Endometrial Cancer

Endometrial cancer, also called endometrial cancer, is a cancer that begins in the lining of the uterus. The most common type of endometrial cancer is called adenocarcinoma. There are more rare types of endometrial cancer but most cases, > 95%, are adenocarcinomas. Adenocarcinomas of the uterus begin in the cells that make up the lining of the uterus called the endometrium.

The average woman in the United States has a risk for endometrial cancer of approximately 2.7%. Most cases are diagnosed after the age of 50, and the average age of diagnosis is 60. Some hereditary cancer syndromes are associated with an increased risk for endometrial cancer.

General Risk Factors

Lifestyle

  • A diet high in animal fat
  • Obesity (being very overweight; having too much body fat)

Hereditary

  • A family history of endometrial cancer

EndometrialCancerRisk-graph

Associated Genes

MLH1, MSH2, MSH6, PMS2, EPCAM, TP53, PTEN, STK11

Health History

  • Beginning menstruation at an early age (before age 12)
  • A late age of menopause (after age 55)
  • Tamoxifen use (a drug used to treat breast cancer or to reduce the risk for breast cancer; the benefits of using tamoxifen outweigh the risks of use in some women)
  • Polycystic ovarian syndrome (PCOS) – this condition is associated with higher levels of androgen and estrogen hormones and lower levels of progesterone and can result in the failure of the ovaries to release an egg during the menstrual cycle
  • Diabetes – an increased risk for endometrial cancer has been observed in women who have diabetes even if they are not obese, but endometrial cancer is more prevalent in women with Type 2 diabetes which is associated with obesity
  • Endometrial hyperplasia (increased growth of the endometrium) – the risk is much higher for endometrial cancer if atypical hyperplasia is present
  • Prior radiation therapy to the pelvis for treatment of a previous cancer
  • Estrogen-only hormone replacement therapy after menopause
  • No history of any pregnancies

Prevention

As with the vast majority of cancers, there is no confirmed way to completely prevent the development of endometrial cancer. Maintaining a healthy weight through a healthy diet and exercise may decrease the risk for endometrial cancer. Women who use birth control pills as a form of contraception (birth control) are thought to have a lower risk for endometrial cancer. This is especially true for women who use birth control pills for longer periods of time. Some progesterone-containing intrauterine devices (IUDs) used for contraception may also reduce the risk for endometrial cancer. Women who have had multiple pregnancies are also thought to have a lower risk for endometrial cancer. Women who are done having children and who have a high risk for endometrial cancer due to a genetic change that increases the risk for endometrial cancer or medical findings that greatly increase their risk may be offered a risk-reducing hysterectomy to help prevent the formation of endometrial cancer. A hysterectomy is a surgery to remove the uterus.

Symptoms and Screening Methods

Symptoms of endometrial cancer can include vaginal bleeding, spotting, or discharge. These symptoms may also be due to medical conditions other than endometrial cancer. Any vaginal bleeding occurring after menopause should be further evaluated to rule out endometrial cancer.

Currently in the United States, there is no standard or routine screening test for women at average risk for endometrial cancer. If your doctor considers you to be at a higher risk than the average person for endometrial cancer due to any of the risk factors mentioned above or if you are experiencing any of the symptoms mentioned above, he or she may recommend that you undergo certain screening tests, which can include some combination of a pelvic exam, endometrial biopsies (removal of tissue samples from the inner lining of the uterus),transvaginal ultrasound, and dilatation and curettage, also called a D&C (a procedure that uses a surgical tool to remove endometrial tissue).

Treatment

If endometrial cancer is diagnosed following any of the tests above, treatment will depend on the stage of the cancer (how far the cancer has grown or spread). Treatment can include some combination of surgery, chemotherapy, radiation, and hormone therapy. Learn more about endometrial cancer treatments here.

References

  1. ACOG Practice Bulletin No. 65. Management of endometrial cancer. Obstet Gynecol 2005 Aug;106(2):413-25.
  2. American Cancer Society: Endometrial Cancer (http://www.cancer.org/cancer/endometrialcancer/index)
  3. American Society of Clinical Oncology: Endometrial Cancer (http://www.cancer.net/cancer-types/uterine-cancer)
  4. Gruber SB, Thompson WD. A population-based study of endometrial cancer and familial risk in younger women. Cancer and Steroid Hormone Study Group. Cancer Epidemiol Biomarkers Prev. 1996 Jun;5(6):411-7. PubMed PMID: 8781735.
  5. Lucenteforte E, Talamini R, Montella M, Dal Maso L, Pelucchi C, Franceschi S, La Vecchia C, Negri E. Family history of cancer and the risk of endometrial cancer. Eur J Cancer Prev. 2009 Apr;18(2):95-9. Doi: 10.1097/CEJ.0b013e328305a0c9. PubMed PMID: 19337055.
  6. National Cancer Institute: Endometrial Cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/Patient)
  7. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov)