By Leona Chang, DO, FACOOG, Gynecologic Oncologist
Virtua Gynecologic Oncology

Endometrial cancer is the most common gynecologic cancer in the U.S. If you’ve been diagnosed with endometrial cancer, the shock of the diagnosis and decisions that follow can feel overwhelming. This information can help you prepare to discuss your treatment options with your care team.

Carcinomas can affect the inner lining of the uterus (the endometrium), and sarcomas can affect the muscle of the uterus (the myometrium). Sarcomas are rare tumors and account for less than 10% of uterine cancers.

The following focuses on endometrial cancer and what you need to know about diagnosis and treatment.

What are the symptoms of endometrial cancer

The signs of endometrial cancer are subtle, so it's important to see your OB/GYN if you experience any of these symptoms, especially if you've already gone through menopause:

• Abnormal vaginal bleeding—whether it's spotting or vaginal discharge—after menopause
• Irregular or heavy periods in younger women
• Less commonly, pelvic pain, bloating, or cramping

Diagnostic testing may include:

• Pelvic or transvaginal ultrasound to look for signs of a mass or thickening of the endometrium.
• Endometrial tissue sampling to take a small sample of the lining of the uterus to test for cancer cells. This can be performed in the office as a biopsy or a surgical procedure called a dilation and curettage (D&C).

If cancer is found, a pathologist determines the cell type and cancer grade. These are preliminary indicators for how aggressive cancer might act. Based on your results, your OB/GYN will refer you to a gynecologic oncologist, who specializes in diagnosing and treating cancers that affect a woman's reproductive organs. 

Staging endometrial cancer

Staging is a standard way of categorizing cancer based on how much it involves other organs. It helps determine the best treatment approach and the likely course of the disease (prognosis).

Endometrial cancer is categorized into stages—I, II, III, or IV. Stage I generally means the cancer is limited to the uterus. Higher stages mean cancer has spread beyond the uterus to nearby organs, lymph nodes, or other parts of the body such as the liver or lungs.

If you've been diagnosed with endometrial cancer, your gynecologic oncologist may order additional tests to see if the cancer has spread to other areas of the body. Tests may include ultrasound, MRI, CT, or PET scans.

Treatment for endometrial cancer

After diagnosis, your care team, led by your gynecologic oncologist, works with you to explain your treatment options, as well as the risks and benefits of those options. Your care team may also include a radiation oncologist, medical oncologist, oncology nurse navigator, and other clinicians who will support you before, during, and after treatment. Depending on the type, grade, and stage of endometrial cancer, your plan may include a combination of treatments, such as:

Surgery
Surgery is the most common treatment for endometrial cancer. It can be performed in two ways: through an incision in the abdomen or through minimally invasive or robotic-assisted surgery. When robotic surgery is feasible, it provides faster recovery, lower risk of infection, and less pain and scarring. Your surgery will likely include:

• Total hysterectomy, which involves removing the uterus and cervix, as well as the ovaries and fallopian tubes.
• Lymph node removal in the pelvis and abdomen to help determine the cancer stage. The surgeon uses sentinel lymph node mapping to identify and test certain lymph nodes for cancer cells. If there's no cancer in the sentinel nodes, no other lymph nodes are removed, reducing the risk for swelling in your legs (lymphedema).
• Tumor debulking for cancer that has spread outside the uterus, which involves removing as much of the cancer as possible to help radiation or chemotherapy treatment work better.

Radiation therapy
Radiation therapy is frequently used for the following:

• To help decrease cancer recurrence in high-risk patients
• For treatment when cancer cannot be removed surgically
• When severe medical conditions make surgery unsafe

Radiation can be delivered both externally and internally. External radiation therapy uses a high-energy X-ray beam to target specific sites to shrink tumors and destroy cancer cells. Internal radiation therapy, also called HDR brachytherapy, involves placing a radioactive source directly into or near the tumor site. This delivers targeted radiation to a small area of the body and limits exposure to normal tissue.

Chemotherapy
Chemotherapy is used to destroy cancer cells that may have spread throughout the body. It's often used in treatment for high-risk, aggressive forms of endometrial cancer.

Hormone therapy
Hormone therapy uses hormone or hormone-blocking medication to treat cancer. It can be used to treat cancer limited to the uterus in a woman who still wants to have children. It also can be used for treatment when cancer can't be removed surgically or for advanced-stage or recurrent endometrial cancer.

Immunotherapy
Immunotherapy is a groundbreaking development in uterine cancer treatment. It has shown that it can improve survival rates and increase the time the disease can be controlled. Immunotherapy uses the body's immune system to fight cancer. It works by giving the immune system an overall boost or training the immune system to attack specific parts of the cancer cells. 

Clinical trials
Clinical trials are used to test new cancer treatment regimens and are often best for treating high-risk or recurrent endometrial cancer. The National Cancer Institute provides updates on endometrial cancer research and clinical trials, including everything from early detection to treatment for endometrial cancer.

Why choose Virtua for endometrial cancer treatment

By choosing the Penn Medicine | Virtua Cancer Program, you have access to the most advanced cancer treatment options and personalized support services to care for your physical and emotional needs—all close to home in South Jersey. Fellowship-trained gynecologic oncologists lead a team that includes medical and radiation oncologists, oncology nurse navigators, social workers, and genetic counselors—all specializing in gynecologic cancer care.  

Alongside them is our caring cancer support network that's here to help you feel your best through treatment and help you navigate the changes you might experience during treatment.

Call 844-896-6367 to speak with a Virtua Women's Health Navigator for referral and more information.