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:

• tamoxifen treatment for breast cancer
• 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
• smoking
• using birth control pills after menopause
• gallbladder disease
• thyroid disease
• family history of colon 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
• bleeding after menopause

In most cases of endometrial cancer, abnormal bleeding is the first symptom. Up to 10% of women who have bleeding from their vagina after menopause may have endometrial cancer. 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 healthcare provider.

How is it diagnosed?

Because endometrial cancer begins inside the uterus rather than in the opening of the uterus (cervix), it is not usually found with a Pap test. Instead, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. One of the following procedures may be used to get a sample of tissue:

• Endometrial 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.
• D&C (dilation and curettage): 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. The tissue scrapings are checked for cancer cells.

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?

The treatment depends on the type of cancer cells and if the cancer has spread. If the cancer is diagnosed early, the uterus is usually removed (hysterectomy). The ovaries, fallopian tubes (tubes from the ovaries to the uterus), part of the vagina, and some lymph nodes usually are removed.

Other treatments are:

• chemotherapy (anticancer drugs to stop the growth of cancer cells)
• radiation therapy (high-energy X-rays or other types of radiation to kill cancer cells)
• hormone therapy (treatment that removes hormones or blocks their action and stops cancer cells from growing)

Any of these treatments may be used alone or in combination.

If your uterus is removed, you will no longer be able to get pregnant. If the cancer is at a very early stage and you want to still be able to have children, it may be possible to treat the cancer with the hormone progesterone instead of with removal of the uterus.

How long will the effects last?

With early treatment, there is a good chance of cure. 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 healthcare 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.
• If you have diabetes, keep it under good control.

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.