Uterine/endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb). It is the most common type of uterine cancer, and although the exact cause of endometrial 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.
Most cases of uterine cancer occur between the ages of 60 and 70 years, but a few cases may occur in women younger than 40 years of age.
Stages of uterine cancer, from least to most aggressive, are:
- The cancer is only in the uterus.
- The cancer is in the uterus and cervix.
- The 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).
- The cancer has spread to the inner surface of the bowel, bladder, abdomen or other organs.
Doctors describe cancer cells as Grades I, II or III. Grade I is the least aggressive, and Grade III is the most aggressive.
- 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
Risks and Prevention
- 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
- 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
When all cases of uterine cancer are considered, the five-year survival rate is 96 percent. Survival rates are even higher when the disease is discovered and treated in its earliest stage. 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.
- It is recommended 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.
The treatment for uterine cancer depends on the patient and the stage of the disease. A personalized treatment plan will be developed by your specialist. At MedStar Health, treatment may include surgery, chemotherapy, and/or radiation.
In order to manage uterine cancers, doctors often recommend a total hysterectomy (complete removal of uterus and cervix) with lymph node dissection. Your doctor will probably recommend removal of the fallopian tubes and ovaries (called a bilateral salpingo-oophorectomy). This procedure can be performed either through an open abdominal incision, or via minimally invasive techniques such as laparoscopy or robotic assisted procedures. The advantage of robotic and other minimally invasive procedures is that they allow you to treat the cancer with minimal blood loss, less pain, shorter hospital stay, and faster return to work and other normal activities.
Following surgery, additional treatment with radiation and/or chemotherapy may be suggested. 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.
Radiation alone is the best treatment for certain types of cancer and some benign (non-cancerous) diseases. Other types of cancer may require radiation therapy to be delivered along with other therapeutic agents such as chemotherapy or hormone therapy. Radiation therapy can be used to shrink tumors prior to surgical removal, or after surgery to destroy tumor cells that may exist microscopically in the surgical area. Radiation therapy may be used to cure disease, control disease, or control the symptoms of disease (such as pain). Learn more about radiation.