Endometrial cancer is a malignancy involving the lining of the uterus. It accounts for 95% of uterine cancers, which are the fourth most common cancer in women in the U.S. About one in 323 women in the U.S. will develop endometrial cancer in their lifetimes. Eighty percent of endometrial cancer cases in the U.S. are diagnosed in postmenopausal women, and the average age at diagnosis is 60 years. However, rates of endometrial cancer are increasing in both older and younger women in the U.S. and worldwide.
A leading risk factor for endometrial cancer is obesity. Other common risk factors are diabetes and a personal or family history of inherited conditions such as Lynch syndrome (a genetic disorder that increases the risk of multiple types of cancer). Additional risk factors include the use of estrogen without progesterone, tamoxifen (a medication to treat or prevent hormone receptor-positive breast cancer), and never having been pregnant. In contrast, combined oral contraceptives and progesterone therapy, including progesterone-releasing intrauterine devices, are associated with a decreased risk of uterine cancer.
About 70% to 90% of patients with endometrial cancer have abnormal vaginal bleeding. Other symptoms may include an enlarged uterus, pelvic or abdominal pain, and anemia. In some patients, pelvic imaging such as ultrasound or CT scans may show a thickened endometrial lining that leads to further evaluation and identification of endometrial cancer. The diagnosis is made with an endometrial biopsy performed in an outpatient clinic or a brief surgical procedure performed in an operating room (dilation and curettage, or D and C) to obtain endometrial tissue. Rarely, endometrial cancer is diagnosed based on results from a Papanicolaou (Pap) test or upon examination of the uterus after it has been surgically removed for another reason.
Endometrial cancer is typically treated with surgery to remove the uterus, cervix, ovaries, and some pelvic lymph nodes. In younger patients, the ovaries may be retained for cardiac and bone health reasons. Surgical findings determine the stage of cancer and guide further treatment. In those with early-stage, low-risk endometrial cancer, observation and Gyn follow-up for at least two years is recommended. Patients with higher risk features and more advanced cancer may be treated with radiation therapy, chemotherapy, and hormonal therapies (progesterones or antiestrogens). Five-year survival rates are 90% for those with cancer confined to the uterus, 72% for those with cancer involving the pelvic lymph nodes, and 22% for those with more distant spread of tumor. Sexual health dysfunction affects about three of four women treated for endometrial cancer and is treated with vaginal lubricants and moisturizers, pelvic floor physical therapy, and referral to a sexual health specialist.
