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 the PDQ summary on
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.
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
Key Points for This Section
There are different types of treatment for patients with endometrial
cancer.
Three types of standard treatment are used:
Surgery
Chemotherapy
Radiation therapy
Hormone therapy
Other types of treatment are being tested in clinical trials.
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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site. 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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
Treatment Options by
Stage
Stage I Endometrial Cancer
Treatment of stage I endometrial cancer may include the following:
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.
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.
Radiation therapy alone for patients who cannot have surgery.
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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
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:
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.
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.
Radiation therapy alone for patients who cannot have surgery.
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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
Stage IIB
Treatment of stage IIB endometrial cancer may include the following:
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.
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.
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:
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.
Radiation therapy alone for patients who cannot have surgery.
Hormone therapy for patients who cannot have surgery or radiation
therapy.
Clinical trials of new therapies.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
Stage IV Endometrial Cancer
Treatment of stage IV endometrial cancer may include the following:
Internal radiation therapy and external-beam radiation therapy.
Hormone therapy.
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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
Treatment Options for Recurrent Endometrial Cancer
Treatment of recurrent endometrial cancer may include the following:
Radiation therapy as palliative therapy to relieve symptoms and improve
the patient's quality of life.
Hormone therapy.
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.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site.
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