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Endometrial Cancer

The most common type of uterine cancer, also called endometrial cancer, involves the development of abnormal cells in the lining of the uterus, called the endometrium. It is the fourth most common cancer among women in the U.S. and the most common gynecologic cancer, with about 45,000 new cases and about 8,400 deaths reported each year in this country. Uterine cancer is usually found in its earliest stage before it has spread, and typically develops after menopause. The primary treatment is removal of the uterus plus the cervix, ovaries, and fallopian tubes through surgery, called a hysterectomy with bilateral salpingo-oophorectomy. Chemotherapy, radiation therapy, and hormone therapy may be used as well. It is more common in women over age 50. Some uterine cancer symptoms may include: vaginal bleeding after menopause or pain and pressure in your pelvic area.

Risk factors for endometrial cancer
  • Diabetes
  • Estrogen replacement therapy without the use of progesterone
  • History of endometrial polyps or other benign growths of the uterine lining
  • Infertility (inability to become pregnant)
  • Infrequent periods
  • Tamoxifen, a drug for breast cancer treatment
  • Never being pregnant
  • Obesity
  • Polycystic ovarian syndrome (PCOS)
  • Starting menstruation at an early age (before age 12)
  • Starting menopause after age 50
Associated conditions include the following:
Symptoms
  • Abnormal uterine bleeding, abnormal menstrual periods
  • Bleeding between normal periods prior to menopause
  • Vaginal bleeding or spotting after menopause
  • Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
  • Lower abdominal pain or pelvic cramping
  • Thin, white or clear vaginal discharge after menopause

Any condition that elevates hormone levels and increases the number of endometrial cells may put women at increased risk. Estrogen replacement therapy, some ovarian tumors, obesity, having had few or no children, and late menopause all are associated with elevated hormone levels.

Diagnosis

Your health care provider may use several tests to see if you have cancer, usually beginning with an internal (pelvic) examination. During the exam, your clinician will feel for any lumps or changes in the size or shape of the uterus. A Pap test (microscopic evaluation of cervical and vaginal cells) will be performed to evaluate the cervix (opening of the uterus) and vagina.

Because cancer of the endometrium begins inside the uterus, it usually does not show up on a Pap test. For this reason, your clinician may also do an endometrial sampling or biopsy, a pelvic ultrasound procedure, and/or dilation and curettage (D&C) to check for cancer cells.

Common treatment for endometrial cancer

Surgery is the most common treatment for endometrial cancer. A hysterectomy (removing the uterus) and bilateral salpingo-oophorectomy (removing fallopian tubes and ovaries) is done most often.  Lymph nodes in the pelvis also may be removed (lymph node dissection). The lymph nodes are small, bean-shaped structures found throughout the body that produce and store infection-fighting cells, but may also contain cancer cells.

If you are diagnosed with endometrial cancer, your physician will work with you and other specialists to determine the best treatment plan for you.

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