Risk Factors

Several factors influence the risk of developing endometrial cancer:

• Age: Cancer of the uterus occurs mostly in women over age 50.
• Endometrial hyperplasia: The risk of endometrial cancer is higher if a woman has endometrial hyperplasia. This condition is an increase in the number of cells in the lining of the uterus. It is not cancer, but sometimes it develops into cancer. Heavy menstrual periods, bleeding between periods, and bleeding after menopause are common symptoms of hyperplasia.
• Hormone replacement therapy (HRT): HRT is used to control the symptoms of menopause, to prevent osteoporosis (thinning of the bones), and to reduce the risk of heart disease or stroke. Women who use estrogen without progesterone have an increased risk of endometrial cancer. Long-term use and large doses of estrogen seem to increase this risk. Women who use a combination of estrogen and progesterone have a lower risk of endometrial cancer than women who use estrogen alone. The progesterone protects the uterus. Women should discuss the benefits and risks of HRT with their doctor. Having regular checkups while taking HRT may improve the chance that the doctor will find endometrial cancer at an early stage, if it does develop.
• Obesity and related conditions: Because the body makes some of its estrogen in fatty tissue, obese women are more likely to have higher levels of estrogen in their bodies. This may be the reason obese women have an increased risk of developing endometrial cancer. The risk is also higher in women with diabetes or high blood pressure (conditions that occur in many obese women).
• Tamoxifen: Women taking the drug tamoxifen to prevent or treat breast cancer have a higer risk of endometrial cancer. This risk appears to be related to the estrogen-like effect of this drug on the uterus. Doctors monitor women taking tamoxifen for possible signs or symptoms of endometrial cancer. Any woman considering taking tamoxifen should discuss concerns or any personal or family medical history with her doctor.
• Race: Caucasian women are more likely than women of other races to get endometrial cancer.
• Colorectal cancer: Women who have had an inherited form of colorectal cancer have a higher risk of developing endometrial cancer than other women.
• Estrogen exposure: Another risk factor is related to how long a woman's body is exposed to estrogen. Women who have had no pregnancies, begin menstruation at a very young age, or enter menopause late in life are exposed to estrogen longer and have a higher risk.

Symptoms

Abnormal vaginal bleeding is the most common symptom of endometrial cancer. Bleeding may start as a watery flow that gradually contains more blood. Women should not assume that abnormal vaginal bleeding is part of menopause.

A woman should see her doctor if she has any of these symptoms:

• Unusual vaginal bleeding or discharge
• Difficult or painful urination
• Pain during sexual intercourse
• Pain in the pelvic area

These symptoms can also be caused by conditions other than cancer. A woman with any of these symptoms should see her health care provider so the problem can be diagnosed and treated as early as possible.

Screening and Diagnosis

Women are encouraged to get regular pelvic exams to find abnormal changes in the uterus and surrounding tissues as early as possible. A woman should talk with her gynecologist about how often these exams are recommended for her.

If a woman has symptoms that suggest endometrial cancer, the doctor may order blood and urine tests and may also perform one or more of the exams or tests described below:

• Pelvic exam: The doctor feels the uterus, ovaries, and nearby organs for lumps or other changes in their shape or size. It is usually performed in the same visit as a Pap test (a screening test for cervical cancer). To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.
• Transvaginal ultrasound: The doctor inserts an instrument into the vagina. The instrument uses high-energy sound waves bounced off internal tissues or organs to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later. If the endometrium looks thicker than average, the doctor may do a biopsy.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present.

Staging

If endometrial cancer is diagnosed, the doctor needs to know the stage (extent) of the disease to plan the best treatment. Staging is the process of finding out whether the cancer has spread, and if so, to what parts of the body.

Doctors may order some of the following tests to identify the stage:

• Blood tests: Doctors check for specific substances in the blood that indicate cancer is present.
• Colonoscopy: The doctor checks for abnormal areas along the entire length of the colon and rectum with a colonoscope.
• Ultrasound: This procedure uses high-energy sound waves bounced off internal tissues or organs to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later.
• X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.

Stages of Endometrial Cancer

Stage I: The cancer is only in the body of the uterus.

Stage II: The cancer has spread from the body of the uterus to the cervix.

Stage III: The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells.

Stage IV: The cancer has spread into the bladder or rectum, or it has spread beyond the pelvis to other body parts.

Treatment

At Huntsman Cancer Institute, endometrial cancer is treated by a team of specialists, including gynecologic oncologists (doctors who specialize in cancers of the female reproductive system), surgeons, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Treatment options for endometrial cancer depend on the size of the tumor, the stage of the disease, whether female hormones affect tumor growth, and the tumor grade. The grade tells how closely the cancer cells resemble normal cells and suggests how fast the cancer is likely to grow. Low-grade cancers usually grow and spread more slowly than high-grade cancers. The doctor also considers other factors, including the woman's age and general health.

Treatment options for endometrial cancer include the following:

• Surgery
• Radiation therapy
• Hormonal therapy
• Clinical trials

Surgery

This treatment removes the uterus (called a hysterectomy) through an incision in the abdomen. The doctor also removes both fallopian tubes and both ovaries. (This procedure is called a bilateral salpingo-oophorectomy).

The doctor may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it may mean the disease has spread to other parts of the body. If cancer cells have not spread beyond the endometrium, the woman may not need to have any other treatment.

Radiation therapy

Doctors use two types of radiation therapy to treat endometrial cancer:

• External radiation: A large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for this type of radiation therapy.
• Internal radiation: Tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.

Hormonal therapy

This is a systemic therapy that can help treat cancer throughout the body. Usually, hormonal therapy is a type of progesterone taken as a pill.

Clinical trials

These are studies that discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctor about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.