Endometrial Cancer

What is endometrial cancer?

Endometrial cancer, or cancer of the endometrium, is a cancer that develops in the inner lining of the uterus (womb). This lining is called the endometrium. Cancer is the uncontrolled growth of cells that invade and cause damage to surrounding tissue.

What are the risk factors for endometrial cancer?

The exact cause of endometrial cancer is not known, but certain risk factors are linked to the disease. Most of the known risk factors are linked to the balance between the hormones estrogen and progesterone. Some risk factors include:

  • Obesity (being very overweight) – Fat tissue in the body can change some other hormones into estrogen. Having more fat tissue can increase a woman’s estrogen levels and her risk for developing endometrial cancer.
  • History of not being able to become pregnant or having never given birth – Women who have not been pregnant have a higher risk due to increased exposure to estrogen.
  • Use of tamoxifen – This drug, which is used to treat women with breast cancer, acts like estrogen in the uterus and can increase the risk of endometrial cancer.
  • Estrogen replacement therapy (ERT) – This therapy, involving the use of female hormone estrogen to offset the effects of menopause, can increase endometrial cancer risk if progesterone is not used to protect against precancerous changes in the endometrium.
  • Ovarian diseases – Women who have certain ovarian tumors have higher than normal estrogen levels and lower levels of progestins. The increase in estrogen compared to progestins can increase a woman’s chance of getting endometrial cancer.
  • A diet high in animal fat – A high-fat diet can increase the risk of several cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity—a confirmed endometrial cancer risk factor.
  • Diabetes – Diabetes has been linked to weight, but some studies suggest that diabetes by itself could be a risk factor for endometrial cancer.
  • Age – As females get older, the likelihood of endometrial cancer increases. Most endometrial cancers occur in women age 50 or older.
  • Early menstruation – If monthly periods begin before age 12, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Late menopause – If menopause occurs after age 50, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Total length of menstruation span – The span of menstruation might be a more important factor than the age at which periods started or ended.
  • Family history – Endometrial cancer risk is increased some families who are also at risk to develop a certain type of colon cancer.
  • Earlier pelvic radiation therapy – Radiation used to treat some other cancers can damage the DNA of cells, increasing the risk of a second type of cancer.

What are the symptoms of endometrial cancer?

The following symptoms might occur with endometrial cancer or other conditions:

  • Vaginal bleeding between normal periods in pre-menopausal women
  • Vaginal bleeding or spotting in post-menopausal women, even a small amount
  • Lower abdominal pain or pelvic cramping
  • Thin white or clear discharge in post-menopausal women
  • Extremely long, heavy or frequent vaginal bleeding episodes in women over 40

How is endometrial cancer diagnosed?

If a woman has any of the symptoms of endometrial cancer described above, she should visit her doctor. The doctor will ask her about her symptoms, risk factors, and family medical history. The doctor will also perform a general physical exam and an exam of the pelvis. Following are some of the procedures that might be used in diagnosing endometrial cancer:

  • Endometrial biopsy — During this procedure, a sample of endometrial tissue is obtained through a very thin flexible tube inserted into the uterus through the cervix. The tube removes a small amount of endometrium using suction.
  • Transvaginal ultrasound or sonography — A transvaginal sonogram uses sound waves to create images of the uterus.
  • Dilation and curettage (D & C) – This procedure is done in the operating room. During this procedure, a special surgical instrument is used to scrape tissue from inside the uterus. Increasingly, in-office hysteroscopy is used to evaluate the endometrium.
  • Testing of endometrial tissue – Endometrial tissue samples removed by biopsy or D & C are examined under the microscope to determine whether cancer is present.
  • CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography) — This is a scan that involves taking series of detailed pictures of areas inside the body. The images are created by a computer linked to an X-ray machine.
  • MRI (also called magnetic resonance imaging) — This is a procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.
  • CA-125 assay — This blood test can measure the level of CA-125, a substance that sometimes is found in an increased amount in the blood, other body fluids, or tissues. A particular level of CA-125 might suggest the presence of some types of cancer.