilated with a metal rod. A curette is then passed through the cervical canal into the uterine cavity where endometrial tissue is scraped away and collected for examination.

      D and C

      illustration

    • Endometrial biopsy

      Endometrial biopsy - illustration

      The mucosal lining of the cavity of the uterus is called the endometrium. It is this lining which undergoes changes over the course of the monthly menstrual cycle, sloughs off and becomes part of the menses. A biopsy of the endometrium is used to check for disease or problems of fertility.

      Endometrial biopsy

      illustration

    • Hysterectomy

      Hysterectomy - illustration

      Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.

      Hysterectomy

      illustration

    • Uterus

      Uterus - illustration

      The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

      Uterus

      illustration

    • Endometrial cancer

      Endometrial cancer - illustration

      Endometrial cancer is a cancerous growth of the endometrium (lining of the uterus). It is the most common uterine cancer.

      Endometrial cancer

      illustration

      • Pelvic laparoscopy

        Pelvic laparoscopy - illustration

        Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

        Pelvic laparoscopy

        illustration

      • Female reproductive anatomy

        Female reproductive anatomy - illustration

        External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

        Female reproductive anatomy

        illustration

      • D and C

        D and C - illustration

        D and C (dilatation and curettage) is a procedure in which the vaginal canal is held open with a speculum and the cervix is dilated with a metal rod. A curette is then passed through the cervical canal into the uterine cavity where endometrial tissue is scraped away and collected for examination.

        D and C

        illustration

      • Endometrial biopsy

        Endometrial biopsy - illustration

        The mucosal lining of the cavity of the uterus is called the endometrium. It is this lining which undergoes changes over the course of the monthly menstrual cycle, sloughs off and becomes part of the menses. A biopsy of the endometrium is used to check for disease or problems of fertility.

        Endometrial biopsy

        illustration

      • Hysterectomy

        Hysterectomy - illustration

        Hysterectomy is surgical removal of the uterus, resulting in inability to become pregnant. This surgery may be done for a variety of reasons including, but not restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A hysterectomy may be done through an abdominal or a vaginal incision.

        Hysterectomy

        illustration

      • Uterus

        Uterus - illustration

        The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

        Uterus

        illustration

      • Endometrial cancer

        Endometrial cancer - illustration

        Endometrial cancer is a cancerous growth of the endometrium (lining of the uterus). It is the most common uterine cancer.

        Endometrial cancer

        illustration

      Review Date: 4/5/2016

      Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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