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Endometrial cancer involves cancerous growth of the endometrium
(lining of the uterus).
Causes of endometrial cancer
Endometrial cancer is the most common type of uterine cancer. Although
the exact cause of endometrial cancer is unknown, increased levels of
estrogen appear to have a role. One of estrogen's normal functions is
to stimulate the buildup of the epithelial lining of the uterus.
Excess estrogen administered to laboratory animals produces
endometrial hyperplasia and cancer.
The incidence of endometrial cancer in women in the U.S. is 1 percent
to 2 percent. The incidence peaks between the ages of 60 and 70 years,
but 2 percent to 5 percent of cases may occur before the age of 40
years. Increased risk of developing endometrial cancer has been noted
in women with increased levels of natural estrogen.
Associated conditions include the following:
- polycystic ovarian disease
- Increased risk is also associated with the following:
- nulliparity (never having carried a pregnancy)
- infertility (inability to become pregnant)
- early menarche (onset of menstruation)
- late menopause (cessation of menstruation)
- Women who have a history of endometrial polyps or other benign growths
of the uterine lining, postmenopausal women who use
estrogen-replacement therapy (specifically if not given in conjunction
with periodic progestin) and those with diabetes are also at increased
- Tamoxifen, a drug used to treat breast cancer, can also increase the
risk of developing endometrial cancer.
Symptoms of endometrial cancer
- abnormal uterine bleeding, abnormal menstrual periods
- bleeding between normal periods in premenopausal women
- vaginal bleeding and/or spotting in postmenopausal women
- in women older than 40: extremely long, heavy, or frequent episodes of
bleeding (may indicate premalignant changes)
- lower abdominal pain or pelvic cramping
- thin white or clear vaginal discharge in postmenopausal women
Signs of endometrial cancer
Results from a pelvic examination are frequently normal, especially in
the early stages of disease. Changes in the size, shape or consistency
of the uterus and/or its surrounding, supporting structures may exist
when the disease is more advanced.
A Pap smear may be either normal or show abnormal cellular changes.
Endometrial aspiration or biopsy may assist the diagnosis.
A dilation and curettage (D and C) procedure is usually necessary for
diagnosing and evaluating the cancer.
Anemia may result, caused by chronic loss of blood. (This may occur if
the woman has ignored symptoms of prolonged or frequent abnormal
A perforation (hole) of the uterus may occur during a D and C or an
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Stages of endometrial cancer
Treatment of endometrial cancer
Women with the early stage 1 disease may be candidates for treatment
with surgical hysterectomy, but removal of the fallopian tubes and
ovaries (bilateral salpingo-oophorectomy) is also usually recommended
for two reasons. Tumor cells can spread to the ovaries very early in
the disease, and any dormant cancer cells that may be present could
possibly be stimulated by estrogen production by the ovaries.
Abdominal hysterectomy is recommended over vaginal hysterectomy
because it affords the opportunity to examine and obtain washings of
the abdominal cavity to detect any further evidence of cancer.
Women with stage 1 disease who are at increased risk for recurrence
and those with stage 2 disease are often offered surgery in
combination with radiation therapy. Chemotherapy may be considered in
some cases, especially for those with stage 3 and 4 disease.
Because endometrial cancer is usually diagnosed in the early stages
(70 percent to 75 percent of cases are in stage 1 at diagnosis; 10
percent to 15 percent of cases are in stage 2; 10 percent to 15
percent of cases are in stage 3 or 4), there is a better probable
outcome associated with it than with other types of gynecological
cancers such as cervical or ovarian cancer.
The 5-year survival rate for endometrial cancer following appropriate
- 75% to 95% for stage 1
- 50% for stage 2
- 30% for stage 3
- less than 5% for stage 4