Endometrial (Uterine) Cancer

Condition Basics

What is endometrial cancer?

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

What causes it?

The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

What are the symptoms?

Abnormal or unexpected bleeding from the vagina is the most common symptom of endometrial cancer. Symptoms of more advanced endometrial cancer include pain or a lump in the pelvic area and weight loss.

How is it diagnosed?

Your doctor will ask about your medical history and do a physical exam. This will include a pelvic exam. Endometrial cancer is usually diagnosed with a biopsy. In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

How is endometrial cancer treated?

Treatment for endometrial cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the uterus. Other treatment options may include radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

What Increases Your Risk

Having a risk factor for endometrial cancer doesn't mean that you'll get it for certain.

The biggest risk factor is related to the hormone estrogen. When estrogen isn't in balance with another hormone, progesterone, it can cause problems that raise the risk for this cancer. Risk factors include:

• Being obese. Fat cells make extra estrogen.
• Taking estrogen without taking progestin.
• Taking tamoxifen.
• Having polycystic ovary syndrome.
• Having your first period before age 12 and starting menopause after age 52.

Other things that increase your risk include:

• Being older than 50.
• Inheriting some kinds of genes, such as those for Lynch syndrome.
• Having some types of endometrial hyperplasia.
• Having type 2 diabetes.
• Never having been pregnant.
• Having past radiation therapy to the pelvis.

Lowering Your Risk

You cannot control some things that put you at risk for endometrial cancer, such as a family history of endometrial or colon cancer.

But you can make personal choices that lower your risk of endometrial cancer.

• Strive for a healthy body weight. The body's fat cells make estrogen.
• Breastfeed if you are able. This decreases ovulation and estrogen activity.
• Get treatment for abnormal or unexpected bleeding. (Endometrial hyperplasia, which may develop into endometrial cancer, is one cause of abnormal bleeding.) Heavy menstrual periods, bleeding between periods, and bleeding after menopause are symptoms of hyperplasia.
• Use hormonal birth control. Hormonal birth control prevents endometrial hyperplasia.
• Exercise regularly. It may help control your weight and may reduce estrogen levels.
• Eat a diet that is low in animal fats and high in fruits and vegetables.

You have no risk for endometrial cancer if you have had your uterus removed (hysterectomy).

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Symptoms

Abnormal or unexpected bleeding from the vagina is the most common symptom of endometrial cancer.

Symptoms of more advanced endometrial cancer include:

• Pain in the pelvic area.
• A pelvic lump.
• Weight loss.

Symptoms of endometrial cancer can be mistaken for those of another condition, such as endometriosis.

Symptoms of recurrent endometrial cancer

When endometrial cancer comes back after treatment, you will probably have symptoms. These include:

• Bleeding from the vagina, bladder, or rectum.
• Decreased appetite.
• Weight loss.
• Pain in your belly, hip, or back.
• Cough.
• Shortness of breath.
• Swelling in your belly or legs.

If you have any of these symptoms, see your doctor right away and don't wait for your next scheduled appointment.

What Happens

Normally, the lining of the uterus (endometrium) builds up and then sheds with each menstrual cycle. This shedding is menstrual bleeding (menstrual period).

But in most cases of endometrial cancer, the endometrium has built up and has not shed and thinned. The lining has remained thick. This is called endometrial hyperplasia. If not treated, the lining cells can grow quickly and become cancer cells.

As cancer cells multiply, they form a mass of tissue, which can cause vaginal bleeding. Especially after menopause, this abnormal bleeding is a reason to call your doctor.

If endometrial cancer isn't treated, it may spread outside of the uterus. It may spread to the pelvic lymph nodes and the vagina or other pelvic organs. Advanced-stage cancer may spread to other lymph nodes, the bladder, the bowels, or the lungs.

The long-term outcome depends on the stage and grade of your cancer.

When to Call a Doctor

See your doctor if you have:

• Abnormal vaginal bleeding or discharge, especially if it occurs after menopause.
• Pain during sex.
• Pain in the pelvic area.
• Irregular bleeding while taking hormone therapy.

If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Examinations and Tests

To check your symptoms, your doctor will ask about your medical history and do a physical exam. This will include a pelvic exam.

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) to be looked at under a microscope.

Other tests may include:

• A transvaginal pelvic ultrasound. This uses sound waves to create images of the uterus. The images can show how thick the endometrium is. A thick endometrium can be a sign of cancer in post-menopausal women. Ultrasound also can help show whether cancer has grown into the uterine muscle.
• A hysteroscopy. This allows your doctor to view the inside of the uterus and get an endometrial tissue sample.
• Dilation and curettage (D&C). This test is done to get a sample of tissue from the inside of the uterus. It may be done at the same time as a hysteroscopy.

Testing for endometrial cancer may show that you have endometrial hyperplasia. This is not cancer but may develop into cancer.

Tests if cancer is found

If cancer is found, surgery is done to find out how much the cancer has grown (stage and grade) and to treat it at the same time.

Before surgery, an imaging test may be done to see if cancer has spread to the abdomen and pelvis. This helps with planning for treatment. Imaging tests may include a CT scan or an MRI.

Other tests done before surgery may include:

• A complete blood count (CBC) to check for anemia and other abnormal blood values.
• A cancer antigen (CA) 125 test. This test helps to identify cancer that has or may spread (metastasize).
• A chest X-ray to check for cancer cells that have spread (metastasized) from the uterus.

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Treatment Overview

Treatment for endometrial cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the uterus. Other treatment options may include radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.

Your doctor will talk with you about your options and then make a treatment plan.

Surgery

The main treatment is surgery. Most people have both of these:

• Surgery to remove the uterus and cervix. This is called a total hysterectomy.
• Surgery to remove the fallopian tubes and ovaries. This is called a bilateral salpingo-oophorectomy.

During surgery, the doctor may remove nearby lymph nodes and check other tissues for signs of cancer.

Pregnancy is no longer possible after a hysterectomy. If you have early-stage cancer and there's a chance that you might want to get pregnant later, talk to your doctor. You may be able to have other treatments and delay surgery. This is called fertility-sparing treatment.

Radiation therapy

This uses high-dose X-rays to destroy cancer cells and shrink tumours. Radiation may be given by placing substances inside the body. This is called internal radiation. Or it may be given by using a machine outside the body. This is called external radiation.

Radiation therapy may be used as a first-line treatment. Or it may be used to treat cancer that has come back. It may also be used to control symptoms and increase comfort.

Medicines

Medicines may be used to control the growth of cancer cells and to relieve symptoms. Medicines include:

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells.

Hormone therapy.

These medicines block hormones that cause certain cancers to grow. This can slow or stop cancer growth.

Hormone therapy may be used after surgery. It may also be an option if you are not able to have surgery or radiation therapy, or if the cancer has come back or spread.

Targeted therapy.

These medicines target cancer cells and may cause less harm to normal cells. They help keep cancer from growing or spreading. Targeted therapy may be used if cancer has come back after treatment.

Immunotherapy.

This treatment helps your immune system fight cancer. It may be given in several ways.

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Supportive Care

Hospice palliative care is a type of care for people who have a serious illness. It's different from care to cure your illness, called curative treatment. Hospice palliative care provides an extra layer of support that can improve your quality of life—not just in your body, but also in your mind and spirit. Sometimes hospice palliative care is combined with curative treatment.

The kind of care you get depends on what you need. Your goals guide your care. You can get both hospice palliative care and care to treat your illness. You don't have to choose one or the other.

Hospice palliative care can help you manage symptoms, pain, or side effects from treatment. It may help you and those close to you better understand your illness, talk more openly about your feelings, or decide what treatment you want or don't want. It can also help you communicate better with your doctors, nurses, family, and friends.

End-of-life care

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.
• Follow your doctor's instructions to relieve pain. Pain from cancer and surgery can almost always be controlled. Use pain medicine when you first notice pain, before it becomes severe.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss.
• Get some physical activity every day, but do not get too tired.
• Get enough sleep, and take time to do things you enjoy. This can help reduce stress.
• Think about joining a support group. Or discuss your concerns with your doctor or a counsellor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take care of your urinary tract to prevent problems that can be caused by endometrial cancer and its treatment. Limit drinks with caffeine, drink plenty of fluids, and urinate every 3 to 4 hours.
• If you have not already done so, prepare an advance care plan. An advance care plan provides instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

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Complementary Treatments

Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Getting Support

Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counselling.

  Counselling can help you cope with cancer and the effect cancer is having on your life. Different types of counselling include family therapy, couples therapy, group counselling, and individual counselling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counselling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counselling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

Adjusting to body changes after treatment

Your feelings about your body and your sexuality may change after treatment for cancer. If you have a partner, it may help to talk openly with that person about your feelings.

Having cancer treatments such as radiation therapy or a hysterectomy may affect your ability to have or enjoy sex.

If you haven't yet reached menopause, your menstrual period will end right after most treatments for endometrial cancer. If your uterus and ovaries have been removed or have had radiation therapy, your body will have a decrease in estrogen. This may cause menopausal symptoms, such as hot flashes, changes in mood, and vaginal dryness.

If you do have sexual concerns or problems, talk with your doctor about treatment or information. Your doctor may also be able to refer you to a group for support.

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