Endometrial Cancer

The key difference between the two main types of endometrial cancer is where in the uterus they start. Uterine sarcomas begin either in the muscle layer or supportive connective tissue. Endometrial carcinomas begin in the cells of the endometrium. 

Endometrial carcinomas

Most endometrial cancers are endometrial carcinomas. The different types of endometrial carcinomas include:

• Adenocarcinomas
• Carcinosarcomas
• Squamous cell carcinomas
• Undifferentiated carcinomas
• Small cell carcinomas
• Transitional carcinomas

The most commonly diagnosed of these endometrial carcinomas are adenocarcinomas. And the most common type of adenocarcinoma is endometrioid cancer. Endometrioid cancer breaks down further into the follow subtypes:

• Adenocarcinomas
• Adenoacanthomas
• Adenosquamous
• Secretory carcinomas
• Ciliated carcinomas
• Villoglandular adenocarcinomas

What causes endometrial cancer is unknown, but a hormonal imbalance is one of the main risk factors. When the hormones estrogen and/or progesterone are out of balance in a woman’s body, the lining of the endometrium may thicken. This abnormal growth can signal the start of cancer.

It’s important to note that many women with endometrial cancer risk factors never develop the disease. And some women with endometrial cancer do not have any known risk factors.

The most common endometrial cancer risk factors include:

Age

Women age 55 and older have an increased risk.

Early menstruation and/or late menopause

Women who have more menstrual cycles during their lifetime than average have a greater risk.

Infertility or no births

The risk is higher among women who have never given birth.

Obesity

Excess weight is a risk factor because fat tissue can change some hormones into estrogen.

Diabetes

Diabetes can raise the risk of developing endometrial cancer.

Estrogen treatment

Using estrogen-only hormone therapy after menopause may raise a woman’s risk of endometrial cancer. Adding progesterone lowers the risk, but may increase the risk of breast cancer and blood clots.

Endometrial hyperplasia

Women who have been diagnosed with this condition, which is an increased growth of the endometrium, may have a greater risk if the growth is not treated.

Past breast or ovarian cancer

A personal history of breast or ovarian cancer may raise a woman’s risk for endometrial cancer.

Family history

A genetic disorder called hereditary nonpolyposis colon cancer (HNPCC) can run in a family and raise the risk of endometrial cancer as well as colon cancer. According to the American Cancer Society, women with HNPCC have a 40% to 60% risk of developing endometrial cancer.

If you’re concerned about your risk for endometrial cancer, talk with your doctor.

There are no endometrial cancer screening exams for women with average risk and no symptoms. If you have risk factors, talk with your doctor about other procedures — such as an endometrial biopsy — to help identify endometrial cancer at its earliest stages.

Endometrial cancer cannot be prevented without removing the uterus, but you can take steps to help reduce your risk.

• Maintain a healthy weight
• Be physically active
• Discuss hormone therapy with your doctor
• Seek treatment for endometrial hyperplasia
• If you have HNPCC, talk with your doctor

If you use contraception, ask your doctor about using birth control pills. According to the American Cancer Society, birth control pills (also called oral contraceptives) lower the risk of endometrial cancer, especially in women who use the pill for a long time. This protection continues for at least 10 years after a woman stops taking birth control pills. But oral contraceptives can raise the risk of other health problems, so talk with your doctor about the benefits and risks.

Endometrial cancer symptoms may include:

• Unexplained vaginal bleeding, such as bleeding between periods, or non-blood discharge
• Pelvic pain
• Feeling of a mass in the pelvic area
• Unintended weight loss

Having any of these symptoms does not mean you have endometrial cancer. Vaginal infections and hormonal changes can cause similar symptoms. But it’s important to let your doctor know if you do have symptoms, so that you can find the cause and any potential problems.

Scripps cancer specialists diagnose and stage endometrial cancer using advanced imaging and diagnostic techniques. Staging helps determine the best course of treatment.

In addition to a physical exam and family medical history, tests to detect and diagnose endometrial cancer may include:

Transvaginal ultrasound

Transvaginal ultrasound uses a probe inserted into the vagina to bounce sound waves off the wall of the uterus, creating images that may show abnormal changes in the lining.

Biopsy

Biopsy involves removing and examining a tissue sample from the endometrial lining. Usually, this can be performed through the vagina.

Hysteroscopy

Hysteroscopy is the insertion of a small telescope through the cervix for a physician to view the uterus.

Cystoscopy or proctoscopy

Cystoscopy or proctoscopy is the insertion of slender tubes with lights and/or lenses that allow doctors to see if endometrial cancer has spread to nearby organs.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Magnetic resonance imaging (MRI)

MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.

Blood tests

Blood tests may check for high levels of CA-125 commonly associated with the spread of a uterine cancer.

The wall of the uterus has two layers. The endometrium is the inner lining. The other layer is the myometrium, or the muscle layer. Endometrial cancer stages indicate how far the cancer may have grown into the wall and beyond to other parts of the body. This helps doctors determine the best course of treatment.

Stage I

Stage I endometrial cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread.

• Stage IA is when cancer is in the endometrium only, or less than halfway through the myometrium or in the glands of the cervix (the entrance to the uterus).
• Stage IB is when cancer has spread halfway or more into the myometrium.

Stage II

Stage II endometrial cancer has spread into the connective tissue of the cervix but not outside the uterus.

Stage III

Stage III endometrial cancer is divided into stages IIIA, IIIB and IIIC, based on how far the cancer has spread.

• Stage IIIA is when cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries and ligaments of the uterus.
• Stage IIIB is when cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus).
• Stage IIIC is when cancer has spread to lymph nodes in the pelvis and/or around the aorta (the large artery that carries blood away from the heart).

Stage IV

Stage IV endometrial cancer is divided into stages IVA and IVB, based on how far the cancer has spread. 

• Stage IVA is when cancer has spread to the bladder and/or bowel wall.
• Stage IVB is when cancer has spread to parts of the body outside the pelvis, such as the abdomen and/or lymph nodes in the groin.

Tumor grades

In addition to staging, doctors may group endometrial cancer by grade. This helps determine the risk of the cancer spreading, as well as treatment.

• Grades 1 and 2 tumors are usually considered low risk and generally do not spread to other parts of the body.
• Grade 3 tumors are considered high risk and often spread to other parts of the body.

No one wants to hear that they have endometrial cancer. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your endometrial cancer diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of endometrial cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones through Scripps.

A multidisciplinary team of Scripps gynecologic oncologists, surgeons, pathologists, oncology nurses and clinicians will work with you to provide the most appropriate and personalized treatment for your individual case. 

In most cases, you’ll be partnered with a nurse navigator who is specially trained and experienced in the treatment of female reproductive cancer. Your nurse navigator will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.

The most appropriate endometrial cancer treatment options depend on several factors, including the stage and grade of the cancer, as well as the patient's overall health.

Endometrial cancer surgery

Surgery is the most common treatment for endometrial cancer. Our surgeons frequently perform gynecologic surgeries that once required large incisions and extensive recovery time, now through minimally invasive techniques. These new techniques use small incisions, potentially resulting in a faster recovery, less blood loss, reduced pain and scarring, and a shorter hospital stay.

• Hysterectomy is removal of the uterus. Whenever possible, Scripps surgeons perform the hysterectomy using single-site robotic surgery, which requires just one small incision. If this is not appropriate, our surgeons can perform the hysterectomy through an abdominal incision, through the vagina or through minimally invasive procedures, such as laparoscopic surgery or robot-assisted surgery.
• Bilateral salpingo-oophorectomy is when surgeons remove the fallopian tubes and both ovaries, often using minimally invasive laparoscopic techniques.
• Lymph node dissection is when surgeons remove lymph nodes from the pelvic region and the area next to the heart’s aorta to see if the cancer has spread. This can be performed through a minimally invasive laparoscopic surgery.

Chemotherapy

Chemotherapy can be part of a treatment plan to attack cancer that has spread from the uterus. A combination of chemotherapy drugs may be part of treatment for uterine cancer.

Radiation

External beam radiation therapy may be provided in combination with chemotherapy. Some patients may receive a form of radiation therapy called brachytherapy, in which radioactive sources are placed directly into the body through catheters or small plastic tubes. High-dose rate brachytherapy may be given alone or in conjunction with a shortened course of external beam radiation therapy.

Hormone therapy

Hormone therapy can be used as part of treatment or post-treatment options. These drugs slow the growth of uterine cancer or reduce the production of estrogen. They include progestin, tamoxifen and gonadotropin-releasing hormone agonists.

Some endometrial cancer treatment plans involve clinical trials. Talk with your physician about whether a clinical trial is right for you.

For a list of clinical trial that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your endometrial cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your endometrial cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Gynecologists
• Gynecologic surgeons
• Gastroenterologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps Cancer Center's multidisciplinary approach to treatment.

In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:

• Nutrition
• Expressive writing
• Yoga
• Meditation

Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.