Endometrial cancer is the most common gynecologic cancer diagnosed in women; over 40,000 women in the U.S. are diagnosed annually. Endometrial cancer is frequently diagnosed early and can often be cured. A number of different types of cancers can occur in the uterus. The most common type of cancer is endometrioid carcinoma. These tumors arise from the endometrial lining of the uterus. Other epithelial tumors (found in connective tissue) such as papillary serous carcinomas and clear cell carcinomas, account for 5-10% of uterine cancers. These tumors tend to be more aggressive and are more likely to have spread beyond the uterus at the time of diagnosis. Uterine sarcomas (cancerous tumors) account for approximately 5% of uterine tumors. These cancers arise in the wall of the uterus and also tend to be more aggressive.
In the majority of women, endometrial cancer is spontaneous and is not associated with a genetic syndrome.
- The most common risk factor for endometrial cancer is obesity. Women who are 30-50 lbs overweight have a substantially increased risk of developing endometrial cancer. Fat (adipose) cells produce estrogen, which can stimulate the endometrial lining and lead to the development of cancer.
- Women taking unopposed estrogen (estrogen without progesterone) are also at increased risk for the development of cancer.
- Other risk factors for endometrial cancer include late menopause, early menstruation, and tamoxifen use.
- Most endometrioid adenocarcinomas (the most common subtype of endometrial cancer) arise from a precancerous change in the uterine lining called endometrial hyperplasia. Endometrial hyperplasia, if untreated, can progress to an endometrial cancer. Women with endometrial hyperplasia, particularly those who have the form associated with the highest risk of cancer, atypical hyperplasia, require treatment.
- Approximately 5-10% of women with endometrial cancer have a hereditary cancer syndrome, in which the cancer is caused by inherited genetic abnormalities.
- The most common hereditary cancer syndrome associated with endometrial cancer is Lynch syndrome or hereditary non-polyposis colorectal cancer syndrome (HNPCC). Lynch syndrome results from a specific genetic abnormality that results in the accumulation of abnormalities in the body’s deoxyribonucleic acid (DNA) that encodes genetic information. The most common cancers associated with Lynch syndrome are colon cancer and endometrial cancer. A strong family history, (i.e. multiple relatives with endometrial or colon cancer), is the strongest predictor of Lynch syndrome. Those women who are at risk for Lynch syndrome require specialized testing and counseling. Both genetic counseling and genetic testing services are readily available through the Division of Gynecologic Oncology at Columbia University. Women with Lynch syndrome who have not developed a cancer may consider options for screening and prophylactic surgery to either prevent cancer or detect cancer early.
Endometrial cancer diagnosed at an early stage, when the disease is confined to the uterus, is associated with a very high cure rate. Endometrial cancer typically begins on the endometrium and grows into the uterine wall. If the cancer is not detected, it can eventually spread beyond the uterus. The cancer typically spreads first to the ovaries and lymph nodes, then into the abdominal cavity. Papillary serous carcinomas, clear cell carcinomas, and sarcomas tend to spread beyond the uterus early on in the course of the disease. These tumors more often spread into the abdominal cavity.
- Vaginal bleeding after menopause is one of the most common signs of endometrial cancer and is a common symptom experienced by the majority of women with endometrial cancer. If you have vaginal bleeding after menopause you should immediately consult your physician. The majority of women with postmenopausal vaginal bleeding do not have a cancer, but evaluation is required.
- Women with vaginal bleeding are typically evaluated with office endometrial biopsy tests, transvaginal ultrasound, or dilation and curettage (D & C).
- Other symptoms may include abdominal pain, nausea, vomiting, weight loss, bloating, and abdominal distension.
- There is no screening test for endometrial cancer currently available.
Surgery is the primary treatment for women with endometrial cancer. Surgery usually involves removal of the uterus (hysterectomy), often in combination with removal of the ovaries (oophorectomy) and lymph nodes (lymphadenectomy). Traditionally hysterectomy for endometrial cancer has required making an incision in the abdomen to remove the uterus. At Columbia University, we focus on minimally invasive surgery when appropriate. Minimally invasive surgery involves removal of the uterus through multiple small incisions, rather than a large abdominal incision. Benefits of minimally invasive surgery may include a shorter recovery, a shorter hospital stay, decreased pain, earlier return to normal activity, and improved cosmetic results. Our surgeons are highly trained in minimally invasive surgery techniques and perform these procedures whenever it is safe for patients. Minimally invasive hysterectomy can be performed either laparoscopically or robotically. The gynecologic oncologists at Columbia University have extensive expertise in both laparoscopic and robotic hysterectomy, and have presented their work regarding these procedures internationally. For some young women who require hysterectomy, but who want to preserve fertility, ovary preservation may be possible. Others with very early endometrial cancer, who wish to preserve fertility, may be candidates for hormonal treatments (progesterone). Adjuvant Treatment(treatment following surgery): The goal of adjuvant treatment is to reduce the risk of cancer recurrance. Adjuvant treatment for endometrial cancer is highly individualized.
- Many women with early endometrial cancer confined to the uterus do not require any additional treatment after surgery and have a high cure rate.
- Some women whose endometrial cancer confined to the uterus but has invaded the wall of the uterus, or is associated with other higher-risk conditions, require radiation treatments. Radiation can be delivered in two ways.
- External beam radiation, which requires several weeks of treatment delivered externally by a radiation machine.
- Vaginal brachytherapy consists of several treatments in which a cylinder is placed inside the vagina for several minutes and radiation is delivered to where the uterus used to be (and the area in which cancer is most likely to return).
- Women with endometrial cancer that has spread outside of the uterus are often treated with chemotherapy, frequently in combination with some form of radiation.
There are many treatment options for women with endometrial cancer. At Columbia University, we are actively participating in clinical trials to allow our patients access to the latest treatment advances for endometrial cancer.
- Clinical trials are the only way new drugs and treatments can be evaluated in a systematic manner to prove or disprove efficacy. Endometrial cancer patients are asked often to participate in a clinical trial, which may offer a patient the opportunity to receive the most advanced treatment. You should discuss with your doctor what clinical trials are available, and if you might benefit by participating.
- A critical need exists to develop novel agents and combinations to treat endometrial cancer to improve survival while preserving quality of life. The use of targeted agents which act on pathways involved in tumorigenesis (tumor formation) may reduce mortality from endometrial cancer, while reducing disabilities associated with treatment by focusing on abnormal rather than normal tissues.
- The majority of current research in advanced and recurrent endometrial cancer focuses on the inhibition of signal transduction pathways and targeting DNA repair mechanisms. Current agents in development for the treatment of ovarian cancer include therapies such as angiogenesis (blood vessel formation) inhibitors, drugs that target cellular survival, and agents that focus on DNA repair pathways.
- For more information and detailed explanations of the stages and treatment of ovarian cancer, please refer to the National Cancer Institute website at www.nci.nih.gov/cancertopics.