Uterine Cancer & Endometrial Cancer

What are common uterine cancer symptoms?

Symptoms will vary by woman, but the most frequent signs of uterine and endometrial cancers include:

• Abnormal uterine bleeding and/or abnormal menstrual periods
• Bleeding between normal periods, before menopause
• Vaginal bleeding or spotting after menopause
• Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
• Lower abdominal pain or pelvic cramping
• Thin white or clear vaginal discharge after menopause

While these symptoms may be caused by other conditions, it's important to seek care from your doctor early.

What causes uterine (endometrial) cancer?

Although the exact cause of this type of cancer is unknown, increased levels of estrogen (a hormone that helps stimulate the buildup of the lining of the uterus) appear to play a role. In addition, most uterine cancer diagnoses occur in women between the ages of 60 and 70 years. However, a few cases may occur in women younger than 40 years of age. Other risk factors that may increase your chance of this disease include:

• Diabetes
• Estrogen replacement therapy without the use of progesterone
• History of endometrial polyps or other benign growths of the uterine lining
• Infertility (inability to become pregnant)
• Tamoxifen, a drug for breast cancer treatment
• Never being pregnant
• Obesity
• Starting menstruation at an early age (before age 12)
• Starting menopause after age 50
• Personal or family history of colon, ovarian, or breast cancer
• Hypertension (high blood pressure)
• Polycystic ovarian disease

How can I detect uterine (endometrial) cancer early?

A yearly pelvic examination and Pap smear are the first line of defense against uterine cancer. They allow a physician to detect and monitor any changes in the endometrial lining. Here's what you should know.

• Screening guidelines recommend that women have regular pelvic exams beginning at the onset of sexual activity (or at the age of 21 if not sexually active) to help detect signs of infection or abnormal development.
• Women with any risk factors for endometrial cancer should be followed more closely by their doctors. Frequent pelvic examinations and screening tests should be considered.
• Women taking estrogen replacement therapy should have regular pelvic examinations and Pap smears.

How is this cancer diagnosed?

If your doctor suspects cancer in the endometrium, your first appointment will involve a thorough evaluation, including a pelvic exam. In addition, your gynecologic oncologist may recommend one or more tests or procedures to learn more about your condition, such as:

• Ultrasound: This imaging test uses sound waves to produce images of the uterus, ovaries, and fallopian tubes. There are different types of ultrasounds, including a pelvic ultrasound which involves using a small wand (transducer) over the abdomen. In other instances, your doctor may recommend a transvaginal ultrasound (TVUS), during which the transducer is placed into the vagina to get a better look at the uterus.
• Endometrial biopsy: Typically an in-office procedure, this involves removing a small sample of tissue from the endometrium for further evaluation under a microscope.
• Hysteroscopy: Using a thin, lighted tube attached to a tiny video camera (hysteroscope), your doctor may examine the uterus and possibly remove small pieces of tissue for additional study.
• Dilation and curettage (D&C): This outpatient procedure involves gently scraping tissue from the uterus using a special instrument.
• Genetic tests: Because some of these cancers are linked to hereditary syndromes, some patients may elect to undergo genetic counseling and testing.
• Additional imaging tests: Computed tomography (CT), MRI, or PET scans may be used to determine the stage of disease, or how far it has spread throughout the body.

What is the most common type of uterine (endometrial) cancer?

Endometrial cancer is the most frequently diagnosed cancer that begins in the uterus. There are various subtypes of endometrial cancer based on the cell type where they develop. Endometrial adenocarcinoma is the most common subtype. A pathologist will review findings to accurately diagnose the type of cancer you have.

Soft tissue sarcoma can also form in the muscular wall of the uterus, although this is quite rare. Uterine sarcoma is not an endometrial cancer and is treated differently than what is described on this page. Learn more about soft tissue sarcomas.

What are uterine (endometrial) cancer stages?

Cancers are staged from least to most aggressive and include:

• Stage I: Cancer is only in the uterus.
• Stage II: Cancer is in the uterus and cervix.
• Stage III: Cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
• Stage IV: Cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

What are common uterine cancer treatments?

If you receive a uterine or endometrial cancer diagnosis, you can expect to be treated by a team of doctors who will collaborate to determine your best treatment options. Treatment will vary based on several factors, including:

• Your uterine cancer diagnosis (Cancer type and stage)
• Your overall health
• Your goals and preferences

You can expect a personalized treatment plan that involves the latest methods available.

Endometrial cancer treatment sometimes involves a total hysterectomy (complete removal of uterus and cervix) with lymph node dissection, depending on the stage of your cancer. Your doctor may also recommend removal of the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy). These procedures may be performed either through an open abdominal incision or via minimally invasive techniques, such as laparoscopic or robotic-assisted approaches. The advantage of robotic and other minimally invasive procedures is that they allow you to receive cancer treatment with minimal blood loss, less pain, a shorter hospital stay, and a faster return to work and other normal activities. Your gynecologic oncologist will help you understand your options and what will be most effective in treating your cancer.

Following surgery, some women benefit from additional treatment with radiation and/or chemotherapy. The decision will be based on findings from the tissue removed at surgery, which may show that the cancer is likely to recur or has already spread beyond the uterus.

Chemotherapy and hormone therapy

Depending on the stage of your cancer, you may also benefit from chemotherapy. This type of cancer treatment uses powerful medications to kill cancer cells that may remain after surgery or when cancer has spread.

For some advanced or recurrent uterine cancers, a medical oncologist may recommend hormone therapy, which uses hormones or hormone-blocking drugs to slow cancer growth. This treatment is different from hormonal therapy that may be given to ease menopause symptoms.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Targeted therapy and immunotherapy are new classes of drugs emerging as effective treatment options for many other types of cancer. We continue investigating their role in treating uterine and endometrial cancer.

Learn More About Immunotherapy

Learn More About Targeted Therapy