Overview

Most uterine cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Risk factors include being overweight and starting periods at an early age.
Symptoms include vaginal bleeding after menopause and bleeding between periods.
Surgery to remove the uterus is the main treatment for most women with uterine cancer. Advanced cases may need chemotherapy or radiation.

Symptoms

Signs and symptoms of endometrial cancer can include:
Vaginal bleeding after menopause
Bleeding between periods
Pelvic bread

Causes

Doctors don’t know what causes endometrial cancer. What we do know is that something happens to create changes (mutations) in the DNA of endometrial cells – the lining of the uterus.
The mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at some point. The abnormal cells grow and multiply uncontrollably, and they don’t die at some point. The abnormal cells that accumulate form a lump (tumor). Cancer cells invade nearby tissues and may separate from an initial tumor and spread elsewhere in the body (metastasize).

Types

Uterine cancers can be of two types:
Endometrial cancer (common) and uterine sarcoma (rare).
Endometrial cancer can often be cured. Uterine sarcoma is often more aggressive and more difficult to treat.

Treatment

Treatment for endometrial cancer is usually with surgery to remove the uterus, fallopian tubes and ovaries. Another option is radiation therapy with powerful energy. Drug treatments for endometrial cancer include chemotherapy with powerful drugs and hormone therapy to block hormones that cancer cells rely on. Other options might be targeted therapy with drugs that attack specific weaknesses in the cancer cells and immunotherapy to help your immune system fight cancer.
Surgery
Treatment for endometrial cancer usually involves an operation to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to become pregnant in the future. Also, once your ovaries are removed, you’ll experience menopause, if you haven’t already.
During surgery, your surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer’s stage.

Radiation therapy
Radiation therapy uses powerful energy beams, such as X-rays and protons, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.
If you aren’t healthy enough to undergo surgery, you may opt for radiation therapy only.
Radiation therapy can involve:
Radiation from a machine outside your body. During external beam radiation, you lie on a table while a machine directs radiation to specific points on your body.
Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.

Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells.
Chemotherapy is sometimes recommended after surgery if there’s an increased risk that the cancer might return. It can also be used before surgery to shrink the cancer so that it’s more likely to be removed completely during surgery.
Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread beyond the uterus.

Hormone therapy
Hormone therapy involves taking medications to lower the hormone levels in the body. In response, cancer cells that rely on hormones to help them grow might die. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.

Targeted drug therapy
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced endometrial cancer.

Immunotherapy
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments haven’t helped.

Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Diagonsis

Doctors use many tests to detect or diagnose cancer. They do tests to find out if the cancer has spread to another part of the body from where it started. If this happens, it is called a metastasis. For example, imaging tests such as CT scans (see below) can show whether the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors can also do tests to find out which treatments might work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of ​​the body has cancer. During a biopsy, the doctor takes a small sample of tissue to test in a lab. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes the diagnostic options for uterine cancer. Not all of the tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:
The type of cancer suspected
Your signs and symptoms
Your age and general health
The results of previous medical tests
In addition to a physical exam, the following tests can be used to diagnose uterine cancer:

Pelvic exam. The doctor feels the uterus, vagina, ovaries, and rectum for any unusual signs. A Pap test, often done along with a pelvic exam, is primarily used to check for cervical cancer. Sometimes a Pap test can detect abnormal glandular cells, caused by cancer of the uterus.
Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests may suggest the presence of cancer, but only a biopsy can make a definitive diagnosis. A pathologist analyzes the sample (s). A pathologist is a physician who specializes in interpreting laboratory tests and evaluating samples of cells and tissues to diagnose disease.
For an endometrial biopsy, the doctor takes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix and the tissue is removed by suction. This process takes a few minutes. Afterward, the woman may have vaginal cramps and bleeding. These symptoms should go away quickly and can be alleviated by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. An endometrial biopsy is often a very accurate way to diagnose uterine cancer. People who have abnormal vaginal bleeding before the test may still need dilation and curettage (D&C; see below), even if no abnormal cells are detected during the biopsy.
Dilation and curettage (D&C). A D&C is a procedure to take tissue samples from the uterus. A woman is given anesthesia during the procedure to block awareness of pain. A D&C is often done in combination with a hysteroscopy so that the doctor can see the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, flexible tube with a lumen through the cervix into the vagina and uterus. After the endometrial tissue is removed, during a biopsy or D&C, the sample is checked by a pathologist for cancer cells, endometrial hyperplasia, and other conditions.
Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. During a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and pointed towards the uterus to take pictures. If the endometrium seems too thick, the doctor may decide to take a biopsy (see above).
Computed tomography (CT or CAT). A scanner takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed three-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the size of the tumor. Sometimes a special dye called a contrast agent is given before scanning to provide better detail in the image. This dye can be injected into a patient’s vein or given as a pill or as a swallow liquid.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the size of the tumor. As with a CT scan, a special dye called a contrast dye can be given intravenously or orally before the scan to create a clearer image. MRI is very useful for obtaining

When to see a doctor

Make an appointment with your doctor if you experience any persistent signs or symptoms that worry you.

Risk factors

Female reproductive organs
Female Reproductive SystemOpen pop-up dialog
Factors that increase the risk of endometrial cancer include:
Changes in the balance of female hormones in the body. The ovaries produce two main female hormones: estrogen and progesterone. Fluctuations in the balance of these hormones cause changes in the endometrium.
A disease or condition that increases the amount of estrogen, but not the level of progesterone, in your body can increase your risk for endometrial cancer. Examples include irregular ovulation patterns, which can occur in polycystic ovary syndrome, obesity, and diabetes. Taking postmenopausal hormones that contain estrogen but no progesterone increases the risk of endometrial cancer.

A rare type of estrogen-secreting ovarian tumor can also increase the risk of endometrial cancer.
No more years of menstruation. Starting menstruation at an early age – before the age of 12 – or starting menopause later increases your risk for endometrial cancer. The more periods you have, the more your endometrium is exposed to estrogen.
Never having been pregnant. If you’ve never been pregnant, you have a higher risk of endometrial cancer than someone who has had at least one pregnancy.
An older age. As you get older, your risk of endometrial cancer increases. Endometrial cancer most often occurs after menopause.
Obesity. Obesity increases your risk of endometrial cancer. This can happen because the excess body fat changes the hormonal balance in your body.
Hormone therapy for breast cancer. Taking tamoxifen, a hormonal medicine for breast cancer, may increase your risk of developing endometrial cancer. If you are taking tamoxifen, discuss this risk with your doctor. For the most part, the benefits of tamoxifen outweigh the low risk of endometrial cancer.
An inherited colon cancer syndrome. Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC), is a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer. Lynch syndrome is caused by a genetic mutation passed from parents to children. If a family member has been diagnosed with Lynch syndrome, discuss your risk for genetic syndrome with your doctor. If you’ve been diagnosed with Lynch Syndrome, ask your doctor what cancer tests you should have.

Duration

Postponing surgery can give the cancer time to spread outside the uterus. If it does not go away in 6 to 12 months, surgery to remove and stage the cancer is recommended (hysterectomy and removal of the fallopian tubes and ovaries).