Endometrial cancer, one of the most common gynecologic cancers, starts in the lining of the uterus. When found early, endometrial cancer can usually be cured. Most endometrial cancer occurs after menopause, so regular pelvic exams and Pap tests should not be discontinued after periods stop. Should endometrial cancer be diagnosed, the multidisciplinary Gynecologic Oncology team at Beaumont offers surgery, including minimally invasive laparoscopic procedures, radiation and hormone therapy, as individually appropriate. Women can also rely on the support of our compassionate and highly skilled staff to meet emotional and medical needs.
For more information about Beaumont's gynecology oncology program, or a referral to an oncologist near you, call our Physician Referral Service at 800-633-7377 .
What is endometrial cancer?
The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium. Endometrioid cancer is a specific type of endometrial cancer.
Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus. About 95 percent of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early. According to the American Cancer Society (ACS), about 54,870 cases of cancer of the uterine body will be diagnosed in the US during 2015.
What are risk factors for endometrial cancer?
The following have been suggested as risk factors for endometrial cancer:
- early menarche - starting monthly periods early - before the age of 12
- late menopause (after the age of 52)
- infertility (inability to become pregnant)
- never having children
- being treated with tamoxifen for breast cancer
- estrogen replacement therapy (ERT) for treatment of effects of menopause
- diet high in animal fat
- age 40 or over
- Caucasian women
- family history of endometrial cancer or colon cancer (hereditary nonpolyposis colon cancer (HNPCC)
- personal history of breast cancer
- personal history of ovarian cancer
- prior radiation therapy for pelvic cancer
What are the symptoms of endometrial cancer?
The following are the most common symptoms of endometrial cancer. However, each individual may experience symptoms differently. Symptoms may include:
- bleeding or discharge not related to your periods (menstruation)
- post-menopausal bleeding
- difficult or painful urination
- pain during intercourse
- pain and/or mass in the pelvic area
- weight loss
Cancer of the endometrium often does not occur before menopause. It usually occurs around the time menopause begins. The occasional reappearance of bleeding should not be considered simply part of menopause.
The symptoms of endometrial cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
How can endometrial cancer be prevented?
The exact cause of endometrial cancer is not known. However, physicians believe that avoiding the known risk factors, when possible, using oral contraceptives, controlling obesity, and controlling diabetes are the best ways to lower the risk of developing endometrial cancer.
How is endometrial cancer diagnosed?
Diagnosis includes a medical history and physical examination, including a pelvic examination to feel the vagina, rectum, and lower abdomen for masses or growths. A Pap test may be requested as part of the pelvic examination. The diagnosis of cancer is confirmed only by a biopsy. Several tests may be used to diagnose endometrial cancer, including:
- internal pelvic examination - to feel for any lumps or changes in the shape of the uterus
- Pap test (Also called Pap smear.) - a test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. However, because cancer of the endometrium begins inside the uterus, problems may not be detected using a Pap test. Therefore, in some cases, an endometrial biopsy will be performed.
- endometrial biopsy - a procedure in which an endometrial tissue sample is obtained by using a small flexible tube that is inserted into the uterus. The tissue sample is examined under a microscope to determine if cancer or other abnormal cells are present. An endometrial biopsy procedure is often performed in a physician's office.
- dilation and curettage (Also called D & C) - a minor operation in which the cervix is dilated (expanded) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
- transvaginal ultrasound (Also called ultrasonography.) - an ultrasound test using a small instrument, called a transducer, that is placed in the vagina. The physician may perform a biopsy if the endometrium looks too thick.
Treatment for endometrial cancer
Specific treatment for endometrial cancer will be determined by your physician based on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
The choice of treatment depends on the stage of cancer - whether it is confined in the endometrium, or has spread to other parts of the uterus or other parts of the body. Generally, treatment for patients with cancer of the endometrium includes one or more of the following:
- hysterectomy - surgical removal of the uterus.
- salpingo-oophorectomy - surgery to remove the fallopian tubes and ovaries.
- pelvic lymph node dissection - removal of some lymph nodes from the pelvis.
- laparoscopic lymph node sampling - lymph nodes are removed through a viewing tube called a laparoscope, which is inserted through a small incision in the abdomen.
Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
- external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
- internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. Tiny tubes that contain substances that produce radiation, called radioisotopes, are inserted through the vagina and left in place for a few days. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Hospitalization is required when an internal radiation implant is in place. In some cases, both internal and external radiation therapies are used.
- hormone therapy In some cases, hormones can kill cancer cells, slow the growth of cancer cells, or stop cancer cells from growing. Hormone therapy as a cancer treatment involves taking substances to interfere with the activity of hormones or to stop the production of hormones.
Before you begin hormone therapy, your physician may recommend a hormone receptor test. This lab test is performed on the uterine tissue to determine if estrogen and progesterone receptors are present. A hormone receptor test can help to predict whether cancer cells are sensitive to hormones.
This test measures the amount of certain proteins (called hormone receptors) in cancer tissue. Hormones (such as estrogen and progesterone that occur naturally in the body) can attach to these proteins. If the test is positive, it is indicating that the hormone is probably helping the cancer cells to grow. In this case, hormone therapy may be given to help keep the hormone away from the cancer cells. If the test is negative, the hormone does not affect the growth of the cancer cells and other effective cancer treatments may be given. Always discuss the results of the hormone receptor test with your physician.
Progesterone (pill) may be given as hormone therapy for endometrial cancer. Tamoxifen may also be used to treat advanced endometrial cancer.