What is endometrial cancer?
Endometrial cancer, also called uterine cancer, is a type of cancer that begins in the uterus. Endometrial cancer happens when abnormal cells grow out of control in the lining (endometrium) of the uterus.
Endometrial cancer is the most common gynecologic cancer diagnosed in women; over 40,000 women in the U.S. are diagnosed annually. Endometrial cancer is frequently diagnosed early and can often be cured.
There are a number of different types of endometrial cancer. The most common type of cancer is endometrioid carcinoma. These tumors arise from the endometrial lining of the uterus. Other epithelial tumors (found in connective tissue) such as papillary serous carcinomas and clear cell carcinomas, account for 5-10% of uterine cancers. These tumors tend to be more aggressive and are more likely to have spread beyond the uterus at the time of diagnosis. Uterine sarcomas (cancerous tumors) account for approximately 5% of uterine tumors. These cancers arise in the wall of the uterus and also tend to be more aggressive.
What causes endometrial cancer?
In the majority of women, endometrial cancer is spontaneous and is not associated with a genetic syndrome.
The most common risk factor for endometrial cancer is obesity. Women who are 30-50 lbs overweight have a substantially increased risk of developing endometrial cancer. Fat cells produce estrogen, which can stimulate the endometrial lining and lead to the development of cancer.
Women taking unopposed estrogen (estrogen without progesterone) are also at increased risk for the development of cancer.
Other risk factors for endometrial cancer include late menopause, early menstruation, and tamoxifen use.
Most endometrioid adenocarcinomas (the most common subtype of endometrial cancer) arise from a precancerous change in the uterine lining called endometrial hyperplasia. Endometrial hyperplasia, if untreated, can progress to an endometrial cancer. Women with endometrial hyperplasia, particularly those who have the form associated with the highest risk of cancer (atypical hyperplasia) require treatment.
What are the symptoms of endometrial cancer?
Vaginal bleeding after menopause is one of the most common signs of endometrial cancer. If you have vaginal bleeding after menopause you should immediately consult your physician. The majority of women with postmenopausal vaginal bleeding do not have a cancer, but evaluation is required.
Other symptoms may include abdominal pain, nausea, vomiting, weight loss, bloating, and abdominal distension.
How is endometrial cancer diagnosed?
Women with vaginal bleeding are typically evaluated with office endometrial biopsy tests, transvaginal ultrasound, or dilation and curettage (D&C).
There is no screening test for endometrial cancer currently available.
How is endometrial cancer treated?
Surgery is the primary treatment for women with endometrial cancer. Surgery usually involves removal of the uterus (hysterectomy), often in combination with removal of the ovaries (oophorectomy) and lymph nodes (lymphadenectomy). Traditionally, a hysterectomy for endometrial cancer has required making an incision in the abdomen to remove the uterus. At ColumbiaDoctors, we focus on minimally invasive surgery when appropriate. Minimally invasive surgery involves removal of the uterus through multiple small incisions, rather than a large abdominal incision. Benefits of minimally invasive surgery may include a shorter recovery, shorter hospital stay, decreased pain, earlier return to normal activity, and improved cosmetic results. Minimally invasive hysterectomy can be performed either laparoscopically or robotically.
For some young women who require hysterectomy, but who want to preserve fertility, ovary preservation may be possible. Others with very early endometrial cancer, who wish to preserve fertility, may be candidates for hormonal treatments (progesterone).
Many women with early endometrial cancer confined to the uterus do not require any additional treatment after surgery and have a high cure rate.
Some women whose endometrial cancer has invaded the wall of the uterus, or is associated with other higher-risk conditions, require radiation treatments. Women with endometrial cancer that has spread outside of the uterus are often treated with chemotherapy, frequently in combination with some form of radiation.