Endometrial cancer is the most commonly diagnosed gynecologic cancer. About 50,000 American women are diagnosed with the disease every year. Endometrial cancer is also the most common form of uterine cancer, so it is frequently referred to as uterine cancer.

What is endometrial cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium is the most common cancer of the female reproductive organs.

Cancer of the endometrium is different from cancer of the connective tissue or muscle of the uterus, which is called uterine sarcoma. About 80 percent of all endometrial cancers are adenocarcinomas. This means the cancer occurs in the cells that develop the glands in the endometrium. Endometrial cancer is highly curable when found early.

Uterine carcinosarcoma is a very rare type of uterine cancer, with characteristics of both endometrial cancer and uterine sarcoma. It is also known as a malignant mixed mesodermal tumor.

Types of Endometrial Cancer

Endometrial cancers are usually grouped into one of four categories:

• p53 mutation
• POLE mutation
• Copy number high
• Copy number low

Clinical trials are being used to assess treatments for cancers found within each of these groups, including novel immunotherapy trials.

Endometrial Cancer Prevention

The exact cause of endometrial cancer is not known. However, doctors believe that avoiding the known risk factors when possible, using oral contraceptives or other forms of hormonal birth control, controlling obesity and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.

Endometrial Cancer Causes and Risk Factors

The following factors may increase a woman’s risk of developing endometrial cancer:

• Obesity
• Diet high in animal fat
• Family history of endometrial, ovarian and/or colon cancers (hereditary nonpolyposis colorectal cancer)
• Starting monthly periods before age 12
• Late menopause
• Infertility (inability to become pregnant)
• Never having children
• Being treated with tamoxifen for breast cancer
• Hormonal imbalance — having too much estrogen and not enough progesterone
• Estrogen replacement therapy for treatment of effects of menopause
• Diabetes
• Personal history of breast cancer
• Personal history of ovarian cancer
• Prior radiation therapy for pelvic cancer
• Personal history of polycystic ovary syndrome or atypical endometrial hyperplasia

The risk for endometrial cancer increases as women get older, and it is most common in white women.

Endometrial Cancer Symptoms

Consult a doctor if you experience any/all of the following symptoms:

• Bleeding or discharge not related to your periods (menstruation) — over 90 percent of women diagnosed with endometrial cancer have abnormal vaginal bleeding
• Postmenopausal bleeding
• Difficult or painful urination
• Pain during intercourse
• Pain and/or mass in the pelvic area

Endometrial Cancer Diagnosis

Diagnosis of endometrial cancer includes a review of your medical history and a general physical exam. It may also include one or more of the following.

• Internal pelvic exam: This is done to feel for any lumps or changes in the shape of the uterus.
• Pap test (also called Pap smear): This test involves microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer and to show noncancerous conditions, such as infection or inflammation. However, the Pap test does not detect endometrial cancer.
• Endometrial biopsy: This procedure uses a small, flexible tube that is put into the uterus to collect an endometrial tissue sample. The sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor’s office.
• Dilation and curettage (also called D&C): Your doctor may recommend a D&C if an endometrial biopsy is not possible or if further diagnostic information is needed. This is a minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
• Transvaginal ultrasound (also called ultrasonography): This ultrasound test uses a small instrument, called a transducer, which is placed in the vagina. The doctor may do a biopsy if the endometrium looks too thick.

Endometrial Cancer Treatment

Specific treatment for endometrial cancer will be determined by your doctor(s) based on:

• Your overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease
• Your opinion or preference

The choice of treatment depends on the stage of cancer — whether it is only in the endometrium, or if it has spread to other parts of the uterus or body. Most people will be treated with surgery first. Some may need additional therapy. Generally, treatment for people with cancer of the endometrium includes one or more of the following.

• Surgery:
  • Hysterectomy — surgical removal of the uterus
  • Salpingo-oophorectomy — surgery to remove the fallopian tubes and ovaries
  • Pelvic lymph node dissection — removal of some lymph nodes from the pelvis
  • Para-aortic lymphadenectomy — removal of lymph nodes that surround the aorta, the main artery of the heart
  • Laparoscopic lymph node sampling — removal of lymph nodes through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly)
  • Sentinel lymph node mapping — use of fluorescent imaging to identify potentially cancerous lymph nodes that would otherwise go undetected
• Radiation therapy: the use of X-rays, gamma rays and charged particles to fight cancer. Brachytherapy and external beam radiation are the most common radiation therapies used to treat endometrial cancer. Novel techniques in image-based brachytherapy with directed magnetic resonance (MR) guidance offer better patient outcomes and fewer side effects.
• Chemotherapy: the use of anticancer drugs to treat cancerous cells
• Immunotherapy: the process of activating the immune system’s natural ability to fight cancer
• Hormone therapy: medication or surgical procedures that interfere with hormone activity

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