Endometrial Cancer

Endometrial cancer, or uterine cancer, is the most common gynecologic (GYN) cancer and is highly curable when diagnosed early. Our skilled GYN oncologists offer diagnosis, advanced treatment options including robotic surgery, and personalized support. 

Endometrial Cancer Symptoms and Risks

If you're close to menopause, you're probably looking forward to closing the chapter on monthly periods, cramps, and PMS. However, the waning hormones that end your period also put you at higher risk for endometrial cancer.

A type of uterine cancer, endometrial cancer affects the inner lining of the uterus (the endometrium). The endometrium thickens and sheds during your period. It's also where an embryo implants and is nourished during pregnancy.

It's important to know your endometrial cancer risks because the symptoms are subtle and include the following:

• 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

Are you at risk for endometrial cancer?

Women ages 50 to 70 are at increased risk for endometrial cancer. However, obesity and genetic predisposition can also put women under age 50 at risk.

Before menopause, your ovaries produce the hormones estrogen and progesterone. These hormones work in balance to keep the endometrium healthy. After menopause, your ovaries stop making these hormones.

Being overweight or obese are top risks for endometrial cancer because excess fat tissue can change other hormones into estrogen. Having higher estrogen levels increases your risk of developing endometrial cancer.

According to the American Cancer Society, in comparison with healthy-weight women (BMI of 18.5 to 24.9), endometrial cancer is twice as common in overweight women (BMI of 25 to 29.9) and more than three times as common in obese women (BMI greater than 30).

Other risk factors include:

• Early onset of menstruation (before age 12)
• Late menopause
• Infrequent, irregular periods or a history of polycystic ovarian syndrome
• History of infertility or not having children
• Unopposed estrogen therapy (taking an estrogen-only pill without the estrogen-balancing hormone progesterone)
• Tamoxifen therapy (for breast cancer prevention or treatment)
• Diagnosis of endometrial hyperplasia or overgrowth of the cells of the uterine lining
• Diabetes
• Personal history of colon cancer before age 50
• Inherited gene mutation such as Lynch Syndrome (hereditary nonpolyposis colorectal cancer), Cowden Syndrome, or a first-degree relative (mother, daughter, sister) with endometrial cancer

Types of Uterine Cancer

Endometrial cancer

Endometrial cancer is the most common gynecological cancer, making up more than 95% of uterine cancer diagnoses. It occurs in the inner lining of the uterus, called the endometrium. 

Uterine sarcoma

This type of cancer is rare, accounting for only 2% to 4% of uterine cancer diagnoses. It develops in the uterine muscle, the myometrium. While its cause is unknown, it occurs most often in middle-aged and older women. Those who have undergone pelvic radiation to treat other cancers may be more likely to develop this type of uterine cancer. 

Endometrial Cancer Diagnosis at Virtua

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).

A pathologist determines the cell type and cancer grade if cancer is found. These are preliminary indicators of how aggressive cancer might act. 

Based on your results, your OB/GYN will refer you to a GYN oncologist specializing in diagnosing and treating cancers affecting 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 GYN oncologist may order additional tests to see if cancer has spread beyond your uterus. Tests may include ultrasound, MRI, CT, or PET scans.

Endometrial Cancer Treatment at Virtua

After diagnosis, your care team, led by your GYN oncologist, works with you to explain your treatment options and 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 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 the following:

• Total hysterectomy 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 specific lymph nodes for cancer cells. If there's no cancer in the sentinel nodes, no other lymph nodes are removed, reducing the risk of swelling in your legs (lymphedema).
• Tumor debulking for cancer that has spread outside the uterus 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 (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 destroys cancer cells that may have spread throughout the body. It's often used to treat high-risk, aggressive forms of endometrial cancer.

Hormone therapy

Hormone therapy uses hormone or hormone-blocking medication to treat cancer. It can 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. They 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 early detection to treatment for endometrial cancer.