Endometrial Cancer

Endometrial cancer forms in the tissue that lines the inside of the uterus. It is one of the most common cancers diagnosed in women in the United States. Most endometrial cancers start in glandular tissue and are called adenocarcinomas.

Endometrial cancer is one type of uterine cancer. Uterine cancer also can start in the cells that make up the wall of the uterus. These cells are muscle or myometrial cells. Cancers that start in these cells become sarcomas. They are much less common. When people say uterine cancer, they are often talking about endometrial cancer.

Risk Factors

The cause of endometrial cancer is mostly unknown. The following factors may increase a woman’s risk of developing the disease. Many relate to having higher levels of estrogen.

• Age – The risk of endometrial cancer goes up as a woman gets older. The average age of diagnosis is 60. This cancer is rare in women under 45.
• Diabetes – Having Type 2 diabetes can increase your risk. This may be in part because it is linked to obesity.
• Diet – Eating a diet high in animal fat may increase risk.
• Endometrial hyperplasia – Endometrial hyperplasia or endometrial intraepithelial neoplasia is an increased growth of the endometrium. Cell growth can cause the uterus to thicken. This is not cancer but, it is associated with an increased risk of endometrial cancer.
• Family history – This type of cancer appears to run in some families. Women with a family history of colon cancer and/or endometrial cancer should talk with a doctor about their risk.
• History of cancer – Women who have had breast, colon, or ovarian cancer may have a higher risk of getting endometrial cancer.
• Hormone use – Women who take unopposed estrogen without progesterone, especially for long periods of time, have a higher risk. Although estrogen treatment can reduce hot flashes, improve vaginal dryness, and help prevent the weakening of the bones (osteoporosis), the use of estrogen on its own increases the risk of developing endometrial cancer. It is important to discuss estrogen therapy with your doctor.
• Menstrual cycles – Women who have more periods may have a higher risk. This may result from early onset of menstruation (before age 12) or late onset menopause (after age 55). The risk comes from having more periods, so starting early and ending early or starting late and ending late may not increase risk. Having many pregnancies can help protect against this cancer.
• Obesity or being overweight – This is a major risk factor. Women who have more fat tissue have more estrogen which increases risk of developing endometrial cancer.
• Polycystic Ovarian Syndrome (PCOS) – Women with PCOS have higher estrogen levels and lower levels of progesterone and may have a higher risk.
• Prior radiation therapy – Radiation to the pelvic area can damage the DNA of cells. This can increase risk of this cancer including sarcomas.
• Tamoxifen – Women who take this drug have a slightly higher risk of this cancer. Tamoxifen is also associated with a slight increased risk of developing uterine sarcomas. It is used to prevent or treat breast cancer.

Signs & Symptoms

Endometrial or uterine cancer usually develops after menopause or around the time that menopause begins. Common symptoms include:

• Abnormal bleeding – Abnormal vaginal bleeding or discharge is the most common symptom. You may notice watery, blood-streaked flow that gradually contains more blood.
• Abnormal pain – Difficult or painful urination, pain during intercourse, or pain in the pelvic region.

Screening

There is no routine screening for endometrial cancer. It is usually found after a woman notices symptoms.

Diagnosis

Endometrial cancer is often found at an early stage. This is because it causes irregular bleeding or bleeding after menopause and/or pain. These symptoms can have other causes as well.

If cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to determine the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body. Staging is conferred based on findings at the time of surgery to treat the cancer. The pathologist may use a grading system (grades 1-3) to describe how the cells look under a microscope. Cells that look more like healthy cells have a lower grade. Pathologists will also assign the cancer a cell type, such as endometrioid (most common), clear cell, mucinous, or serous, for example.

• Stage I – The cancer is only in the body of the uterus. It is not in the cervix. Stage I has two levels depending on where the cancer is found with regards to the wall of the uterus.
• Stage II – The cancer has spread from the body of the uterus to the cervix.
• Stage III – The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). It may have spread to the vagina, ovaries, or lymph nodes in the pelvis. Stage III has four levels depending on where the cancer is found.
• Stage IV – The cancer has spread into the bladder or rectum (stage IVA). Or, it has spread beyond the pelvis to other organs or body parts such as the lungs or bones (stage IVB).

Treatment 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 women have surgery. In some cases, it may be the only treatment needed. Radiation, hormone therapy, or chemotherapy may follow. When surgery is not an option, hormone therapy and radiation therapy are often used. If the cancer has spread, treatment may include targeted therapy or immunotherapy. Clinical trials may be an option as well.

Follow-up care after treatment is important. Even when there are no signs of disease, undetected cancer cells can remain in the body and cause the cancer to return. Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups may include a physical exam, a pelvic exam, x-rays, and lab tests.

Being informed is a key part of managing your cancer and its treatment. Endometrial cancer can affect many areas of your life—not just your health, but also your emotions, finances, and more. If you’re facing challenges in any of these areas, know that there are resources and support available to help you.

Managing the Cost of Cancer Treatment 

Worrying about the cost of cancer care is very common. If you have concerns about paying for your treatment, you’re not alone. It’s important to talk openly about the financial side of cancer and to know where you can find assistance. There are organizations and professionals who can help you understand your options and find support.

Support for Caregivers

Cancer doesn’t just affect the person diagnosed—it touches everyone close to them. Spouses, partners, siblings, children, and friends may suddenly find themselves in the role of caregiver, even if they’ve never done it before.

The ripples of a cancer diagnosis extend to spouses, partners, siblings, children and friends. Many of these family members will find they now need to take on the role of caregiver — something they may never have done before.

Navigating Mental Health and Cancer

A cancer diagnosis can be life-changing and often impacts mental health. This is true for both patients and their loved ones. Feeling overwhelmed, anxious, or down is common, and it’s important to remember that needing support is nothing to be ashamed of. Reaching out for help, whether it’s counseling, support groups, or talking to a healthcare professional, can make a real difference in coping with cancer’s emotional and mental challenges.

Experiencing a cancer diagnosis is difficult and can impact your mental health. This is true whether you are the person diagnosed with cancer or a loved one. No one chooses to have a mental health challenge, but once you know that you or someone you love does, it is important to seek support.

Addressing Cancer Treatment Side Effects

Cancer treatment can be tough, and the side effects may add even more stress and uncertainty. These side effects affect not just the person with cancer, but also those who care for them. Knowing what to expect and when to ask for help can ease the burden. Healthcare teams can guide you through managing side effects, and there are resources and tips to help you or your loved one feel as comfortable as possible during treatment.

Receiving a cancer diagnosis and undergoing cancer treatment can be challenging for both you and your loved ones. Unwanted side effects can intensify the disruption in your life even further.