Cancer of the Uterus (Endometrial Cancer)

What is cancer of the uterus (endometrial cancer)?

Endometrial cancer is an abnormal growth of cells in the lining of the uterus. It is the most common type of uterine cancer. The uterus (womb) is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

Uterine cancer is one of the most common cancers among women. It occurs most often in women between the ages of 50 and 70.

How does it occur?

The cause of cancer of the uterus is not known. However, you are at greatest risk of having this type of cancer if you have a condition that causes your body to produce a lot of the hormone estrogen and you have gone through menopause. Having a high level of estrogen in your body does not create a high risk of cancer by itself. It is a risk only when your body also does not have enough of another hormone called progesterone. After you go through menopause, the progesterone in your body decreases or disappears. Usually estrogen levels also drop quite a bit.

Examples of conditions in which you may have high levels of estrogen without enough progesterone are:

• obesity (being very overweight)
• a history of infertility or no pregnancies during your lifetime
• starting menstruation early or having a late menopause
• polycystic ovary syndrome
• tumors of the ovary that produce a lot of estrogen
• use of estrogen hormones for estrogen replacement therapy without the addition of progesterone.

Other factors related to an increased risk of uterine cancer are:

• radiation treatment of the pelvic area
• a combination of high blood pressure, diabetes, and obesity
• start of menstrual periods at an early age
• previous breast or ovarian cancer
• tamoxifen treatment for breast cancer.

What are the symptoms?

Symptoms include:

• bleeding or discharge not related to menstruation (periods)
• difficult or painful urination
• pain during sexual intercourse
• pain in the pelvic area.

Abnormal bleeding is the first symptom in 90% of endometrial cancers. Many women ignore this bleeding or blame it on menopause. If you have unusual bleeding or any of the other symptoms listed above, contact your health care provider.

How is it diagnosed?

Rarely uterine cancer is found as a result of a Pap test. For the Pap test, your health care provider takes a sample of cells from the opening of the uterus (the cervix). The cells are then examined in a lab. A Pap test may miss cancers that develop higher up in the uterus.

Your provider will examine the condition and size of your uterus. You will probably have a pelvic exam. You may have an ultrasound scan. The scan is done with high-frequency sound waves and their echoes to create video pictures of the uterus.

You may have a biopsy. For a biopsy, your provider will remove a small sample of the endometrium to be examined under a microscope. The biopsy can usually be done in your provider's office. It causes only a little discomfort. You may have cramps or pain for a short time after the procedure.

You may also have a D&C (dilation and curettage) to remove tissue for examination. This procedure is done under local or general anesthesia. Your cervix is widened (dilated) and a sharp tool called a curette is used to scrape the walls of the uterus. These tissue scrapings are checked for cancer cells. After a D&C, your uterus will bleed for a couple of days and you may have some low back and pelvic pain. However, this procedure often reduces or stops any abnormal bleeding you were having.

Another procedure that may be done is a hysteroscopy. This is an exam of the uterus with a thin telescopelike tube, a tiny camera, and a tool to remove part of the endometrium.

If you have cancer, you may have some blood tests, a urine test, a CT scan, or x-rays to see if the cancer has spread to other parts of your body.

How is it treated?

If the cancer is diagnosed early, the uterus is usually removed (hysterectomy), along with the ovaries, fallopian tubes (tubes from the ovaries to the uterus), and some lymph nodes.

Other treatment will depend on the type of cancer cells present and the extent of spread. Besides surgery, hormone therapy, radiation therapy, or (rarely) chemotherapy may be used alone or in combination.

How long will the effects last?

With early treatment, more than 80% of women with uterine cancer survive more than 5 years and most are completely cured. The longer the condition goes untreated, the lower the survival rate. For this reason, regular gynecologic exams are important for all women. If you develop unusual spotting or bleeding not related to menstrual periods, see your provider to evaluate your symptoms.

How can I prevent it?

Because the cause of uterine cancer is unknown, there is no way to prevent it. However, the following may help lower your risk:

• Eat a diet low in animal fat.
• Control your weight by eating healthy foods and exercising.
• Control your blood pressure by decreasing stress and eating a diet low in salt.
• Report abnormal vaginal bleeding promptly to your health care provider.
• Have an annual pelvic exam and Pap test.
• If you still have your uterus and are taking estrogen hormone therapy, you should take progesterone with the estrogen and follow your provider's advice for regular exams.

For more information, contact your local chapter of the American Cancer Society or call 800-ACS-2345. The National Cancer Institute (800-4-CANCER) is another resource. You may also visit their Web sites at http://www.cancer.org or http://www.cancer.gov.