Endometrial (Uterine) Cancer: The Basics

Endometrial cancer, also called uterine cancer, happens when cells in the endometrium (inner lining of the uterus) grow out of control. As the number of cells grows, they form a tumor. There are a few types of endometrial cancer:

• Endometrioid Adenocarcinoma (75 out of 100 cases of endometrial cancers).
• Papillary Serous Adenocarcinoma (about 10 out of 100 cases of endometrial cancers).
• Clear Cell Carcinoma (about 4 out of 100 cases of endometrial cancers).
• Mixed Adenocarcinoma is an endometrial cancer that has features of more than one subtype (about 10 out of 100 cases of endometrial cancers).
• Rare types, including mucinous adenocarcinoma and squamous cell adenocarcinoma (less than 1 out of 100 cases of endometrial cancers).

Endometrial cancer that has spread from the endometrium to another part of the body is called metastatic cancer.

Fibroids are called tumors, but they are benign (not cancer).

Risk Factors

Factors that can raise your risk of endometrial cancer are:

• Being an older age.
• Having a high estrogen level (either naturally or from an outside source).
• Obesity.
• Diabetes.
• High blood pressure.
• Having a family history of colon cancer or Lynch Syndrome (HNPCC).
• Eating a diet high in animal fat (like red meats) and low in fruits and vegetables.
• Having taken an estrogen-only hormone replacement therapy medication.

Screening

If you do not have a family history of endometrial cancer, there are no screening guidelines. If you have Lynch Syndrome (HNPCC), a family member with Lynch Syndrome, or a strong family history of colon cancer, endometrial biopsies are recommended every year, starting at age 30 to 35.

Signs & Symptoms of Endometrial Cancer

The early and late stages of endometrial cancer can cause symptoms, like:

• Vaginal bleeding in post-menopausal women.
• Abnormal bleeding (in between periods/heavier or longer periods).
• Abnormal vaginal discharge (may smell bad).
• Pelvic or back pain.
• Pain with urination.
• Pain with sex.
• Blood in the urine or stool.

Keep in mind these symptoms are not specific to endometrial cancer and may be caused by something else.

Diagnosis of Endometrial Cancer

The only way to know for sure if a tumor in the endometrium is cancer is to have a biopsy. This can be done in your provider’s office or in an operating room. A transvaginal ultrasound can also be used to help diagnose cancer. The thickness of the endometrium can be seen with an ultrasound. If it looks too thick, and your provider thinks you have cancer, they will do a biopsy. For a biopsy, your provider will take a sample of cells to be looked at under a microscope. A pathology report goes over these results and is sent to your healthcare provider. This report helps plan your treatment. You can ask for a copy of your report for your records.

Staging Endometrial Cancer

Surgery is needed to stage endometrial cancer. Your provider may order more testing, such as a CT scan, MRI, chest X-ray, colonoscopy, barium enema or a blood test called CA-125, to see the extent of the cancer. Healthcare providers use two different staging systems for endometrial cancer, called the FIGO system and the TNM system. These systems describe:

• Where and how big the tumor is.
• If cancer cells are found in the lymph nodes.
• If cancer cells are found in other areas of the body.

Stages range from stage I (one) to stage IV (four), with a higher stage describing more advanced cancer.

Treatment

Surgery

• Surgery is often the treatment choice for endometrial cancer.
• Surgery is needed to stage the cancer and, at the same time, to remove as much of the cancer as possible.
• A surgeon may also do a hysterectomy (removal of the uterus) and bilateral-salpingo-oophorectomy (removal of both ovaries and fallopian tubes) to make sure there are no cancer cells left behind. After this type of surgery, a woman can no longer have children. In younger women, this surgery is avoided if possible so that they may have the ability to have children in the future.
• In advanced cases of endometrial cancer, the surgeon may remove as much cancer as possible to help with symptoms like pain, rather than curing the cancer.

Radiation

Radiation therapy uses high-energy x-rays to kill cancer cells. Radiation therapy:

• Is often used to prevent recurrence (the cancer coming back).
• Is often used after surgery.
• Can be used in 2 ways: External beam radiation therapy and brachytherapy (a radioactive source is placed inside the vagina to deliver the radiation).
• May be given with chemotherapy (called chemoradiation).

Chemotherapy

• Used in advanced stages or endometrial cancer that is recurrent (has come back after treatment).

Hormone Therapy

• Used in advanced stages or endometrial cancer that is recurrent (has come back after treatment).

Targeted Therapy

• These are medications that target something specific to the cancer cells. These medications are often used in advanced stage or recurrent endometrial cancer. 

Immunotherapy

• These medications use your own immune system to fight the cancer cells. Immune checkpoint inhibitors are used to treat endometrial cancer.  

This article is a basic guide to endometrial cancer. You can learn more about your type of endometrial cancer and treatment by using the links below.

Endometrial (Uterine) Cancer: Staging and Treatment

Surgical Procedures: Surgical Staging for Endometrial Cancer