Endometrial Cancer

Below, we provide you with information that will help you to understand, detect, and treat endometrial cancer. This guide is designed to offer valuable insights into the signs, symptoms, risk factors, detection methods, treatment options, and post-treatment support related to endometrial cancer.

Understanding Endometrial Cancer

Endometrial cancer develops in the tissue lining the interior of the uterus (womb). It is one of the most prevalent cancers affecting American women. The majority of endometrial cancers are adenocarcinomas, which originate in the cells that produce mucus and other fluids.

Endometrial cancer is one type of uterine cancer. Another form of uterine cancer begins in the muscle cells or myometrial cells that comprise the uterine wall. These cancers are classified as sarcomas and are less common. The term “uterine cancer” is often used interchangeably with endometrial cancer, though they are not identical.
Signs and Symptoms
Endometrial or uterine cancer typically develops after menopause or around the onset of menopause.

The most common symptoms include:

Abnormal Bleeding: This is the most frequent symptom. It may begin as a watery, blood-streaked discharge that gradually contains more blood. Post-menopausal women should be particularly vigilant about any vaginal bleeding.

Pelvic Pain: This can manifest as difficult or painful urination, pain during sexual intercourse, or general pain in the pelvic region.
Causes, Risk Factors, and Risk Reduction  
Risk Factors
While the exact cause of endometrial cancer remains largely unknown, several factors may increase a woman’s risk of developing the disease.
Many of these factors are associated with elevated estrogen levels:
Age: The risk of endometrial cancer increases with age. The average age at diagnosis is 60, and it is rare in women under 45.
Obesity or Overweight: This is a significant risk factor. Excess fat tissue produces more estrogen, which increases risk.
Diet: A diet high in animal fat may elevate risk.
Prior Radiation Therapy: Pelvic radiation can damage cellular DNA, potentially increasing the risk of endometrial cancer and sarcomas.
Hormone Use: Women who use unopposed estrogen (without progesterone), especially for extended periods, face a higher risk.
Tamoxifen: This breast cancer treatment slightly increases the risk of endometrial cancer and uterine sarcomas.
Menstrual History: Women with more menstrual cycles throughout their lifetime may have a higher risk. This can result from early onset of menstruation (before age 12) or late menopause (after age 55). Multiple pregnancies may offer some protection against this cancer.
Polycystic Ovarian Syndrome (PCOS): Women with PCOS typically have higher estrogen levels and lower progesterone levels, potentially increasing their risk.
Family History: Endometrial cancer appears to have a hereditary component in some families. Women with a family history of colon and/or endometrial cancer should discuss their risk with a healthcare provider.
Personal Cancer History: Women who have had breast, colon, or ovarian cancer may face an elevated risk of endometrial cancer.
Diabetes: Type 2 diabetes can increase risk, partly due to its association with obesity.
Endometrial Hyperplasia: This condition causes thickening of the uterus. While not cancerous, it can, in rare cases, increase cancer risk.
Screening, Detection and Diagnosis
Screening & Diagnosis
Currently, there is no routine screening test for endometrial cancer. Most cases are discovered after a woman experiences symptoms and consults her healthcare provider.
Endometrial cancer is often detected at an early stage due to the onset of pain or unusual bleeding. However, these symptoms can also indicate other conditions.
The diagnostic process may include:
Pelvic Exam: The healthcare provider examines the pelvic area, checking the vagina, uterus, bladder, and rectum for abnormalities in shape or size. A speculum may be used to visualize the upper vagina and cervix.
Transvaginal Ultrasound: This imaging technique uses sound waves to create a picture of the uterus. If the endometrium appears unusually thick, a biopsy may be recommended.
Pap Test: While primarily used to detect cervical cancer, this test may be performed to rule out cervical cancer as a cause of symptoms.
Endometrial Biopsy: The doctor removes small tissue samples from the uterine lining. This is typically an in-office procedure, but in some cases, a dilation and curettage (D&C) may be necessary. A pathologist examines the samples for cancer cells.
CT Scan: This imaging test provides detailed pictures of internal body areas from various angles. A contrast dye may be used to enhance visibility of organs and tissues.
MRI: Using radio waves and a strong magnetic field, an MRI produces detailed images. It may be used to assess how far cancer has invaded the uterine wall.
These diagnostic tools help healthcare providers determine the presence of endometrial cancer and, if present, its stage and extent. This information is crucial for developing an appropriate treatment plan.
Treatment
Treatments & Side Effects
The treatment plan for endometrial cancer depends on the stage and where the cancer is found. If you still hope to get pregnant, talk with your doctor about your options before you start treatment. This will affect your treatment plan.
Most patients undergo surgery, which may be the sole treatment required in some cases. Additional treatments such as radiation, hormone therapy, or chemotherapy may follow. When surgery is not feasible, hormone therapy and radiation therapy are often employed. For advanced cases, targeted therapy or immunotherapy may be considered. Clinical trials may also be an option for some patients.
Post-treatment follow-up care is essential. Even when there are no apparent signs of disease, undetected cancer cells may remain, potentially leading to recurrence. Your healthcare team will monitor your recovery and check for cancer recurrence through regular follow-ups, which may include physical exams, pelvic exams, imaging studies, and laboratory tests.

Treatment Options
It’s important to discuss all available options, including their potential benefits and side effects, with your healthcare team to determine the most appropriate treatment plan for your specific situation.

Surgery:
Surgery is often used to treat uterine cancer. The surgery includes a total hysterectomy. This is an operation in which the uterus and cervix are removed. The surgery should be performed either laparoscopically or robotically, when deemed safe and appropriate by the surgeon. Often, the surgeon has to make a cut in the abdomen.
The operation also requires removal of the ovaries and fallopian tubes as well. This procedure is called a bilateral salpingo-oophorectomy. The doctor may also remove nearby lymph nodes to check for cancer. When the cancer is found early, surgery may be the only treatment used.
Side effects may include:
Pain
Infection at the surgical site
Fatigue
Scarring
Numbness
Immediate onset of menopause (if ovaries are removed pre-menopause)
Lymphedema (swelling and pain due to lymph node removal)
Radiation Therapy:
Radiation therapy is the use of high-energy rays to kill or damage cancer cells.  Two types of radiation may be used to treat this cancer:
External radiation involves the use of a large machine. It is done on an outpatient basis. It does not take long, but you may need to go to hospital five days/week for a month or more.
Internal radiation therapy uses tiny tubes. The tubes contain a radioactive substance. They are inserted through the vagina and left in place for a few days. This treatment involves a hospital stay. A patient may not be allowed visitors to protect others from radiation exposure.
Some women have both external and internal radiation.
Side effects may include:
Vaginal dryness, itching, tightening, and burning
Fatigue
Skin changes at the treatment site
Hormone Therapy:
Hormone therapy is the use of drugs that block hormones that drive cancer growth. In endometrial cancer, it often takes the form of progesterone in pill form. Other drugs may be an option too. Blood tests may help identify cancers that are more likely to respond to hormone therapy. It is used after or in place of surgery.
Side effects may include:
Hot flashes
Fluid retention
Sleep problems
Muscle aches
Weight gain
Menstrual changes in pre-menopausal women
Chemotherapy:
Chemotherapy involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment. Chemotherapy may be used to treat high-grade endometrial cancers that can grow quickly. It is also used for stage III and IV cancers that return after treatment. Most patients receive chemotherapy after surgery, sometimes with radiation. It is given through a vein. Often, you will get a combination of two drugs. Side effects vary greatly depending on the drug.

Immunotherapy:
Immunotherapy uses the body’s natural defenses (the immune system) to find, attack, and kill cancer cells.
Immunotherapy can be used in combination with targeted therapies for people with advanced endometrial cancer that tests negative to MSI-high or dMMR, after other treatment has been tried. It can also be used with chemotherapies for MSI-high or dMMR recurrent endometrial cancers.

Targeted Therapy:
Targeted therapy aims to more precisely attack cancer cells. These drugs target changes in the genes or proteins of cancer cells that help them grow, divide, and spread.

Clinical Trials:
Be sure to ask your healthcare provider about clinical trials. Clinical trials are research studies to test new treatments or learn how to use current treatments better. Today’s standard drugs were once in clinical trials. Tomorrow’s drugs are in them today.
In some cases, the treatments with the best chance of success may be available only through clinical trials. Trials are offered for many cancers, at many different stages.
Everyone is not eligible for every trial. If you have cancer that has come back or spread, it is especially important to ask about clinical trials.
Key Takeaways
Key Takeaways

Understanding endometrial cancer is crucial for early detection and effective treatment. While the disease can be serious, many cases are caught early due to noticeable symptoms like abnormal bleeding. With proper medical care and treatment, the outlook for many women with endometrial cancer is positive.
Remember:
Be aware of the risk factors and discuss any concerns with your healthcare provider.
Report any unusual vaginal bleeding or pelvic pain promptly.
Attend regular check-ups and follow your doctor’s recommendations for screenings.
If diagnosed, work closely with your healthcare team to understand your options and create a treatment plan that’s right for you.
Consider seeking support from counselors, support groups, or patient advocacy organizations throughout your journey.
Additional Resources
Additional Resources
For more information about endometrial cancer, consider exploring these reputable sources:
National Cancer Institute: www.cancer.gov
Foundation for Women’s Cancer: www.foundationforwomenscancer.org
Society of Gynecologic Oncology: www.sgo.org
Glossary
Glossary
Adenocarcinoma: A type of cancer that begins in glandular cells.
Biopsy: The removal of cells or tissues for examination by a pathologist.
Endometrium: The inner lining of the uterus.
Hysterectomy: Surgery to remove the uterus.
Lymphedema: Swelling caused by a build-up of lymph fluid in the body’s tissues.
Menopause: The time in a woman’s life when menstrual periods permanently stop.
Metastasis: The spread of cancer from one part of the body to another.
Sarcoma: A type of cancer that begins in bone or soft tissues.
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We hope this content provided education and guidance. Remember to stay informed, make educated choices early, and speak to your health care team about any concerns. Also, you don’t have to face these challenges alone. Seek support from friends, family, support groups, and mental health professionals to navigate this journey.

This information is intended for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for personalized medical guidance and treatment options.