Easy Guide To: Cancer of the Uterus/Womb

Uterus Cancer


Endometrial Cancer


What is Endometrial Cancer?
How Is It Staged?
What Causes Endometrial Cancer?
What Are The Symptoms?
How Is It Diagnosed?
What Are The Treatment Options?
Can I Be Screened For It?


Cancer Guide
Breast Cancer
Cervical Cancer
Fallopian Tube
Ovarian Cancer
Vaginal Cancer
Vulva Cancer

Topics In This Section:

Hyperplasia (Pre-Cancer)
Survival Rates
Cancer remission

Related Articles:

Female Reproductive System

Endometrial cancer is also called uterine cancer or cancer of the womb.

What Is Endometrial Cancer?

Endometrial cancer (image) is where cancer cells start to grow in the lining of the uterus (womb). The tissue which lines the womb is called the endometrium, and hence the name. The womb lies between the bladder and the rectum and is shaped like an upside down pear (image). During pregnancy it houses the growing fetus and expands as the baby grows. Endometrial cancer is the most common type of gynecologic cancer in America. It accounts for about 6 percent of all new female cancers and affects 39,000 American women a year. Occurrences of the disease are just as common in Europe. Fortunately few women die from endometrial cancer, mainly because it is often diagnosed early when it is at its most curable stage. In fact most women with the disease, who have good access to medical care, can look forward to a complete cure. Sometimes an endometrial cancer lump is mistaken for another type of growth which occurs in the uterus called uterine fibroids - however these are benign tumors which do not become cancerous, although they have their own set of issues.

How Is It Staged?

Endometrial cancer staging: The tumor begins in the lining of the womb (endometrium) and is mostly detected at this stage because it produces symptoms. If undetected or untreated it may persist and go on to invade the uterus wall (stages IB and IC) or even further and invade the wall of the cervix (stage 2). Stage 3 is where it invades the organs and structures surrounding the uterus (image) and eventually more distant organs like the liver, bowel and bladder (stage 4). When it comes to endometrial cancer survival rates: about 85 percent of women at stage 1 can expect to survive after year 5 of therapy. This reduces to 60 percent at stage 2, 30 percent at stage 3 and 10 percent at stage 4.

What Causes Endometrial Cancer?

The causes of endometrial cancer - in fact the causes of cancer generally - are still largely unknown. There are however certain risk factors which make people more likely to develop cancer in the uterus. Hormone levels for example seem to play a part in endometrial cancers. In the normal course of life a woman will produce both estrogen and progesterone. The risk of developing the disease rises in a woman who has had prolonged exposure to excessive levels of the estrogen hormone relative to the progesterone hormone. Factors which can cause this shift include:

Estrogen Therapy
Menopausal women who took estrogen replacement therapy (ERT), without progesterone are at a higher risk. For this reason, since the 1980s most doctors prescribe hormone replacement therapy (HRT) which includes both estrogen and progesterone, or supplement ERT with progesterone.

Total Number of Periods (Menstrual Cycles)
Having more periods during a woman's lifetime raises her risk of endometrial cancer. So women who had their first period (menarche) early or experienced menopause later than the average age, or never bore children, are at most risk. On the other side, most cases which occur in younger women occur in those who have had fewer periods - irregular periods (oligomenorrhea) or missed periods (amenorrhea). This is because persistent failure to ovulate, common to these conditions, can over stimulate the endometrium with estrogen without any counter-balancing progesterone (which is normally produced after ovulation).

Women who are obese produce more estrogen than those of average weight. Even a woman who is 30 pounds over her ideal weight is at risk.

Women with PCOS syndrome have irregular hormone balances such as higher levels of estrogen and lower levels of progesterone.

Endometrial cancer is very uncommon in women under the age of 40. Most cases are found in postmenopause women over the age of 50. In fact nearly 50 percent of cases are found in the 50 to 69 age group.

Previous Cancers
Another high risk group is women who have previously had breast cancer or ovarian cancer. Women who are taking the drug tamoxifen to reduce the risk of breast cancer recurrence are also at increased risk.

A small amount of endometrial cancers are genetic. It seems to run in some families who are prone to colon cancer. This is called HNPCC (hereditary nonpolyposis colon cancer), also known as Lynch syndrome. Genetic testing is usually recommended in such instances. This can be arranged by talking to a genetic counselor.

Endometrial Hyperplasia
Endometrial hyperplasia is an abnormal increase in endometrial and stromal cells that can affect all women, including teenagers. Some experts believe it is a pre-cancerous condition (similar to CIN and cervical cancer). This condition can revert to normal on its own or after treatment. It the hyperplasia is called 'atypical' it is more likely to become cancerous.

What Are The Symptoms?

Symptoms of endometrial cancer: Endometrial cancer is unique among women’s cancers in that it produces symptoms very early. The most common sign is vaginal bleeding or spotting - which is more likely to be noticed in a woman after menopause when periods have stopped. Although this can be frightening, it does prompt women to seek immediate attention. For younger women, any abnormal vaginal bleeding between periods or unusually heavy menstrual bleeds should be checked. Some women with this form of cancer may notice a watery vaginal discharge. Only in more advanced stages of the disease is pain or any discomfort usually noted. If a tumor has narrowed the neck of the cervix then blood and pus can gather causing pain. It is important to remember that vaginal bleeding is not always cancer, it can also be a sign of inflammatory bowel disease, urinary tract infections, hemorrhoids or vaginitis.

How Is It Diagnosed?

A diagnosis of endometrial cancer occurs in the same way as other gynecologic cancers (see generally how cancer is diagnosed). A physical examination and complete medical history will be taken by a doctor or nurse. A Pap test will also be taken. Although a Pap test is very useful in cervical cancer diagnosis it is not as valuable with endometrial cancer, although it is still usually performed. If cancer is suspected an endometrial biopsy is performed to examine the cells of the uterus. This can be carried out in the doctor's office. Some women who continue to bleed, despite a negative biopsy result may require a D&C (dilation and curettage). If cancerous cells are detected the woman will be referred to a gynecological oncologist who specializes in cancers of the reproductive organs. The oncologist will want to stage the cancer, in other words, work out how advanced it is. Another physical examination will be necessary, and possibly also a transvaginal ultrasound or X-ray (CT, MRI or PET scan) of the lungs or other organs to check for metastasis (cancer spreading). The woman is then usually hospitalized for exploratory surgery.

What Are The Treatment Options?

Treatment of endometrial cancer: Once the oncologist has determined the stage of cancer, treatment will be next. Early stages of the cancer are usually cured by a total hysterectomy as well as the removal of the fallopian tubes and both ovaries. If the disease is more advanced surgery is combined with radiation therapy. If cancer has spread beyond the uterus, hormonal therapy may be added to the treatment plan.

Can I Be Screened For It?

Endometrial cancer prevention: Currently there is no acceptable screening process for uterus cancer. The risks associated with endometrial biopsy and D&C, which include infection, do not justify their use as a national screening measure. While pap tests can sometimes identify endometrial cancer cells, in 4 out of 5 cases cancerous cells can appear normal. It may be possible to reduce your risk factors for developing the disease by avoiding obesity and maintaining a healthy body weight (BMI). In premenopausal women, taking oral contraceptives can also lower the risk. Women who have had a hysterectomy and are taking estrogen supplements should ensure that they are also taking progesterone. Finally, any abnormal vaginal bleeding should always be checked by a doctor.

To read about the risks of cancer coming back, see our article on Endometrial cancer recurrence. For general questions on this or any other topic, see womens health questions.

  Other Useful Guides

Health Screenings Recommended For Women: List for all ages.
The Female Body Explained: How it works, visual guide with diagrams.
Reproductive System Problems: Symptom checker for vagina/vulva problems.

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