Endometrial cancer Health Article

Definition

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).

Alternative Names

Endometrial/uterine adenocarcinoma; Uterine cancer; Adenocarcinoma of the endometrium/uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer

Causes, incidence, and risk factors

Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a role. Estrogen helps stimulate the buildup of the lining of the uterus. Studies have shown that high levels of estrogen in animals result in excessive endometrial growth and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

The following increase your risk of endometrial cancer:

• Diabetes
• Estrogen replacement therapy without the use of progesterone
• History of endometrial polyps or other benign growths of the uterine lining
• Infertility (inability to become pregnant)
• Tamoxifen, a drug for breast cancer treatment
• Never being pregnant
• Obesity
• Starting menstruation at an early age (before age 12)
• Starting menopause after age 50

Associated conditions include the following:

• Colon or breast cancer
• Hypertension
• Polycystic ovarian disease

Symptoms

• Abnormal uterine bleeding, abnormal menstrual periods
  • Bleeding between normal periods before menopause
  • Vaginal bleeding or spotting after menopause
• Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
• Lower abdominal pain or pelvic cramping
• Thin white or clear vaginal discharge after menopause

Signs and tests

A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.

Tests that may be done include:

• Endometrial aspiration or biopsy
• Dilation and curettage (D and C)
• Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.

Stages of endometrial cancer:

1. The cancer is only in the uterus.
2. The cancer is in the uterus and cervix.
3. The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
4. The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

Cancer is also described as Grade 1, 2, or 3. Grade 1 is the least aggressive, and grade 3 is the most aggressive.