Endometrial cancer begins in the lining of the uterus and is the most common type of uterine cancer. At Saint John’s Cancer Institute, our multidisciplinary team provides personalized care based on the type and characteristics of the cancer, how far it has progressed, your overall health and the needs and priorities that matter to you.
What Is Endometrial Cancer?
Endometrial cancer and uterine cancer are related terms, but they do not mean exactly the same thing. Uterine cancer describes cancers that begin in the uterus, while endometrial cancer specifically begins in the endometrium, the tissue that lines the inside of the uterus.
Most uterine cancers are endometrial cancers. Less common uterine cancers can develop in the muscle or other supporting tissues of the uterus and are generally classified as uterine sarcomas. Distinguishing between these cancers is important because their behavior and treatment can differ. Learn more about Uterine Cancer.
Risk Factors and Causes of Endometrial Cancer
Endometrial cancer develops when cells in the lining of the uterus acquire changes that allow them to grow and divide abnormally. There is usually no single identifiable cause. Several factors, however, can increase the likelihood of developing endometrial cancer, particularly conditions that affect the body’s exposure to estrogen and certain inherited genetic changes.
Risk factors can include obesity, increasing age, never having been pregnant, beginning menstruation at an early age or reaching menopause later in life, certain forms of estrogen therapy, tamoxifen use, and health conditions associated with changes in hormone or metabolic function. Having one or more risk factors does not mean that you will develop endometrial cancer, and some people diagnosed with the disease have few or no known risk factors.
Inherited Risk and Lynch Syndrome
A small proportion of endometrial cancers are associated with inherited genetic conditions. Lynch syndrome, caused by inherited changes in genes involved in repairing DNA, increases the risk of endometrial cancer as well as colorectal and several other cancers. Your care team may recommend testing of the tumor and, when appropriate, genetic counseling or additional testing to determine whether an inherited cancer risk may be present.
Signs and Symptoms of Endometrial Cancer
Abnormal vaginal bleeding is the most common symptom of endometrial cancer and often leads to evaluation while the cancer is still at an earlier stage. Bleeding after menopause should always be evaluated. Before menopause, unusually heavy periods, bleeding between periods or other changes from your normal menstrual pattern should also be discussed with your healthcare provider.
Other possible symptoms can include unusual vaginal discharge, pelvic pain or pressure, and pain during sexual intercourse. These symptoms are not specific to endometrial cancer and can occur with many noncancerous conditions, but new, persistent or unexplained changes warrant medical evaluation.
When Should You Seek Evaluation?
Any vaginal bleeding after menopause should be evaluated by a healthcare professional. If you have not reached menopause, talk with your healthcare provider about bleeding that is unusually heavy, occurs between periods or represents a persistent change from what is normal for you.
Other changes may be easier to dismiss or attribute to another condition. Talk with your healthcare provider if you experience new, persistent or unexplained symptoms such as:
- Unusual vaginal discharge, especially when it is not related to your normal menstrual cycle
- Pelvic pain, pressure or discomfort that persists or is different from what is normal for you
- Pain during sexual intercourse
- Difficulty or pain with urination
These symptoms can have many causes and do not necessarily mean that cancer is present. What matters is recognizing a change from what is normal for you and having persistent or unusual symptoms evaluated. When endometrial cancer is present, abnormal bleeding and other symptoms can provide an opportunity for diagnosis before the disease has progressed further.
How Endometrial Cancer Is Diagnosed
Evaluation for possible endometrial cancer usually begins with a review of your symptoms and medical history and may include a pelvic examination and transvaginal ultrasound. If endometrial cancer is suspected, a sample of tissue from the lining of the uterus is examined by a pathologist to determine whether cancer is present.
If cancer is diagnosed, additional information about the tumor helps your care team understand its behavior and determine the appropriate treatment approach. This can include the type and grade of the cancer, how deeply it has grown into the uterus, whether it has spread, and results from molecular or biomarker testing when appropriate.
Endometrial Biopsy
An endometrial biopsy removes a small sample of tissue from the lining of the uterus so that it can be examined under a microscope. In some situations, additional tissue sampling or a procedure such as dilation and curettage (D&C) may be needed to obtain enough tissue for an accurate diagnosis.
Pathology and Molecular Testing
Pathology confirms the diagnosis and provides important information about the type and grade of endometrial cancer. Testing of the tumor may also identify molecular characteristics that can help refine prognosis, identify possible inherited cancer risk and, in some situations, influence treatment decisions.
Determining the Extent of Cancer
Once endometrial cancer has been diagnosed, your care team determines how far the cancer has progressed. Imaging and findings from surgery or other testing may be used to determine whether cancer is limited to the uterus or has reached nearby tissues, lymph nodes or more distant parts of the body. This information contributes to the stage of the cancer and helps guide treatment planning.
Stages of Endometrial Cancer
Endometrial cancer is classified from Stage I through Stage IV according to how far the disease has progressed. Modern staging considers where the cancer is located and can also incorporate characteristics such as tumor type, grade, lymphovascular involvement and, when available, molecular findings. Because staging has become increasingly detailed, your gynecologic oncologist can explain what your specific stage and tumor characteristics mean for treatment and prognosis.
Stage I
Stage I generally describes endometrial cancer that remains within the uterus. The extent of growth into the muscular wall of the uterus and other characteristics of the cancer help further define the stage and the risk associated with the tumor.
Stage II
Stage II includes cancers with certain features indicating greater local involvement or higher-risk characteristics while the disease remains regionally limited. Depending on the specific staging criteria, this can include involvement of the cervical tissue or other tumor characteristics that affect how the cancer is classified.
Stage III
Stage III generally means that cancer has spread beyond the uterus to nearby structures and/or regional lymph nodes. The exact stage depends on the areas involved, such as the ovaries or fallopian tubes, vagina, surrounding pelvic tissues or pelvic and para-aortic lymph nodes.
Stage IV
Stage IV describes endometrial cancer that has spread more extensively, including certain cancers involving the bladder or bowel lining, the abdominal cavity beyond the pelvis, or distant parts of the body such as the lungs, liver, brain or bones.
Your stage is only one part of understanding endometrial cancer. The type and grade of the tumor and its molecular characteristics can also provide important information about how the cancer may behave and which treatments may be appropriate.
Treatment for Endometrial Cancer
Treatment for endometrial cancer depends on the stage, type and other characteristics of the cancer, as well as your overall health and individual priorities. Surgery is an important treatment for many patients, while radiation therapy, chemotherapy, hormone therapy, immunotherapy or targeted therapy may also be recommended depending on the clinical situation.
Because endometrial cancer is the most common type of uterine cancer, our uterine cancer treatment information includes the treatment approaches used for endometrial cancer as well as important differences that may apply to other uterine cancers.
Questions to Discuss With Your Care Team
Understanding an endometrial cancer diagnosis can involve more than knowing the stage alone. The type and characteristics of the cancer, whether it has spread, the treatments being considered and your own health and priorities can all influence decisions about care. Your gynecologic oncologist can help explain how these factors apply specifically to you.
What type, grade and molecular characteristics does my cancer have?
The type and grade of endometrial cancer provide information about the tumor and how it may behave. Molecular testing can provide additional information that may help refine prognosis, identify possible inherited cancer risk and, in some situations, influence treatment decisions. Your oncologist can explain which findings are important in your particular diagnosis.
Has my cancer spread outside the uterus?
Determining whether cancer is confined to the uterus or has reached nearby tissues, lymph nodes or more distant parts of the body is an important part of staging and treatment planning. Your oncologist can explain what examinations, imaging, surgical findings or other tests show about the extent of your cancer and what that means for your care.
What treatment options are appropriate for me?
Endometrial cancer can be treated with surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, targeted therapy or a combination of approaches, depending on the clinical situation. Rather than every treatment being appropriate for every patient, your care team will consider the stage and characteristics of your cancer, your overall health, previous treatment and your individual priorities when recommending an approach.
What side effects should I expect from treatment?
Side effects vary considerably according to the treatment you receive. Before treatment begins, ask your care team about both short- and long-term effects, which symptoms should prompt a call to the office, and what medications, supportive care or other strategies are available to help manage side effects.
How could treatment affect my daily life and long-term health?
Treatment can affect people differently and may have implications for recovery, work and daily activities, sexual health, fertility, menopause and other aspects of long-term well-being. Discussing these concerns before treatment can help your care team understand what matters to you and identify services or strategies that may support you during treatment and recovery.
Moving Forward After an Endometrial Cancer Diagnosis
An endometrial cancer diagnosis can involve a series of decisions, but you do not need to understand every aspect of staging, pathology or treatment before meeting with your care team. Knowing the basic characteristics of your cancer and bringing questions about your treatment options, priorities and concerns can help you participate in those conversations and understand the next steps of your care.
As your evaluation and treatment progress, recommendations may change as additional information becomes available. Your gynecologic oncologist and other members of your care team can explain what new findings mean and help you understand the next steps in your care.
If you have questions regarding Endometrial or uterine cancer or would like an expert second opinion, please call today or click here to schedule an appointment.
