Endometrial Cancer

What is endometrial cancer?

It's cancer of the lining of the uterus, a hollow pear-shaped organ in women in which a fetus can develop. (This lining is known as the endometrium.) Endometrial cancer is the most common cancer of the female reproductive tract, with an estimated 40,000 women diagnosed each year. Fortunately, it has a high cure rate. According to the American Cancer Society, the 5-year survival rate is 88 percent.

Endometrial cancer is not the same as some other less-common malignancies involving the uterus. For example, uterine sarcomas are malignancies arising from the wall of the uterus, not the lining. All in all, these other cancers make up less than 10 percent of the malignant tumors arising from the uterus.

Who has the greatest risk of developing endometrial cancer?

Women who get endometrial cancer tend to share certain characteristics. Having these risk factors doesn't mean you'll get the cancer, of course, just as being free of risk factors doesn't guarantee safety. But you're more likely to develop this cancer if:

• You're over the age of 50. Less than 5 percent of endometrial cancer cases are diagnosed in women under 40.
• You're on hormone replacement therapy. Both large doses of estrogen and long-term treatment with it seem to elevate the risk of endometrial cancer. Using both estrogen and progesterone appears to reduce the risk of taking estrogen by itself.
• You're overweight. If your weight is somewhat above the acceptable range for your height, you're twice as likely to get endometrial cancer as a woman at a lower weight. If you're obese, your risk is three to 10 times greater than that of those who aren't. Scientists believe this is because the more fat cells a woman has, the more estrogen she produces.
• You have diabetes or high blood pressure. Studies show these conditions may increase the risk of endometrial cancer, but scientists aren't sure whether this is a direct result of the diseases or because people who have these diseases tend to be overweight.
• You're taking tamoxifen. Using this drug to treat breast cancer raises your risk of developing endometrial cancer, perhaps because it affects the uterus much as estrogen does.
• You're white. White women are more likely to develop endometrial cancer than women of other races.

Other risk factors include having no biological children, going through menopause late in life, suffering from polycystic ovarian syndrome, and having a history of breast or ovarian cancer. One thing that lowers your risk, according to the American Cancer Society, is having used oral contraceptives containing both estrogen and progesterone, especially over a long period of time.

What are the symptoms of endometrial cancer?

Bleeding after menopause can be an indication of endometrial cancer. If that happens, you should see your doctor for a checkup as soon as possible. For women who haven't gone through menopause, bleeding between periods might signal either endometrial or cervical cancer (or other problems, such as vaginal infections). Other symptoms of endometrial cancer include pain during intercourse and painful or difficult urination.

When should I see my doctor?

Make an appointment promptly if you have any of the following symptoms:

• Unusual discharge or vaginal bleeding
• Difficult or painful urination
• A chronic ache in the pelvic area
• Pain during intercourse

These symptoms often have other causes, but your doctor can make sure your problem isn't an early sign of endometrial cancer.

How is endometrial cancer diagnosed?

If your doctor suspects you have endometrial cancer, she'll do a pap smear (take a sample of cells from your cervix to be inspected for abnormalities) and a transvaginal ultrasound (where a probe is inserted into your vagina and sound waves are used to detect tumors). She'll probably also do a biopsy of your uterine lining, removing a sample of tissue that will be examined for cancerous cells.

If cancer is detected, your doctor will then determine how far it has spread. There are four stages: Stage I means the cancer is confined to the uterus. In stage II, it has spread to the cervix. In stage III, it has spread to other reproductive organs. In stage IV, it's spread to elsewhere in the body. Endometrial cancer is usually diagnosed in the first stage.

What are my treatment options?

A hysterectomy -- surgery to remove the uterus -- is typically the first line of treatment. The extent of the surgery depends on whether -- and how much -- the cancer has spread. Your doctor may want to remove your cervix, fallopian tubes, and ovaries along with your uterus. She may recommend a course of radiation after the surgery as an adjunct therapy. According to guidelines published by the American College of Obstetricians and Gynecologists, postoperative radiation therapy can reduce the risk of recurrence, but it does not appear to improve overall survival rates. If adjunct radiation therapy is not done, ACOG recommends pelvic exams every three to four months for two to three years after surgery and then two times a year after that to watch for recurrence.

For those who are poor candidates for surgery, radiation therapy may be used, but it is not considered as effective. Less common complementary treatments for this cancer include hormone therapy and chemotherapy. Discuss the advantages and side effects of the possibilities with your doctor or oncologist, and be sure to get a second opinion.

Will a hysterectomy affect my sex life?

Some studies suggests that this surgery can lessen sexual desire, but others have found that it has no effect on libido or satisfaction. But if feelings of emotional loss detract from your sex life, counseling (either individual or for both you and your partner) may help.

How can I help prevent endometrial cancer?

In your reproductive years, try to maintain a normal weight through a healthy diet and regular exercise. If you have already gone through menopause and are worried about endometrial cancer, you might want to skip estrogen replacement therapy or take the kind that includes progesterone. If your doctor does recommend estrogen or tamoxifen, you should have regular follow-up visits during the treatment.

What other resources are available?

The National Cancer Institute has a wealth of booklets on cancer, including Eating Hints for Cancer Patients, Chemotherapy and You, Radiation Therapy and You, and Facing Forward: A Guide for Cancer Survivors. To order them, call the Cancer Information Service at (800) 4-CANCER, or (800) 422-6237.

The National Cancer Institute's Web site, offers materials on cancer treatment, screening, and clinical trials for health professionals and the public; it's at http://www.cancer.gov.

You can also read up on complementary approaches to the standard medical treatments. Special diets, yoga, herbal supplements, and "mind-body" techniques are among the alternative therapies that many cancer patients use in conjunction with conventional treatments. The National Center for Complementary and Alternative Medicine (NCCAM) is the lead government agency that researches these unconventional treatments. The NCCAM Web site (http://nccam.nih.gov/) has fact sheets, resources, and clinical trial information (in English and in Spanish) that can help to guide you.

Research has shown that cancer support groups can increase both the quality of life and long-term survival for people with cancer. The American Cancer Society (http://www.cancer.org ) can put you in touch with support groups in your area.

References

Endometrial Cancer Home Page, National Cancer Institute http://www.cancer.gov/CancerInformation/CancerType/endometrial

Endometrial Cancer, Oncolink, University of Pennsylvania Cancer Center

What Are the Key Statistics for Endometrial Cancer? American Cancer Society.

American Cancer Society. Endometrial Cancer.

National Cancer Institute. Endometrial Cancer Screening. February 2009.