This section will take you through the basics of what you need to know about endometrial cancer. It will introduce you to the people who may be part of your treatment team. Also, it will identify the different types of treatments for endometrial cancer. Hopefully, this information will help prepare you to talk with your treatment team and to feel more confident about your treatment plan.
Uterine/endometrial cancer overview
Cancer occurs when cells in an area of the body grow abnormally. Endometrial cancer is cancer of the lining of the uterus (called the endometrium). The uterus (or womb) is where a baby grows during pregnancy. The fallopian tubes and ovaries are on both sides of the uterus. The cervix is the mouth of the uterus (or womb) that connects it to the vagina. These reproductive organs are located in the pelvis, close to the bladder and rectum.
The endometrium is the inside lining of the uterus that grows each month during the childbearing years. It does this so that it will be ready to support an embryo if a woman becomes pregnant. If pregnancy does not occur, the endometrium is shed during the menstrual period.
Uterine/endometrial cancer symptoms
The most common warning sign for uterine cancer, including endometrial cancer, is abnormal vaginal bleeding. Recognition of this symptom often affords an opportunity for early diagnosis and treatment. In older women, any bleeding, spotting, or brownish discharge after menopause may be a symptom of endometrial cancer. Younger women are also at risk and should note irregular or heavy vaginal bleeding as this can be a symptom of endometrial cancer.
Medical evaluation and diagnosis
When a woman experiences concerning symptoms, a pelvic exam, including a rectovaginal exam, and a general physical should be performed. If the exam is abnormal or she presented for abnormal vaginal bleeding, the woman should undergo an endometrial biopsy, an ultrasound and/or a D&C (dilation and curettage) procedure.
If endometrial cancer is suspected or diagnosed, it is important to seek care first from a gynecologic oncologist—medical doctors with specialized training in treating gynecologic cancers who can manage your care from diagnosis to completion of treatment. Use our Seek a Specialist tool to find a gynecologic oncologist in your area.
During your treatment, you will come in contact with many health care professionals—these people make up your treatment team. They will work with each other and you to provide the special care you need. Learn more about your treatment team.
Though the majority of endometrial cancers are confined to the uterus, your treatment team may recommend more tests to determine if the cancer has spread. Additionally, specific procedures during surgery may be performed to determine the extent of disease. This process is called staging. Staging helps to determine the exact extent of your cancer and the best treatment plan for you.
Following surgery, your cancer will be categorized into Stage I, II, III, or IV. The cancer will also be assigned a grade. Grade refers to how abnormal the cells appear under a microscope. Low grade tumors, also called grade 1, have features that resemble normal endometrium cells. In contrast, in high grade tumors (grade 3) the microscopic appearance is greatly altered from normal.
Uterine/endometrial cancer stages
Stage I: The cancer is found only in the uterus. It has not spread to the cervix (opening of the uterus).
Stage II: The cancer has spread from the uterus to the cervix (opening of the uterus), but it has not gone any farther.
Stage III: The cancer has spread outside the uterus itself. It may have spread to nearby lymph nodes, ovaries, fallopian tubes, and vagina, but it has not gone outside the pelvic area. It has not spread to the bladder or rectum.
Stage IV: The cancer has spread into the bladder or rectum and/or to other body parts outside the pelvis, such as the abdomen or lungs.
Uterine/endometrial treatment and side effects
Endometrial cancer may be treated with surgery, radiation therapy, chemotherapy, or hormonal therapy. Depending on your situation, your treatment team may recommend using a combination of therapies to treat your cancer.
All treatments for endometrial cancer have side effects, but most side effects can be managed or avoided. Treatment may affect various aspects of your life, including your function at work, home, intimate relationship, and deeply personal thoughts and feelings.
Before beginning treatment, it is important to learn about the possible side effects and talk with your treatment team members about your feelings or concerns. They can prepare you for what to expect and tell you which side effects should be reported to them immediately. They can also help you find ways to manage the side effects that you experience.
Understanding the goals of treatment
As you begin your treatment, make sure that you understand what to expect. Is this for cure? What are the chances of cure? If there is no cure, will the treatment make me live better or longer? It is very important to understand the truth about what to expect from the treatment—and what are the potential costs of side effects, expenses, etc.—so that you can make the best decisions for yourself and the life you want to lead.
Uterine/endometrial cancer treatment options
The most common treatment for endometrial cancer is surgery. Several types of surgery can be performed.
Hysterectomy (total) involves removal of the uterus, cervix, fallopian tubes, and ovaries and is the standard procedure for treating endometrial cancer. The uterus, cervix, fallopian tubes, and ovaries can be removed in one of two ways:
- Total abdominal hysterectomy: The uterus, cervix, fallopian tubes, and ovaries are taken out through an incision in the abdomen.
- Minimally invasive hysterectomy (laparoscopic-assisted vaginal hysterectomy and robotic-assisted laparoscopic hysterectomy): The uterus, cervix, fallopian tubes and ovaries are taken out through the vagina with the assistance of a laparoscope or robotic device (with a camera attached) that is placed through the abdomen via a small incision.
For patients with multiple medical problems who are not healthy enough to undergo an extensive surgical procedure, a vaginal hysterectomy is another option, although some patients are not surgical candidates. In most cases, both ovaries and both fallopian tubes must also be removed. This procedure is called a bilateral salpingo-oophorectomy.
In addition to these procedures, lymph nodes in the abdomen and pelvis may also be removed to see whether they contain cancer.
Side effects of surgery
Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing any pain. Other possible side effects are:
- Nausea and possible vomiting
- Wound problems
- Swelling of the legs caused by lymphedema
- Blood clots
- Difficulty urinating or constipation
Radiation therapy (also called radiotherapy) uses high-energy x-rays, or other types of radiation, to kill cancer cells or stop them from growing.
Radiation therapy can be used:
- Instead of surgery to treat early-stage endometrial cancer, although this is uncommon.
- Before surgery, to shrink the cancer (called neoadjuvant therapy).
- After surgery, to kill any cancer cells that may have spread to other tissues within the pelvis (called adjuvant therapy).
Two types of radiation therapy are used to treat endometrial cancer:
- External radiation therapy uses a machine that directs the x-rays toward a precise area on the body. The therapy is usually given every day for about 6 weeks. It does not hurt and only takes a few minutes each day. You can be treated at a clinic, hospital or radiation oncology office.
- Internal radiation therapy (also called brachytherapy) involves placing a small capsule of radioactive material inside the vagina. This procedure can be performed either on an inpatient or outpatient basis, depending on your treatment team’s recommendation.
Side effects of radiation
The side effects of radiation therapy depend on the dose used and the part of the body being treated. Common side effects include:
- Dry, reddened skin in the treated area
- Discomfort when urinating
- Narrowing of the vagina
Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects that you experience. They can help you find ways to manage them.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for endometrial cancer is usually given intravenously (injected into a vein). You may be treated in the doctor’s office or the outpatient part of a hospital.
The drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating endometrial cancer that has spread beyond the uterus. However, the same drugs that kill cancer cells may also affect healthy cells.
Another method of delivering chemotherapy drugs is intraperitoneal (IP) therapy, which is the delivery of anti-cancer drugs directly into the peritoneal space (abdominal cavity), the space that lies between the abdominal muscles and abdominal organs.
To limit the damage to healthy cells, chemotherapy is usually given in cycles. Periods of chemotherapy are alternated with rest periods, during which no chemotherapy is given. Some side effects may still occur.
Most women with endometrial cancer receive intravenous chemotherapy that is usually given after surgery, but in some cases, it may be given prior to hysterectomy surgery. Commonly used chemotherapy drugs include: carboplatin, cisplatin, paclitaxel, docetaxel, doxorubicin, and others. These medications are given alone or in combination. The combination of carboplatin and paclitaxel is the most commonly used therapy for patients requiring chemotherapy for endometrial cancer.
Side effects of chemotherapy
Each person responds to chemotherapy differently. Some people may have very few side effects, while others experience several. Most side effects are temporary. They include:
- Loss of appetite
- Mouth sores
- Increased chance of infection
- Bleeding or bruising easily
- Hair loss
Some types of endometrial cancer have hormone receptors that can be targeted to prevent their growth. In such cases, hormone therapy is a treatment option. Hormone therapy can block these receptors and inhibit female hormones as a way of preventing endometrial cancer cells from getting or using the hormones they may need to grow. It is usually taken as a pill but can be given as a shot.
Side effects of hormone therapy
The side effects of hormone therapy depend on the type of hormones being used. Some women retain fluid and have a change in appetite or have hot flashes. Other hormones can sometimes cause blood clots.
We’re excited to share news about immunotherapies, one of the most promising treatments to emerge for gynecologic cancer. Before immunotherapies, cancer treatment included surgery, radiation, chemotherapy and hormonal therapy. Immunotherapies are showing benefits in prolonged disease control, or longer survival rates.
Pembrolizumab is one of several new immunotherapies developed recently and has been approved to treat certain types of gynecologic cancers, including uterine and cervical. Pembrolizumab could provide benefit for up to 30 percent of patients with advanced endometrial cancer. Recent reports also show that some women with chemotherapy-resistant GTN (gestational trophoblastic neoplasia) respond well to immunotherapies when multiple cycles of chemotherapy have failed.
PARP inhibitors are another recent breakthrough in cancer treatment. PARP inhibitors are being developed for multiple indications, the most significant being the treatment of ovarian cancer. Experts say they are changing the landscape for ovarian cancer treatment.
Another innovative treatment method, sentinel lymph node mapping, is changing the standard of care for some gynecologic cancers. Sentinel lymph node mapping can safely replace pelvic lymphadenectomy in staging certain types of cancer such as endometrial. And for patients with early stage vulvar cancer, sentinel lymph node biopsy has become the new standard of care.
Genetic testing is another area in gynecologic oncology that continues to evolve. Genetic tests now screen not only for BRCA1 and BRAC2, the most common gene mutations, but for a complete panel of genes less frequently associated with the risk for developing breast or ovarian cancer. Researchers also are working to develop a test that can diagnose ovarian cancer in its earliest stages.
Survival rates for many types of gynecologic cancer continues to climb. Advances are being made every year. But funding for clinical trials has been eroded. Rare cancers are challenging to study due to their low incidence rates.
The SGO and FWC remain undeterred, however, in our collective goal to continue to advance innovation to eradicate gynecologic cancer. Please click on one of the major cancer types to discover more about recent advances made in the prevention, detection and treatment of gynecologic cancer.
This section provided through a generous unrestricted educational sponsorship from Eisai. Content excludes editorial input.
Follow up after treatment
The frequency of exams, imaging, and blood tests varies because of many factors. Typically, you will be followed every 3 to 6 months for the first 2 years with at least an examination of the vagina and rectum to detect any recurrences early at the most curable stage. These examinations will occur less frequently thereafter. In addition, imaging studies such as x-rays, CT scans, or MRIs may be periodically performed, especially if you have any new pains or symptoms. The top of the vagina is the most common site of recurrent endometrial cancer, and patients will typically present with vaginal bleeding.
If your cancer recurs, there are several options for treatment. These include repeat surgery, re-treatment with the same chemotherapy given initially, treatment with a different type of agent (chemotherapy, hormonal, or targeted therapy) and sometimes radiation therapy. As each recurrence will be different, it is important to discuss your individual situation with your team. It is also important to investigate whether there is a clinical trial that is appropriate for you. Don’t be afraid to seek a second opinion.
Isolated vaginal recurrences can often be cured so early detection and recognition of abnormal symptoms is critical. Notify your physician if you develop abnormal bleeding or other unusual pelvic symptoms following treatment for endometrial cancer.
Importance of participation in clinical trials
There are many ongoing clinical trials studying new and better ways to treat endometrial cancer. Many treatment options are available today because women diagnosed with endometrial cancer were willing to participate in prior clinical trials.
Clinical trials are designed to test some of the newest and most promising treatments for endometrial cancer. The Foundation for Women’s Cancer (FWC) partners with NRG Oncology (formerly Gynecologic Oncology Group), part of the National Cancer Institute cooperative group working only on gynecologic cancer clinical trials, and others to make information about current clinical trials available. For more information about clinical trials available for enrollment, visit ClinicalTrials.gov.
Living with Cancer Therapy
Regardless of the treatment prescribed, you are likely to experience fatigue, frequent medical appointments and times when you do not feel well.
Survivorship is about living, and is something you and your care team should be thinking about from the time you are diagnosed.