Leading-edge treatments for the most common gynecologic cancer
Leading-edge treatments for the most common gynecologic cancer
Scripps MD Anderson Cancer Center is a leader in caring for women with endometrial cancer. The most common gynecologic cancer, endometrial cancer is usually treated by hysterectomy, or surgical removal of the uterus. Our oncology specialists treat endometrial cancer with advanced therapies designed to eliminate cancer and prevent recurrence, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery, and immunotherapy to harness the power of the body’s own immune system.
Our multidisciplinary, collaborative board of cancer specialists reviews every patient’s care plan to ensure you receive the best possible care from diagnosis to recovery.
About endometrial cancer
Endometrial cancer is also known as uterine cancer. The most common type of gynecologic cancer, it starts in the body of the uterus — specifically in the inner lining of the uterus, known as the endometrium. During a woman’s childbearing years, the endometrium thickens during pregnancy, and is shed during menstruation if a woman is not pregnant.
Endometrial cancer differs from cervical cancer, which starts in the cervix — the lower portion of the uterus — and then spreads to the body of the uterus.
Endometrial cancer is most common among women who have gone through menopause and primarily affects women age 55 and older.
Types of 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.
Most endometrial cancers are endometrial carcinomas. The different types of endometrial carcinomas include:
- 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:
- Secretory carcinomas
- Ciliated carcinomas
- Villoglandular adenocarcinomas
Endometrial cancer causes, risks and family history
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:
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.
Excess weight is a risk factor because fat tissue can change some hormones into estrogen.
Diabetes can raise the risk of developing endometrial cancer.
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.
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.
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.
Endometrial cancer prevention, screenings and early detection
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, diagnosis and stages
In some cases, endometrial cancer symptoms may appear in the early stages of the disease. In other women, there may be no symptoms until the disease has advanced. As with most cancers, the sooner endometrial cancer is found, the more likely treatment will be successful. Learn more about symptoms, imaging and diagnostic testing, and the stages of endometrial cancer below.
Endometrial cancer symptoms
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 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 involves removing and examining a tissue sample from the endometrial lining. Usually, this can be performed through the vagina.
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 may check for high levels of CA-125 commonly associated with the spread of a uterine cancer.
Endometrial cancer stages
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 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 endometrial cancer has spread into the connective tissue of the cervix but not outside the uterus.
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 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.
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.
Understanding your diagnosis
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.
Treatment and clinical trials
Scripps MD Anderson physicians, in combination with our world-class facilities and technology, are ready to help you fight endometrial cancer. We develop personalized treatment plans designed to eliminate cancer and keep it from coming back. Our specialists use the most advanced treatment options, including minimally invasive and robotic-assisted surgical procedures, and the most comprehensive and advanced radiation therapy choices in San Diego.
Our approach to treating endometrial cancer
A multidisciplinary team of Scripps MD Anderson 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.
Endometrial cancer treatment options at Scripps MD Anderson
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 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.
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 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.
Endometrial cancer clinical trials
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 custom cancer treatment plan
Your Scripps MD Anderson 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 cancer care team
Your endometrial cancer care team includes health and medical professionals from a wide range of specialties. Scripps MD Anderson will customize your team to ensure you have the expertise and support you need.
Your team may include:
- Gynecologic surgeons
- Surgeons and surgical oncologists
- Radiation oncologists
- Medical oncologists
- Registered nurses
- Nurse navigators
- Oncology social workers
Visit your cancer care team for more on Scripps MD Anderson's multidisciplinary approach to treatment.
Endometrial cancer treatment locations
Scripps diagnoses and treats endometrial cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
We are now offering Video Visits for some specialty care appointments. If you are interested in scheduling a Video Visit, contact the provider’s office directly. The doctor’s office will work with you to determine if this is the right type of visit for you.
Visit cancer care locations for details of each cancer hospital, clinic and specialty center.
Support groups, services and resources
As leaders in endometrial cancer care, we know what it takes to fight a winning battle. That’s why we equip our patients with the support and resources necessary to achieve their best possible outcome. From connecting you with support groups and services to empowering you with the latest resources and research, Scripps offers a comprehensive lineup to help you along every step of your cancer journey.
Endometrial cancer support groups for patients, family members and survivors
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:
- Expressive writing
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.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps MD Anderson offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:
- Bookmark the Scripps glossary of cancer terms for easy referencing.
- Download the appointment form and list of medications form on our resources page.
- Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site.
Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.