Diseases & Conditions

Endometrial cancer

Although the diagnosis of endometrial cancer is difficult to receive, the good news is that this type of cancer is often found at its earliest, most treatable stage.

Endometrial cancer, one of the most common cancers in American women, begins in the cells of the endometrium, the lining of your uterus — a hollow, pear-shaped pelvic organ where fetal development occurs. Endometrial cancer is sometimes called uterine cancer, but there are other cells in the uterus that can become cancerous — such as muscle or myometrial cells. These form much less common cancers called sarcomas.

Endometrial cancer is often detected at an early stage because it frequently produces vaginal bleeding between menstrual periods or after menopause. If endometrial cancer is discovered early, removing the uterus surgically often eliminates all of the cancer.

Most cases of endometrial cancer develop in postmenopausal women, whose periods have stopped. The first clue that something is wrong may be abnormal vaginal bleeding.

Signs and symptoms of endometrial cancer may include:

• Any bleeding after menopause
• Prolonged periods or bleeding between periods
• An abnormal, nonbloody discharge from your vagina
• Pelvic pain
• Pain during intercourse
• Unintended weight loss

When to see a doctor
Because endometrial cancer is more likely to be cured the earlier it's detected, see your doctor if you experience any signs or symptoms of the disease — including vaginal bleeding or discharge not related to your periods, pelvic pain or pain during intercourse. Many of the same symptoms may be associated with noncancerous (benign) conditions, such as vaginal infections, uterine fibroids or uterine polyps. But it's very important to bring them to the attention of your doctor.

If you're at increased risk of endometrial cancer, talk with your doctor about what screening tests might be appropriate for you. If you have had endometrial cancer, your doctor should outline a regular follow-up program to watch for possible recurrence.

Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes cells become abnormal (mutate) and grow out of control. The cells continue dividing even when new cells aren't needed. These abnormal cells can invade and destroy nearby tissues and even have the ability to travel to other parts of the body and begin growing there.

In endometrial cancer, cancer cells develop in the lining of the uterus. Why these cancer cells develop isn't entirely known. However, scientists believe that estrogen levels play a role in the development of endometrial cancer. Factors that can increase the levels of this hormone and other risk factors for the disease have been identified and continue to emerge. In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium to become cancerous.

The most serious complication of any cancer, including endometrial cancer, is that it can spread to other parts of your body (metastasize). Fortunately, when discovered early, endometrial cancer is usually treatable. Five-year survival rates are 95 percent for early-stage endometrial cancer. If endometrial cancer has reached an advanced stage before diagnosis, it may have already spread to other parts of your body and be more difficult to treat successfully.

Surgery is the most common treatment for endometrial cancer. Most doctors recommend either the surgical removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes in the area should also be removed during surgery along with other tissue samples.

A hysterectomy is a major operation, and because you can't get pregnant after your uterus has been removed, it can be a difficult decision for some women. However, surgery is usually the only way to eliminate the cancer or the need for further treatment.

If you have an aggressive form of endometrial cancer or the cancer has spread to other parts of your body, you may need additional treatments. These may include:

• Radiation. If your doctor believes you're at high risk of cancer recurrence, he or she may suggest that you have radiation therapy after a hysterectomy. Your doctor may also recommend radiation therapy if the cancerous tumor is fast growing, invades deeply into the muscle of the uterus or involves blood vessels. Radiation therapy involves the use of high-dose X-rays to kill cancer cells. When done from outside the body, it's called external beam radiation therapy. Brachytherapy is another form of radiation that involves the internal application of radiation, usually to the inner lining of the uterus. Brachytherapy has fewer side effects than conventional radiation therapy does. However, brachytherapy treats only a small area of the body.

• Hormone therapy. If the cancer has spread to other parts of your body, synthetic progestin, a form of the hormone progesterone, may stop it from growing. The progestin used in treating endometrial cancer is administered in higher doses than is used in hormone replacement therapy for menopausal women. Other medications may be used as well. Treatment with progestin may be an option for women with early endometrial cancer who want to have children and, therefore, don't want to have a hysterectomy. However, this approach is not without the risk that the cancer will return. Carefully discuss this treatment with an expert in this field.

  Another hormone therapy option is gonadotropin-releasing hormone agonists. These drugs can lower estrogen levels in premenopausal women.

• Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells. Often, chemotherapy drugs are used in combination to increase their efficacy. Generally, women with stage III or stage IV endometrial cancer will be offered chemotherapy as part of their treatment regimen. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells outside the uterus.

Each type of treatment for endometrial cancer can have side effects. Ask your doctor what side effects you can expect and what can be done to manage them.

If you have late-stage or recurrent endometrial cancer, you may benefit from participating in clinical trials that provide new experimental treatment options. For more information on clinical trials, contact the National Cancer Institute at 800-4-CANCER (800-422-6237) or visit its Web site.

After treatment for endometrial cancer, your doctor will likely recommend regular follow-up examinations to determine whether the cancer has returned. Checkups may include a physical exam, a pelvic exam, a Pap test, a chest X-ray and laboratory tests.