Endometrial Cancer: Key Q&A

Reviewed By:
Martin E. Liebling, M.D., FACP

How common is endometrial cancer?

Endometrial cancer is the fourth most common cancer in American women and the most common female reproductive cancer, according to the American Cancer Society (ACS). The ACS estimates that more than 40,000 American women will be diagnosed with endometrial cancer in 2008. The death rate from this disease declined for 15 years until the early 1990s and has remained stable since then.

Is endometrial cancer the only kind of uterine cancer?

No. Although it is commonly called uterine cancer, endometrial cancer is only one type of uterine cancer. Other, less common, forms of uterine cancer also exist.

Do any different kinds of endometrial cancer exist?

Yes. According to the ACS, more than 90 percent of all endometrial cancers develop from a layer of glandular cells called the endometrial epithelium. Cancers of these cells are called adenocarcinomas. Sometimes these glandular cells are accompanied by squamous cells, a type of cell found on the skin and the surface of the cervix. Several subtypes of adenocarcinomas can be defined based on whether or not these squamous cells are cancerous. Other, less common types of endometrial cancer include clear cell and papillary serous adenocarcinomas. These are different from most endometrial cancers because they tend to develop and spread more rapidly.

Does the presence of uterine fibroids signify cancer?

No. Fibroids are benign tumors that often develop in the wall of the uterus. They are not cancerous, but may occasionally become malignant. However, they can require a hysterectomy or other treatment. Fibroids are often referred to as tumors or growths by medical professionals. Women should understand that these tumors do not mean cancer. If a hysterectomy is performed for fibroids, it is for other medical reasons, not the removal of cancer.

What causes endometrial cancer?

The exact cause of endometrial cancer is not known. However, the female hormone estrogen seems to play an important role. The ovaries are sex glands that produce eggs and usually produce two kinds of female hormones, estrogen and progesterone. The balance between these hormones changes every month during a woman's menstrual cycle, producing a woman's monthly periods and maintaining the health of the endometrium. Increased risk of endometrial cancer can come from any shift toward more estrogen in the hormonal balance, including starting menstruation at an early age, late menopause and few or no pregnancies. Obesity is also a risk factor because fat tissue can increase the body's estrogen levels.

Does diabetes increase a woman's risk of endometrial cancer?

Yes. For unknown reasons, women with diabetes are more likely to develop endometrial cancer than those without diabetes. Some doctors attribute this increased cancer risk to excess body weight because many people with type 2 diabetes are overweight. However, this theory does not explain why women with type 1 diabetes, which is not characterized by excess body weight, also have higher endometrial cancer rates.

Why would tamoxifen increase my risk of endometrial cancer if it is an anti-estrogen medication?

Tamoxifen is used to treat and reduce the risk of breast cancer. Even though tamoxifen is called an anti-estrogen, it functions like an estrogen in the uterus. Therefore, women taking tamoxifen have a slightly increased risk of developing endometrial cancer. Women who decide to take tamoxifen should visit their gynecologist regularly and immediately report any signs or symptoms of endometrial cancer, which affects about one out of every 500 users of tamoxifen. Tamoxifen is often prescribed to treat or help prevent breast cancer.

What is the most common early symptom of endometrial cancer?

According to the ACS, approximately 90 percent of women diagnosed with endometrial cancer experience postmenopausal or unusual vaginal spotting or bleeding. In addition, some women experience unusual vaginal discharge that is not bloody.

What is the most common test for endometrial cancer?

Endometrial biopsy is the most common test for endometrial cancer. In this procedure, a thin, flexible tube is inserted through the cervix into the uterus and suction is used to obtain a sample of endometrial tissue. This procedure takes about a minute and is typically performed in a medical office. A patient may experience pain that resembles severe menstrual cramps, which usually can be relieved with over-the-counter pain medication.

How is endometrial cancer usually treated?

Complete abdominal hysterectomy is the primary surgical treatment for endometrial cancer. This is the removal of the entire uterus, cervix, fallopian tubes and ovaries through an abdominal incision. This surgery requires general or regional anesthesia, and typically requires a three-to five-day hospitalization. Complete recovery generally takes approximately four to six weeks. Depending on the stage of the cancer, radiation therapy or chemotherapy also may be used.

How often should I schedule follow-up appointments?

Most doctors recommend that you schedule follow-up visits every three to six months for the first three years after treatment for endometrial cancer. Approximately 75 percent of recurrences are detected during this time. After three years, the likelihood of recurrence is reduced, and follow-up visits are typically scheduled semiannually.

 

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