The most common symptom of endometrial cancer is postmenopausal bleeding—in essence, having menstrual-type bleeding after cessation of menses, or menopause.
Whether postmenopausal bleeding is limited to simple spotting or involves heavy vaginal bleeding, bleeding after the cessation of menses is not a normal occurrence. A woman should contact her doctor immediately.
For pre-menopausal women, irregular menses, especially in women with polycystic ovary syndrome (PCOS), can also be a symptom of endometrial cancer, though it is most often explained by noncancerous conditions.
Abnormal vaginal bleeding in obese women who are taking unopposed estrogen or tamoxifen with HNPCC may also be a symptom of endometrial cancer.
Less common symptoms include pelvic pain, bloating or cramping, and the presence of a pelvic mass, especially one that is growing in size.
Most uterine cancer cases are diagnosed with a biopsy of the endometrial canal. This is typically performed in the office by passing a narrow suction catheter through the cervix into the uterus. It does not require anesthesia, though it may cause brief cramping.
Some women cannot be biopsied in the office and need to have an outpatient surgical dilation and curettage (D&C) procedure. The D&C procedure is often performed with a hysteroscopy, which involves the use of a small camera to view the uterine cavity.
The biopsy sample is sent to a pathologist. If cancer is detected, the pathologist can determine the grade and cell types, which are preliminary indicators of how aggressively the cancer may behave. For example, grade 1 cancers tend to be diagnosed at an earlier stage and cured more often than grade 3, serous or clear cell tumors. However, this is a generalization.
The stage of uterine cancer at the time of diagnosis is the single most important factor in determining cancer treatment and prognosis. Historically, uterine cancers were staged with a physical examination. In 1988, surgical staging became the standard.
- Stage I: Cancer is confined to the body, or corpus, of the uterus .
- Stage II: Cancer has spread to the uterine cervix.
- Stage III: Cancer has spread to the tubes and ovaries, vagina or lymph nodes.
- Stage IV: Cancer has invaded the lining of the bladder or colon, or has spread to the upper abdomen, lung or groin lymph nodes.
Surgery is not only required to determine the stage of the cancer, it is also the most important treatment method for women with uterine cancer.
The minimum surgical procedure to fully stage a uterine cancer includes a complete hysterectomy, including removal of fallopian tubes and ovaries, as well as lymph nodes along the major blood vessels of the pelvis and abdomen. Only gynecologic oncologists are specifically trained to perform this procedure.
To access the lymph nodes, this surgery is typically performed through a vertical incision. Advances in minimally invasive surgery, however, have enabled oncologists to perform this operation through several small incisions instead.
Patients treated with minimally invasive techniques, which include standard laparoscopy and robot-assisted surgery, experience less postoperative pain, fewer perioperative complications—particularly those associated with incisional healing—and better postoperative body image than patients treated with open surgery.
Minimally-invasive surgical techniques are readily available to patients treated at UC Irvine.
Historically, chemotherapy for uterine cancer has been less effective for uterine cancer than for ovarian cancer. Its use is currently limited to women with advanced-stage (III and IV) and recurrent endometrial cancer. The use of chemotherapy in endometrial cancer is rapidly evolving, however, because we are better able to identify which patients are likely to benefit most from chemotherapy.
We are also investigating novel therapies that target many of the abnormalities specific to endometrial cancer. Many of these revolutionary chemotherapy treatments are available only to patients enrolled in clinical trials. Our gynecologic oncologists actively participate in high-priority clinical trials studying these new therapies.
Radiation therapy is most commonly used to help reduce the recurrence of uterine cancer in women who are at risk based on surgical findings. Typically, but not always, this involves deep uterine invasion by the cancer cells or their spread to the cervix or vagina.
Radiation therapy also may be a primary treatment for women who are poor surgical candidates, either because the cancer is not surgically removable or because of medical conditions that make surgery an unsafe option. A gynecologic oncologist can determine who would benefit from radiation.
Management of recurrent disease
Recurrent endometrial cancer is a complex problem and every patient has a different set of circumstances. These factors include the number and location of site(s) of recurrence, the time interval since the last treatment, the type of previous treatments (radiation, chemotherapy or both), and the patient’s overall health and activity level at the time of recurrence.
Many women are eligible for clinical trials, especially those investigating novel chemotherapies. Gynecologic oncologists are experts at interpreting and integrating all of these factors to craft an optimal treatment plan for each patient.
Questions? Please call us at 714-456-8000.
Among the known risk factors for endometrial uterine cancers are:
The incidence of uterine cancer increases with age. More than half of cases are diagnosed after menopause or after age 55. Women under the age of 55 who have other risk factors, however, can develop uterine cancer.
Obesity is a strong risk factor for endometrial cancer. Women who are obese are two to four times more likely to develop uterine cancer than women of normal weight. It is unclear why obesity is associated with uterine cancer, but high estrogen levels, insulin resistance and inflammation are being studied as potential mediators.
Most women who use hormone therapy of any kind will not get uterine cancer, however, those who use unopposed estrogen are at higher risk than the general population. Using unopposed estrogen means taking an estrogen-containing pill, supplement or cream that does not contain the estrogen-balancing hormone, progesterone. This also applies to bio-identical hormone preparations.
Additionally, non-hormonal medications that affect how the body utilizes estrogen can increase the risk of endometrial cancer. Tamoxifen, used to prevent breast cancer recurrence, is one such medication. Other estrogen-modulating drugs, such as raloxifene and the aromatase inhibitors (anastrozole, exemestane and letrozole) are much less likely to be associated with uterine cancer.
Polycystic ovarian syndrome (PCOS)
PCOS is a metabolic disorder that causes ovulation irregularities. Its name is derived from a common ultrasound finding in women who have ovulation irregularities or who don’t ovulate due to high production of estrogen and lack of timed progesterone production by the ovaries.
These women also can have abnormal hair growth, infertility and be obese. The body’s over-production of estrogen and lack of progesterone create a similar scenario of excessive unopposed estrogen, coupled with obesity, increasing the risk of endometrial cancer.
Complex atypical hyperplasia
Complex atypical hyperplasia of the uterus is an abnormal thickening of the uterine lining. Women who are obese are at higher risk for this condition, but it can occur in any woman. This condition can be managed with medications, but 35 percent to 40 percent of women with this condition actually have endometrial cancer.
Family history does not necessarily increase a woman’s risk of endometrial cancer unless a genetic mutation is present. Women who are carriers of mutations in one of several genes that protect against colon and uterine cancer are at risk. This disorder is commonly known as hereditary non-polyposis colorectal cancer (HNPCC) or Lynch II syndrome.
Screening for these genetic mutations is recommended in women who have three or more family members with cancers of the colon, endometrium, small intestine, ureter or ovary in two successive generations (at least one a first-degree relative). Only one family member is required if that person was under age 50 at the time of cancer diagnosis. Genetic screening involves a DNA blood test that can be very costly. The best person to test is the family member with the cancer diagnosis.