What is endometrial (uterine) cancer?

Endometrial cancer is the rapid growth of abnormal cells that line the uterus. It also is called uterine cancer. These cells may spread to nearby organs, lymph glands, or distant organs. This cancer can be cured most often when found early.

Treatment may include surgery to remove the uterus, ovaries, fallopian tubes, and sometimes the pelvic lymph nodes. Radiation and hormones to stop cancer growth also are sometimes used. Chemotherapy, targeted therapy, or immunotherapy may be used if the cancer has spread.

Normally, the lining of the uterus (endometrium) builds up and then sheds with each menstrual cycle. This shedding is menstrual bleeding (menstrual period).

But in most cases of endometrial cancer, the endometrium has built up and has not shed and thinned. The lining has remained thick. This is called endometrial hyperplasia. If not treated, the lining cells can grow quickly and become cancer cells.

As cancer cells multiply, they form a mass of tissue, which can cause vaginal bleeding. Especially after menopause, this abnormal bleeding is a reason to call your doctor.

If endometrial cancer isn't treated, it may spread outside of the uterus. It may spread to the pelvic lymph nodes and the vagina or other pelvic organs. Advanced-stage cancer may spread to other lymph nodes, the bladder, the bowels, or the lungs.

The long-term outcome depends on the stage and grade of your cancer.

Abnormal or unexpected bleeding from the vagina is the most common symptom of endometrial cancer. Symptoms of more advanced endometrial cancer include pain or a lump in the pelvic area and weight loss.

Treatment for endometrial cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the uterus. Other treatment options may include radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

Your doctor will talk with you about your options and then make a treatment plan.

Surgery

The main treatment is surgery. Most people have both of these:

• Surgery to remove the uterus and cervix. This is called a total hysterectomy.
• Surgery to remove the fallopian tubes and ovaries. This is called a bilateral salpingo-oophorectomy.

During surgery, the doctor may remove nearby lymph nodes and check other tissues for signs of cancer.

Pregnancy is no longer possible after a hysterectomy. If you have early-stage cancer and there's a chance that you might want to get pregnant later, talk to your doctor. You may be able to have other treatments and delay surgery. This is called fertility-sparing treatment.

Radiation therapy

This uses high-dose X-rays to destroy cancer cells and shrink tumors. Radiation may be given by placing substances inside the body. This is called internal radiation. Or it may be given by using a machine outside the body. This is called external radiation.

Radiation therapy may be used as a first-line treatment. Or it may be used to treat cancer that has come back. It may also be used to control symptoms and increase comfort.

Medicines

Medicines may be used to control the growth of cancer cells and to relieve symptoms. Medicines include:

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells.

Hormone therapy.

These medicines block hormones that cause certain cancers to grow. This can slow or stop cancer growth.

Hormone therapy may be used after surgery. It may also be an option if you are not able to have surgery or radiation therapy, or if the cancer has come back or spread.

Targeted therapy.

These medicines target cancer cells and may cause less harm to normal cells. They help keep cancer from growing or spreading. Targeted therapy may be used if cancer has come back after treatment.

Immunotherapy.

This treatment helps your immune system fight cancer. It may be given in several ways.

You cannot control some things that put you at risk for endometrial cancer, such as a family history of endometrial or colon cancer.

But you can make personal choices that lower your risk of endometrial cancer.

• Strive for a healthy body weight. The body's fat cells make estrogen.
• Breastfeed if you are able. This decreases ovulation and estrogen activity.
• Get treatment for abnormal or unexpected bleeding. (Endometrial hyperplasia, which may develop into endometrial cancer, is one cause of abnormal bleeding.) Heavy menstrual periods, bleeding between periods, and bleeding after menopause are symptoms of hyperplasia.
• Use hormonal birth control. Hormonal birth control prevents endometrial hyperplasia.
• Exercise regularly. It may help control your weight and may reduce estrogen levels.
• Eat a diet that is low in animal fats and high in fruits and vegetables.

You have no risk for endometrial cancer if you have had your uterus removed (hysterectomy).

Your doctor will ask about your medical history and do a physical exam. This will include a pelvic exam. Endometrial cancer is usually diagnosed with a biopsy. In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Follow your doctor's instructions to relieve pain. Pain from cancer and surgery can almost always be controlled. Use pain medicine when you first notice pain, before it becomes severe.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss.
• Get some physical activity every day, but do not get too tired.
• Get enough sleep, and take time to do things you enjoy. This can help reduce stress.
• Think about joining a support group. Or discuss your concerns with your doctor or a counselor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take care of your urinary tract to prevent problems that can be caused by endometrial cancer and its treatment. Limit drinks with caffeine, drink plenty of fluids, and urinate every 3 to 4 hours.
• If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

Your feelings about your body and your sexuality may change after treatment for cancer. If you have a partner, it may help to talk openly with that person about your feelings.

Having cancer treatments such as radiation therapy or a hysterectomy may affect your ability to have or enjoy sex.

If you haven't yet reached menopause, your menstrual period will end right after most treatments for endometrial cancer. If your uterus and ovaries have been removed or have had radiation therapy, your body will have a decrease in estrogen. This may cause menopausal symptoms, such as hot flashes, changes in mood, and vaginal dryness.

If you do have sexual concerns or problems, talk with your doctor about treatment or information. Your doctor may also be able to refer you to a group for support.

Having a risk factor for endometrial cancer doesn't mean that you'll get it for certain.

The biggest risk factor is related to the hormone estrogen. When estrogen isn't in balance with another hormone, progesterone, it can cause problems that raise the risk for this cancer. Risk factors include:

• Being obese. Fat cells make extra estrogen.
• Taking estrogen without taking progestin.
• Taking tamoxifen.
• Having polycystic ovary syndrome.
• Having your first period before age 12 and starting menopause after age 52.

Other things that increase your risk include:

• Being older than 50.
• Inheriting some kinds of genes, such as those for Lynch syndrome.
• Having some types of endometrial hyperplasia.
• Having type 2 diabetes.
• Never having been pregnant.
• Having past radiation therapy to the pelvis.

The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50.

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.