Endometrial cancer is a cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman’s pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
Diagnosis
If you have symptoms that suggest uterine cancer, your doctor will try to find out what’s causing the problems. You may have a physical exam and blood tests. Also, you may have one or more of the following tests:
- Pelvic exam: Your doctor can check your uterus, vagina, and nearby tissues for any lumps or changes in shape or size.
- Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the pelvis. The echoes create a picture of your uterus and nearby tissues. The picture can show a uterine tumor. For a better view of the uterus, the device may be inserted into the vagina (transvaginal ultrasound).
- Biopsy: The removal of tissue to look for cancer cells is a biopsy. A thin tube is inserted through the vagina into your uterus. Your doctor uses gentle scraping and suction to remove samples of tissue. A pathologist examines the tissue under a microscope to check for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.
Grade
If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal uterine tissue. It may suggest how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.
Staging
If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if uterine cancer spreads to the lung, the cancer cells in the lung are actually uterine cancer cells. The disease is metastatic uterine cancer, not lung cancer. It’s treated as uterine cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.
To learn whether uterine cancer has spread, your doctor may order one or more tests:
- Lab tests: A Pap test can show whether cancer cells have spread to the cervix, and blood tests can show how well the liver and kidneys are working. Also, your doctor may order a blood test for a substance known as CA-125. Cancer may cause a high level of CA-125.
- Chest x-ray: An x-ray of the chest can show a tumor in the lung.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest.
- MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your uterus and lymph nodes.
In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells.
These are the stages of uterine cancer:
- Stage 0: The abnormal cells are found only on the surface of the inner lining of the uterus. The doctor may call this carcinoma in situ.
- Stage I: The tumor has grown through the inner lining of the uterus to the endometrium. It may have invaded the myometrium.
- Stage II: The tumor has invaded the cervix.
- Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the vagina or a lymph node.
- Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread to parts of the body far away from the uterus, such as the liver, lungs, or bones.
Treatment Options
Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.
Surgery
Surgery is the most common treatment for women with uterine cancer. You and your surgeon can talk about the types of surgery (hysterectomy) and which may be right for you.
The surgeon usually removes the uterus, cervix, and nearby tissues. The nearby tissues may include:
- Ovaries
- Fallopian tubes
- Nearby lymph nodes
- Part of the vagina
Surgery to remove lymph nodes may cause lymphedema (swelling) in one or both legs. Your health care team can tell you how to prevent or relieve lymphedema.
Radiation Therapy
Radiation therapy is an option for women with all stages of uterine cancer. It may be used before or after surgery. For women who can’t have surgery for other medical reasons, radiation therapy may be used instead to destroy cancer cells in the uterus. Women with cancer that invades tissue beyond the uterus may have radiation therapy and chemotherapy.
Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the treated area only.
Doctors use two types of radiation therapy to treat uterine cancer. Some women receive both types:
- External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment is usually given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each session takes only a few minutes.
- Internal radiation therapy(also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. This common method of brachytherapy may be repeated two or more times over several weeks. Once the radioactive substance is removed, no radioactivity is left in the body.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat uterine cancer that has an increased risk of returning after treatment. For example, uterine cancer that is a high grade or is Stage II, III, or IV may be more likely to return. Also, chemotherapy may be given to women whose uterine cancer can’t be completely removed by surgery. For advanced cancer, it may be used alone or with radiation therapy.
Chemotherapy for uterine cancer is usually given by vein (intravenous). It’s usually given in cycles. Each cycle has a treatment period followed by a rest period.
Hormone Therapy
Some uterine tumors need hormones to grow. These tumors have hormone receptors for the hormones estrogen, progesterone, or both. If lab tests show that the tumor in your uterus has these receptors, then hormone therapy may be an option.
Hormone therapy may be used for women with advanced uterine cancer. Also, some women with Stage I uterine cancer who want to get pregnant and have children choose hormone therapy instead of surgery. The most common drug used for hormone therapy is progesterone tablets.
Visit the National Cancer Institute where this information and more can be found about Endometrial Cancer including side effects of treatments, support information and more. Or ask your cancer care team questions about your individual situation.
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