Uterine Cancer (Endometrial Cancer)

Uterine cancer is a term that describes cancer in your uterus:

• Endometrial cancer develops in the lining of your uterus (the endometrium). It’s one of the most common cancers in women.
• Uterine sarcomadevelops in the muscle wall of your uterus (the myometrium).
• Cervical cancer can also develop in the bottom part of the uterus, but this is often a different type of cancer.

Uterine cancer can refer to more than one type, but the terms “uterine cancer” and “endometrial cancer” are often used interchangeably. That’s because most cases of uterine cancer are endometrial cancer. Uterine sarcoma is much less common.

Endometrial cancer mainly develops after age 50. About 3 in 10 women will receive a diagnosis of uterine cancer at some point in their lives.

Symptoms of uterine cancer

Symptoms of uterine cancer can include:

• Vaginal bleeding between periods
• Vaginal bleeding or spotting after menopause (even a tiny amount)
• Lower abdominal pain or cramping in your pelvis
• Thin white or clear vaginal discharge after menopause
• Heavier, longer or more frequent periods, especially after age 40

Uterine cancer causes

Researchers aren’t sure of the exact cause. Something happens to create changes in cells in your uterus. These cells grow and multiply out of control. This can form a mass called a tumor.

Certain risk factors can increase the chances you’ll develop uterine cancer. If you’re at high risk, talk to your healthcare provider about steps you can take to protect your health.

Risk factors

There are several risk factors for endometrial cancer. Many of them relate to the balance between estrogen and progesterone. Possible risk factors are:

• Having obesity
• Having polyendocrine metabolic syndrome (or PMOS, formerly known as polycystic ovary syndrome(PCOS))
• Taking estrogen without progesterone when you have a uterus. Certain medications to treat or reduce risk of breast cancer (like Tamoxifen), can also be a risk factor for uterine cancer

Other risk factors include:

Age, lifestyle and family history

• Age: Most uterine cancers happen after age 50.
• Diet high in animal fat: Eating high-fat foods can increase your risk of several cancers, including uterine cancer. Fatty foods are also high in calories, which can lead to obesity.
• Family history: Some people inherit genetic disorders that increase cancer risk. People with Lynch syndrome have increased risk of endometrial cancer.

Other medical conditions

• Diabetes: This disease is often related to obesity, a risk factor for cancer. But some studies suggest a more direct tie between diabetes and uterine cancer.
• Ovarian diseases: Certain ovarian tumors can cause high estrogen levels and low progesterone levels. These hormone changes can increase the risk of uterine cancer.

Menstrual and reproductive history

• Early menstruation: If your period started before age 12, your risk for uterine cancer might increase. That’s because you’re exposed to estrogen for more years of your life.
• Late menopause: Similarly, if menopause happens after age 50, the risk also increases. Your uterus gets exposed to estrogen longer.
• Not getting pregnant: Your risk may be higher if you’ve never been pregnant.

Previous treatments for other conditions

• Radiation therapy to your pelvis: Radiation therapy to treat cancer can damage cell DNA. This damage may increase your risk of developing a second type of cancer.
• Estrogen replacement therapy (ERT): Receiving estrogen therapy without progesterone puts you at a higher risk for uterine cancer.
• Use of tamoxifen: People may receive this drug for breast cancer treatment. It acts like estrogen in the uterus and can increase the risk of uterine cancer.

How doctors diagnose endometrial cancer

Talk to your healthcare provider if you have signs of uterine cancer like unusual bleeding. Your provider will:

• Ask about your symptoms, risk factors and family history
• Perform a physical exam
• Perform a pelvic exam

Your provider may use one or more tests to evaluate a possible diagnosis of uterine cancer:

• Endometrial biopsy: Your provider removes a small amount of the endometrial lining from your uterus.
• Imaging tests: Tools like CT scan, MRI and ultrasound can create pictures of your uterus and pelvic area.
• Blood tests: A CA-125 blood test measures the protein CA-125. A certain amount can point to cancer in your body.
• Hysteroscopy: Your provider uses a long thin tube with a light and camera at the end to look at and take pictures of your uterus.
• Dilation and curettage (D&C): This is a more complex procedure to remove uterine tissue. It takes place in the operating room.

If you had a D&C or biopsy to remove tissue samples, your provider then sends the sample to a lab. There, a pathologist looks at the tissue to confirm if there’s cancer.

Uterine Cancer Types and Staging

If your healthcare provider diagnoses endometrial cancer, they also need to determine the type. The type is based on information from the biopsy. Knowing the cancer type helps your care team figure out the best treatment:

• Type 1 endometrial cancer doesn’t usually spread to other tissues quickly. This type is more common.
• Type 2 endometrial cancer is more likely to spread quickly to tissues outside of your uterus. Treatment is more aggressive.

Your provider will also determine cancer stage. Imaging tests like CT, MRI or ultrasound may be helpful. But surgery results usually provide the most accurate staging. but the most accurate staging is based on surgery findings and results. Uterine cancers are staged on a scale that ranges from I to IV.

• Stage I cancer hasn’t spread beyond your uterus.
• Stage II cancer has spread to your cervix or has a high risk of spread or recurrence based on the type.
• Stage III cancer has spread to your vagina, ovaries and/or lymph nodes.
• Stage IV cancer has spread to your bladder or other organs far away from your uterus.

In some cases, your provider may not be able to tell you what stage of cancer you have until you’ve had surgery to remove the cancer.

How is uterine cancer treated?

Surgery is often the primary treatment for uterine cancer, especially if it appears that there is no evidence of cancer spreading outside the uterus. Your exact treatment plan depends on the type of cancer you have and your overall health. You’ll most likely have a hysterectomy. There are many ways to perform this surgery. Your surgeon will talk to you about the different kinds and what they recommend. The goal is to remove all the cancer.

During a hysterectomy for uterine cancer, surgeons may perform other surgeries:

• Bilateral salpingo-oophorectomy (BSO) to remove your ovaries and fallopian tubes. This lowers your risk of cancer forming in those organs.
• Lymph node dissection (lymphadenectomy) to remove lymph nodes and see if cancer has spread.

Often, surgeons use a single procedure to diagnose, stage and treat uterine cancer.

In cases of uterine sarcoma, treatment options are similar to those for endometrial cancer. You may have a hysterectomy, as well as a BSO to remove your ovaries and fallopian tubes.

Your healthcare provider may recommend nonsurgical treatments, too. These could include:

• Chemotherapy, which uses powerful drugs to destroy cancer cells.
• Radiation therapy, which sends targeted radiation beams to destroy cancer cells.
• Hormone therapy, which gives hormones or blocks them to treat cancer.
• Immunotherapy, which helps your immune system fight cancer.
• Targeted therapy, which uses medications to target specific cancer cells to stop them from multiplying.

How can I take care of myself after uterine cancer treatment?

After you finish treatment, your care team will talk to you about your follow-up visits. It’s important to go to these appointments. During a follow-up visit, your provider will do a pelvic exam. They’ll also ask you about any symptoms. The goal is to make sure cancer isn’t coming back (recurring) and that you’re feeling OK after treatment.

You can also talk to your provider about ways to live a healthy life after cancer. Eating well, getting enough sleep and exercising can help you feel your best.

When should I see my healthcare provider?

Contact your healthcare provider if you have any unusual vaginal bleeding. They’ll want to take a look to see what’s causing the bleeding.

What’s the survival rate for uterine cancer?

The five-year survival rate for endometrial cancer is 81%. That means 81 in 100 women diagnosed with the disease are alive five years later. The rate is even higher when cancer hasn’t spread outside your uterus. Then, the survival rate reaches as high as 95%. Treatments continue to improve, along with survival rates.

Uterine cancer is often fatal when it goes undiagnosed and spreads. The survival rate decreases to 17% when cancer spreads to other parts of your body. This means only 17 in 100 women will survive. Early detection and early treatment are key.

Is there a cure for uterine cancer?

If healthcare providers catch cancer early and before it spreads to other organs, surgery to remove your uterus may cure it.

Can uterine cancer be prevented?

Most of the time, you can’t prevent it. But you can take steps to reduce your risk by managing diabetes and maintaining a weight that’s healthy for you.

Talk to your provider about using progesterone-based or combined estrogen and progesterone birth control. These medications may offer some protection against uterine cancer.

If you are taking estrogen replacement therapy to treat menopause symptoms and still have a uterus, it is important to make sure you are also taking progesterone medication. Ask your provider about this if you are unsure.

Is there a screening test for uterine cancer?

No, there’s isn’t. If you have a high risk of endometrial cancer, your provider may recommend yearly biopsies beginning at age 35.