Endometrial cancer (also known as uterine cancer) is a cancer of the cells in the uterus. Endometrial cancer starts in the lining of the uterus. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer.
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What is Endometrial Cancer?
Doctors define endometrial cancer as the growth of abnormal cells in the lining of the uterus (endometrium).
Endometrial cancer is actually the most common type of uterine cancer, with 95% of uterine cancers being endometrial cancer. Because of this, most people refer to it simply as uterine cancer.
Endometrial cancer can usually be cured when it's found early. Most of the time, this cancer is found in its earliest stage — before it has spread outside the uterus.
Despite advances in cancer research, endometrial cancer is on the rise in the U.S. — and is the only type of cancer increasing in incidence and mortality. Endometrial cancer is rising in all age groups, even though it usually occurs in postmenopausal women between the ages of 50 and 60.
How common is endometrial cancer?
According to the National Institutes of Health (NIH), endometrial cancer is the fourth most common cancer and the sixth most common cause of death among women in the U.S. It's the most common gynecological cancer in the U.S., with more than 66,000 new diagnoses and 13,000 deaths in 2023.
What are the types of endometrial cancer?
There are four types of this cancer:
- Adenocarcinoma — Develops in the glands that line the uterus.
- Endometrial stromal sarcoma — Tumors that begin in the cells that produce the sex hormones (estrogen, progesterone, and testosterone).
- Leiomyosarcoma — A type of uterine sarcoma that forms in the smooth muscle cells of the uterus.
- Uterine sarcoma — A rare cancer that forms from the layer of muscle in the myometrium (wall of the uterus) or nearby tissues.
What causes endometrial cancer?
The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in your body. This imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up, the cells can become abnormal, leading to a precancer or cancer.
If left untreated, endometrial cancer may metastasize (spread) from the endometrium (inside of the uterus) into the myometrium (surrounding muscle layer) toward the outer lining of the uterus. It can also grow into the adjacent fallopian tubes, which are attached to the uterus, and from there to the ovaries.
Endometrial cancer risk factors
Any woman can develop endometrial cancer, but certain factors may increase your risk.
These include:
- Age — Being over 50.
- Endometrial hyperplasia — This precancerous condition increases your risk, especially if it's termed "atypical."
- Estrogen replacement therapy without progesterone — Menopausal hormone therapy that uses estrogen alone may lead to endometrial cancer.
- Genetics — Some families have a higher risk of reproductive cancers or colon cancer (lynch syndrome).
- Having few or no pregnancies — Hormonal shifts in pregnancy can protect you against endometrial cancer. Never being pregnant puts you at an even higher risk.
- Many menstrual cycles — The more periods you have, the more at risk you are for endometrial cancer. For this reason, people who start menstruating at an early age and those who go through menopause late have a higher risk.
- Obesity or a high-fat diet — Both increase your risk of endometrial cancer.
- Previous cancer diagnosis — Having had breast cancer or ovarian cancer increases your risk. So do ovarian diseases, including polycystic ovarian syndrome (PCOS).
- Tamoxifen — Taking this drug that affects your hormones after breast cancer may slightly increase your risk.
- Type 2 diabetes — Endometrial cancer is twice as common for people with this type of diabetes.
What Are the Signs and Symptoms of Endometrial Cancer?
Symptoms of endometrial cancer may include:
- Abnormal vaginal bleeding, especially after menopause.
- Bleeding between periods.
- Bloating or other abdominal discomfort.
- Difficult or painful urination.
- Pain during intercourse.
- Pelvic pain.
- Prolonged periods.
- Unexplained weight changes.
When should I see a doctor about my endometrial cancer symptoms?
If you have any symptoms of endometrial cancer, make an appointment with your doctor right away. It's curable when it's found and treated early.
How Do You Diagnose Endometrial Cancer?
To diagnose endometrial cancer, your doctor will examine your medical history, ask about any family history of certain cancers, and ask about your symptoms.
They'll also perform a physical exam and a pelvic exam, and run tests.
Tests to diagnose uterine and endometrial cancers
Tests your doctor may order include:
- Endometrial biopsy — A small sample of the endometrial lining of the uterus is taken and examined under a microscope for abnormal cells.
- Hysteroscopy — This test allows your doctor to look at the lining of the uterus through a small lighted tube.
- Imaging tests — CT and MRI can show if the cancer has spread.
- Ultrasound – Pelvic and transvaginal ultrasounds may show a mass in your uterus, cancer in the muscle, and the thickness of your endometrium.
How Do You Treat Endometrial Cancer?
If you're diagnosed with endometrial cancer, your treatment will depend on your cancer's stage and the size of your tumor. Doctors will also consider factors like your age, whether you have other medical conditions, and whether you plan to have children.
Surgery is often the main treatment for uterine and endometrial cancers.
Sometimes, neoadjuvant (before surgery) or adjuvant (after surgery) chemotherapy may be recommended to control an aggressive cancer or to reduce the risk of recurrence. Whether you have chemo will depend on your age and the stage of your gynecologic cancer.
Radiation therapy also may be recommended to treat endometrial cancer.
Why Choose UPMC for Endometrial Cancer Care?
Through the UPMC Gynecologic Cancer Program, you have access to additional treatment options and services, including:
