Endometrial Cancer


General Information

What is endometrial cancer?

Endometrial cancer is a disease in which malignant (cancer) cells form in the tissues of the endometrium. The endometrium is the lining of the uterus. The uterus is a hollow, muscular organ in a woman's pelvis. The uterus is where a fetus grows. In most nonpregnant women, the uterus is about 3 inches long.

Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus. Refer to Uterine Sarcoma Treatment for more information.

Taking tamoxifen for breast cancer or taking estrogen alone (without progesterone) can affect the risk of developing endometrial cancer.
Endometrial cancer may develop in breast cancer patients who have been treated with tamoxifen. A patient taking this drug should have a pelvic examination every year and report any vaginal bleeding (other than menstrual bleeding) as soon as possible. Women taking estrogen (a hormone that can affect the growth of some cancers) alone have an increased risk of developing endometrial cancer. Taking estrogen in combination with progesterone (another hormone) does not increase a woman's risk of this cancer.

Possible signs of endometrial cancer include unusual vaginal discharge or pain in the pelvis. A woman should see her doctor if any of the following problems occur:

-Bleeding or discharge not related to menstruation (periods).
-Difficult or painful urination.
-Pain during sexual intercourse.
-Pain in the pelvic area.

Tests that examine the endometrium are used to detect (find) and diagnose endometrial cancer.
Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. For this reason, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. One of the following procedures may be used:

Endometrial biopsy: A procedure in which a thin flexible tube is inserted through the cervix into the uterus. The tube is used to gently scrape small amounts of tissue from the lining of the uterus. The tissue samples of the endometrium are then sucked out through the tube.

Dilatation and curettage (D&C): A procedure in which the cervix is dilated so that a surgical instrument can be inserted into the uterus to remove larger samples of tissue.

Certain factors affect treatment options and prognosis (chance of recovery). The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the endometrium only, involves the whole uterus, or has spread to other places in the body), the type of cancer, the size of the tumor, and the patient's general health. The chance of recovery may also depend on how the cancer cells look under a microscope and whether they are affected by progesterone. Endometrial cancer is highly curable.

Stages of Endometrial Cancer

After endometrial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the uterus or to other parts of the body.
The process used to find out whether the cancer has spread within the uterus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. Certain tests and procedures are used in the staging process. A hysterectomy (an operation in which the uterus is removed) will usually be done to help find out how far the cancer has spread.

The following stages are used for endometrial cancer:

Stage I
In stage I, cancer is found in the uterus only. Cancer is not found in the cervix (the canal between the uterus and the vagina). Stage I is divided into stages IA, IB, and IC, based on how far the disease has spread from the endometrium into the muscles of the uterus.

Stage II
In stage II, cancer has spread from the uterus to the cervix, but not beyond the cervix. Stage II is divided into stages IIA and IIB, based on how far the disease has spread into the cervix.

Stage III
In stage III, cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on whether cancer has spread to the connective tissue holding the uterus in place, the ovaries, fallopian tubes, vagina, and lymph nodes in the pelvis. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.)

Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on whether cancer has spread to the lining of the bladder (the sac that holds urine), to the bowel, or to lymph nodes or other parts of the body beyond the pelvis.

Recurrent Endometrial Cancer
Recurrent endometrial cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the pelvis, in lymph nodes in the abdomen, or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with endometrial cancer.
Different types of treatment are available for patients with endometrial cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery
Surgery (removing the cancer in an operation) is the most common treatment for endometrial cancer. The following surgical procedures may be used:

Hysterectomy and bilateral salpingo-oophorectomy: This surgery involves removing the uterus, fallopian tubes, and ovaries through an incision in the abdomen. Pelvic lymph nodes may also be removed to see if they contain cancer cells.

Radical hysterectomy: This surgery involves removing the cervix, uterus, fallopian tubes, ovaries, and part of the vagina. Lymph nodes in the area may also be removed.
Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered radiation therapy or hormone treatment. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Endometrial cancer is treated with internal and external radiation therapy. Radiation may be used alone or in addition to surgery, chemotherapy, or both.

Hormone therapy
Hormones are chemicals produced by glands in the body and circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way the hormones work or by surgically removing organs that make hormones, such as the ovaries.

Other types of treatment are being tested in clinical trials.

Treatment Options By Stage

Stage I Endometrial Cancer
Treatment of stage I endometrial cancer may include the following:

1.Hysterectomy (surgery to remove the uterus) and bilateral salpingo-oophorectomy (surgery to remove both ovaries and fallopian tubes). Lymph nodes in the pelvis and abdomen may also be removed for examination under a microscope to check for cancer cells.
2.Hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen, followed by internal radiation therapy or external-beam radiation therapy to the pelvis. After surgery, a plastic cylinder containing a source of radiation may be placed in the vagina to kill any remaining cancer cells.
3.Radiation therapy alone for patients who cannot have surgery.
4.Clinical trials of radiation therapy and/or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Endometrial Cancer
Treatment of stage IIA endometrial cancer is usually a combination of therapies, including internal and external radiation therapy and surgery.

Stage IIA
Treatment of stage IIA endometrial cancer may include the following:

1.Hysterectomy (surgery to remove the uterus) and bilateral salpingo-oophorectomy (surgery to remove both ovaries and fallopian tubes). Lymph nodes in the pelvis and abdomen may also be removed for examination under a microscope to check for cancer cells.
2.Hysterectomy and bilateral salpingo-oophorectomy, with or without removal of lymph nodes in the pelvis and abdomen, followed by internal radiation therapy or external-beam radiation therapy to the pelvis. After surgery, a plastic cylinder containing a source of radiation may be placed in the vagina to kill any remaining cancer cells.
3.Radiation therapy alone for patients who cannot have surgery.
4.Clinical trials of radiation therapy and/or chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IIB
Treatment of stage IIB endometrial cancer may include the following:

1.Hysterectomy (surgery to remove the uterus), bilateral salpingo-oophorectomy (surgery to remove both ovaries and fallopian tubes), removal of lymph nodes in the pelvis and abdomen for examination under a microscope to check for cancer cells, followed by radiation therapy.
2.Internal radiation therapy and external-beam radiation therapy, followed by hysterectomy and bilateral salpingo-oophorectomy, and removal of lymph nodes in the pelvis and abdomen for examination under a microscope to check for cancer cells.
3.Radical hysterectomy (surgery to remove the cervix, uterus, fallopian tubes, ovaries, and part of the vagina) with or without removal of lymph nodes in the pelvis for examination under a microscope to check for cancer cells.

Stage III Endometrial Cancer
Treatment of stage III endometrial cancer may include the following:

1.Radical hysterectomy (surgery to remove the cervix, uterus, fallopian tubes, ovaries, and part of the vagina), removal of lymph nodes in the pelvis for examination under a microscope to check for cancer cells, followed by internal radiation therapy and external-beam radiation therapy.
2.Radiation therapy alone for patients who cannot have surgery.
3.Hormone therapy for patients who cannot have surgery or radiation therapy.
4.Clinical trials of new therapies.

Stage IV Endometrial Cancer
Treatment of stage IV endometrial cancer may include the following:

1.Internal radiation therapy and external-beam radiation therapy.
2.Hormone therapy.
3.Clinical trials of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Endometrial Cancer
Treatment of recurrent endometrial cancer may include the following:

1.Radiation therapy as palliative therapy to relieve symptoms and improve the patient's quality of life.
2.Hormone therapy.
3.Clinical trials of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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