Endometrial Cancer

Overview

Endometrial cancer is the most common gynecologic cancer in women in the United States with >65,000 cases annually. Median age at diagnosis is 63 years old. The body of the uterus has two main layers:

  • The myometrium is the thick outer layer of muscle.
  • The endometrium is the inner layer. During a woman’s menstrual cycle, hormones cause the endometrium to change. Estrogen causes the endometrium to thicken so that it can nourish an embryo if pregnancy occurs. If there is no pregnancy, estrogen is produced in lower amounts and more of the hormone called progesterone is made. This causes the endometrial lining to shed from the uterus and become the menstrual flow. This cycle repeats until menopause.
  • Endometrial cancer starts in the endometrium and is the most common type of cancer in the uterus. Endometrial carcinomas can be divided into different types based on how the cells look under the microscope. They include:
    • Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid endometrial carcinoma)
    • Uterine carcinosarcoma
    • Squamous cell carcinoma
    • Small cell carcinoma
    • Transitional carcinoma
    • Serous carcinoma

Endometrial Cancer Risk Factors

Risk factors for endometrial cancer include:

  • Obesity
  • Advanced age
  • Type 2 diabetes
  • Elevated hormone hormone exposure such as taking estrogen after menopause, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnancy, certain ovarian tumors and polycystic ovarian syndrome (PCOS)
  • Family history (having close relatives with endometrial or colorectal cancer)
  • Having had breast or ovarian cancer in the past
  • Having had endometrial hyperplasia in the past
  • Treatment with radiation therapy to the pelvis to treat another cancer

Pregnancy, birth control pills, and the use of an intrauterine device are linked to a lower risk of endometrial cancer.

Endometrial Cancer Symptoms

There are a few symptoms that may point to endometrial cancer.

Unusual vaginal bleeding, spotting or other discharge

About 90 percent of women with endometrial cancer have abnormal vaginal bleeding. This might be a change in their periods, bleeding between periods, or bleeding after menopause. Non-cancer problems can also cause abnormal bleeding. But it’s important to have a doctor check out any irregular bleeding right away. If you’ve gone through menopause, it’s especially important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor.

Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you can’t see blood in the discharge, it doesn’t mean there’s no cancer. Any abnormal discharge should be checked out by a doctor.

Pelvic pain, a mass, and weight loss

Pain in the pelvis, feeling a mass (tumor) and losing weight without trying can also be symptoms of endometrial cancer. These symptoms are more common in later stages of the disease. Still, any delay in seeking medical help may allow the disease to progress even further. This lowers the odds of treatment being successful.

Although any of these symptoms can be caused by things other than cancer, it’s important to have them checked out by a physician.

Endometrial Cancer Prevention

There’s no sure way to prevent endometrial cancer. But there are things you can do that may help lower your risk of developing this disease. They’re based on changing your risk factors whenever possible.

Get to, and stay at, a healthy weight

Women who are overweight or obese are up to three times more likely to get endometrial cancer compared with women at a healthy weight.

Be physically active

Studies have linked higher levels of physical activity to lower risks of endometrial cancer, so getting regular physical activity (exercise) may also be a way to help lower endometrial cancer risk. An active lifestyle can help you stay at a healthy weight, as well as lower the risk of high blood pressure and diabetes (another risk factor for endometrial cancer).

Endometrial Cancer Treatment

Surgery is the first treatment for most women with endometrial cancer that has not spread to other parts of the body. The operation includes removing the uterus, fallopian tubes, and ovaries. Lymph nodes from the pelvis and around the aorta may also be removed and tested for cancer spread. Pelvic washings may be done, too. The tissues removed at surgery are tested to see how far the cancer has spread which gives the surgical/pathologic stage.

Depending on the stage of the cancer, other or additional treatments, such as radiation and chemotherapy may be recommended.

Radiation Therapy at CCC

Douglas County patients with endometrial cancer who are candidates for radiation therapy have access to state-of-the-art treatment at the Community Cancer Center. The specific course of therapy chosen depends on the cancer stage and individual patient risk factors.

Radiation therapy uses high-energy X-rays, protons or other particles to kill cancer cells. Rapidly growing cells, such as cancer cells, are more susceptible to the effects of radiation therapy than are normal cells. The X-rays or particles are painless and invisible. Radiation therapy for breast cancer may be delivered through:

  • External radiation. A machine delivers radiation from outside the body to the cancer site inside the body
  • Internal radiation (brachytherapy). After surgery to remove the cancer, a radiation-delivery device is temporarily placed in the area where the cancer once was. A radioactive source is placed into the device for short periods of time over the course of treatment.