Overview of Endometrial Cancer

Hysterectomy Is the Typical Treatment for Endometrial Cancer

When doctors use the term endometrial cancer, they are typically referring to what's known as a carcinoma that begins in the endometrium, or the inner lining of the uterus. The cells in these cancers fall in to one of two categories: 1) Those that are near-normal in appearance, slow-growing and less likely to spread or 2) those that tend to grow and spread quickly.

Another form of uterine cancer, accounting for only 5% of diagnoses, is called a "sarcoma," which starts in the uterine muscle wall and may spread to the endometrium. It is generally considered a separate condition and has a five-year survival rate of 50% when diagnosed in its earliest stage.

Symptoms and Risk Factors 

According to the American Cancer Society, some 40,000 women are diagnosed with endometrial cancer each year, most of them post-menopausal. Symptoms include:

• Unusual vaginal bleeding or spotting, especially after menopause
• Vaginal discharge
• Difficulty urinating
• Pelvic pain, painful intercourse
• Weight loss

Pelvic pain and weight loss usually indicate a more advanced stage of the disease.

Vaginal bleeding is a symptom of 90% of patients; therefore, immediately report any unusual bleeding to your gynecologist to ensure the best chances of early diagnosis. This is especially important if you have any risk factors for endometrial cancer, including:

• Age 55 or older
• Early menstruation (before 12) or late menopause (mid- to- late-50s)
• No children, whether by choice or due to infertility
• Obesity
• Diabetes
• High blood pressure
• Using oral estrogen supplements
• Taking Soltamox or Nolvadex (tamoxifen)

Also at risk are women who've had previous pelvic radiation, breast or ovarian cancer or a specific colon cancer called "hereditary nonpolyposis colon cancer" (HNPCC) or have a family history of HNPCC.

The exact cause of endometrial cancer is unknown, but it is related to the hormone estrogen. The balance of estrogen and progesterone between menstrual periods protects women from endometrial cancer until menopause.  Using oral contraception lowers your chances of developing uterine cancer but comes with its own risks for cardiovascular problems.

Having human papilloma virus (HPV) or exposure to diethylstilbestrol (DES) before birth are factors in cervical, but not endometrial, cancer.

Diagnosis and Staging

Once endometrial cancer is suspected, your gynecologist will remove a small sample of endometrial tissue, usually during an office procedure, and send it to a lab.

If the lab finds the tissue is cancerous, it will be assigned a grade of 1, 2 or 3, depending on the appearance of the cells. Lower-grade endometrial cancers are less advanced and not as likely to recur.

Next, the doctor will determine the scope of the cancer, often using imaging tests, such as an ultrasound, by using sound waves from a probe placed in the vagina to take a picture. Blood tests may be ordered to detect the presence of CA 125, a substance released by many uterine and ovarian cancers.

The stages of the cancer range from Roman numerals I through IV. While grades indicate the type of cells, stages indicate the degree to which they have spread. The cervix, fallopian tubes and ovaries are almost always removed in order for the cancer to be staged.

Stage I: Confined to the uterus.

Stage II: Spread to the cervix.

Stage III: Beyond the uterus and cervix, but contained in the pelvis.

Stage IV: Spread beyond the pelvis.

Stages are narrowed down more by sub-stages A through C, further indicating severity. For example, in stage IIIB, the cancer has spread not only beyond the uterus and cervix but also in to the vagina, but not in to the pelvis.

Treatment and Recovery

Surgery, which may be followed by other treatments, is the standard treatment for almost all patients.

Hysterectomy: A hysterectomy is the surgical procedure used to remove the uterus. The cervix, ovaries and fallopian tubes may also be removed if the cancer has spread to these areas. Surrounding lymph nodes may additionally be taken out for examination to see if or how far the cancer has advanced.

Radiation: External x-rays or radioactive pellets placed in the pelvis can eliminate or shrink tumors.

Chemotherapy: Drugs that kill cancer cells may be given intravenously or in pill form.

Hormone therapy: Progesterone or estrogen inhibitors may be prescribed for advanced or recurrent cancers.

Radiation, chemotherapy and hormone therapy are most often used if surgery is not possible, if the cancer comes back or if the patient hopes to become pregnant. After treatment, the overall 5-year survival rate is 88%. When the cancer is found at an early stage, though, which is typical, the rate jumps to 95%.

New treatments are in the works. Doctors at Washington University in St. Louis are planning clinical trials based on their discovery that a specific inhibitor drug, called "PD173074," can stop the growth of tumors in a large number of patients, even those with gene mutations that resist other treatments.

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