If you have endometrial cancer, talk to your doctor. In most cases, this type of cancer is very treatable

What Is Cancer?

Normally, healthy cells that make up the body's tissues grow, divide, and replace themselves on a regular basis. This keeps the body healthy. Sometimes certain cells develop abnormally and begin to grow out of control. When this occurs, growths or tumors begin to form. Tumors can be benign (not cancer) or malignant (cancer).

Malignant tumors can invade and destroy nearby healthy tissues and organs. Cancer cells also can spread (or metastasize) to other parts of the body and form new tumors.

One type of cancer of the uterus is called endometrial cancer (adenocarcinoma). This can occur when the lining of the uterus becomes too thick. Sarcomas are another type of uterine cancer. They form from muscle and other tissue. Although rare, this type of uterine cancer is more aggressive than adenocarcinoma and has different symptoms. Because endometrial cancer is more common and its symptoms differ from those of sarcoma, this pamphlet will focus on endometrial cancer.

It is important for your doctor to find out as early as possible if a tumor is benign or malignant. As soon as a malignant tumor is found, your doctor can begin treatment. Cancer is much easier to treat before it has spread to other parts of the body.

Who Is at Risk for Endometrial Cancer?

Endometrial cancer is the most common gynecologic cancer in the United States. About 2 or 3 women out of every 100 women will develop endometrial cancer during their lifetime.

Endometrial cancer is rare in women younger than 40 years. It most often occurs in women between the ages of 60 years and 75 years. Some women are at higher risk than others (see box). Some risk factors may be related to the use of estrogen. Estrogen is a hormone produced in a woman's ovaries. It also can be taken after menopause, when a woman's ovaries stop producing estrogen. When taken with another hormone, progesterone, it protects against endometrial cancer. Taken alone, however, estrogen increases the risk of endometrial cancer.

Symptoms

The key to finding endometrial cancer early is being alert to its symptoms. Abnormal bleeding, spotting, new discharge from your vagina, or bleeding or spotting after menopause all are symptoms of endometrial cancer. These symptoms may be consistent or come and go. The cause of any abnormal bleeding or discharge, especially after menopause, should be checked by your doctor.

Diagnosis

There are no screening tests to detect endometrial cancer in women with no symptoms. But most women who have endometrial cancer have early symptoms. Methods that may be used to detect whether endometrial cancer is present include:

• Endometrial biopsy: A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope. This will likely be the first step in checking for abnormal cells.
• Vaginal ultrasound: A test in which sound waves are used to check the thickness of the lining of the uterus.
• Hysteroscopy: A surgical procedure in which a slender, light-transmitting device is used to view the inside of the uterus or perform surgery.
• Dilation and curettage (D&C): A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

Treatment

The type of treatment you receive depends on your health and your condition. Talk to your doctor about what option is best for you.

Surgery

If endometrial cancer is found, surgery usually is done to treat the disease and decide further treatment. During surgery, the stage of disease is determined. Staging helps your doctor decide what treatment has the best chance for success. Stages of cancer range from I to IV. Stage IV is the most advanced. The stage of cancer can affect the treatment and outcome.

Most patients have both hysterectomy and salpingo-oophorectomy. This can be done through the vagina or through the abdomen. It also can be done with laparoscopy. Even though the cancer is in the uterus, the ovaries may be removed because these women have an increased risk of ovarian cancer. Tissue from lymph nodes in the pelvic region may be tested to find out if the cancer has spread.

Radiation

Risk Factors Women are at increased risk of uterine cancer if they: Are obese Do not ovulate regularly and often miss periods Have never given birth Have late menopause (the time when menstrual periods end, which is most often around age 50 years) Have polycystic ovary syndrome Have endometrial hyperplasia Have had cancer of the ovary, breast, or colon Have taken tamoxifen to treat breast cancer Have a close family member who has or has had endometrial cancer Have diabetes Have taken estrogen without progesterone

Radiation therapy may be done after surgery based on the stage of the disease. Although rare, some women are treated with radiation alone. Radiation stops cancer cells from growing by exposing them to high-energy rays. The treatment usually lasts several weeks and can require daily visits to a special center.

Other Treatments

Other forms of treatment include chemotherapy or hormone therapy. Some women may be treated with progestin, a synthetic version of the hormone progesterone. This form of treatment may be tried when:

• Surgery is not an option
• Tests show that the cancer has spread or come back after surgery or radiation
• A younger patient wants to have a baby in the future

Women should see their doctors every 3–4 months for 2–3 years to make sure the treatment is working. After that, they should see their doctors twice a year. With stage I disease, 85–90% of women will have no sign of cancer 5 or more years after treatment. The chance of a cure decreases with a more advanced disease (higher stage).

Finally...

If you have endometrial cancer, talk to your doctor. In most cases, this type of cancer is very treatable. Your doctor and the other people involved in your care may be able to help you get well and keep you healthy.

Glossary

Adenocarcinoma: Cancer that arises in glandular tissue, such as the uterus.

Estrogen: A female hormone produced in the ovaries.

Hyperplasia: A condition in which the lining of the uterus grows too much; if left untreated for a long time, it may lead to cancer.

Hysterectomy: Removal of the uterus.

Laparoscopy: A surgical procedure in which a slender, light-transmitting device, the laparoscope, is used to view the pelvic organs or perform surgery.

Lymph Nodes: Small glands that filter the flow of lymph (a nearly colorless fluid that bathes the cells) through the body.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Polycystic Ovary Syndrome: A condition in which increased androgen levels occur and eggs are not released from the ovaries.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Salpingo-oophorectomy: Removal of the ovary and fallopian tube.

Stage: The size of a tumor and the extent (if any) to which the disease has spread.

Tumors: Growths or lumps made up of cells.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © November 2006 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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