Uterine and Endometrial Cancer Services at UPMC in Central Pa.

Cancer of the endometrium, or the lining of the uterus, is the most common form of gynecological cancer. Our experts have vast experience treating this disease.

What is Endometrial Cancer?

The lining of the uterus is called the endometrium. Cancer of the endometrium, the most common cancer of the female reproductive organs, is a disease in which malignant (cancerous) cells are found in the endometrium.

Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called uterine sarcoma. About 80 percent of all endometrial cancers are adenocarcinomas. Endometrial cancer is highly curable when found early. According to the American Cancer Society, about 49,560 cases of cancer of the uterine body will be diagnosed in the U.S. during 2013.

Endometrial Cancer Symptoms

The symptoms of endometrial cancer can be easily confused with other conditions. These symptoms include:

• Bleeding or discharge not related to your periods (menstruation)
• Postmenopausal bleeding
• Difficult or painful urination
• Pain during intercourse
• Pain and/or mass in the pelvic area

These are signs of endometrial cancer. Less serious, noncancerous conditions may also cause these symptoms. If you have symptoms such as these that won't go away, and cannot be explained by other reasons, report them to your doctor.

What are Risk Factors for Endometrial Cancer?

The following have been suggested as risk factors for endometrial cancer:

• Starting monthly periods early - before the age of twelve
• Late menopause
• Infertility (inability to become pregnant)
• Never having children
• Obesity
• Being treated with tamoxifen for breast cancer
• Estrogen replacement therapy (ERT) for treatment of effects of menopause
• Diet high in animal fat
• Diabetes
• Increases as women get older
• Most common in white women
• Family history of endometrial cancer or colon cancer (hereditary nonpolyposis colon cancer)
• Personal history of breast cancer
• Personal history of ovarian cancer
• Prior radiation therapy for pelvic cancer
• Personal history of polycystic ovary syndrome or atypical endometrial hyperplasia

How is Endometrial Cancer Diagnosed?

Diagnosis includes a medical history and physical exam. It may also include one or more of the following:

• Internal pelvic examination. This is done to feel for any lumps or changes in the shape of the uterus
• Pap test (also called Pap smear). A test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation. However, because cancer of the endometrium begins inside the uterus, problems may not be detected using a Pap test. Therefore, in some cases, an endometrial biopsy will be done.
• Endometrial biopsy. A procedure in which an endometrial tissue sample is collected by using a small flexible tube that is put into the uterus. The tissue sample is examined under a microscope to see if cancer or other abnormal cells are present. An endometrial biopsy procedure is often done in a doctor's office.
• Dilation and curettage (also called D & C). A minor operation in which the cervix is dilated (opened) so that the cervical canal and uterine lining can be scraped with a curette (spoon-shaped instrument). The pathologist examines the tissue for cancer cells.
• Transvaginal ultrasound (also called ultrasonography). An ultrasound test using a small instrument, called a transducer, that is placed in the vagina. The doctor may perform a biopsy if the endometrium looks too thick.

Treatment for Endometrial Cancer

Specific treatment for endometrial cancer will be determined by your doctor(s) based on:

• Your overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

The choice of treatment depends on the stage of cancer and whether it is just in the endometrium, or has spread to other parts of the uterus or other parts of the body. Generally, treatment for patients with cancer of the endometrium includes One or more of the following:

Surgery for Endometrial Cancer

The surgeons at the Women's Cancer Center in Central Pa. specialize in minimally invasive procedures to treat endometrial cancer. The goals of surgery are to remove the cancer and to perform a biopsy. The results of your biopsy will help your doctor see if the cancer is spreading. The extent of the surgery depends on the size and stage of the cancer.

• Hysterectomy. Surgical removal of the uterus.
• Radical hysterectomy. removal of uterus, ovaries and fallopian tubes.
• Salpingo-oophorectomy. Surgery to remove the fallopian tubes and ovaries.
• Pelvic lymph node dissection. Removal of some lymph nodes from the pelvis.
• Laparoscopic lymph node sampling/dissertation. Lymph nodes are removed through a narrow viewing tube called a laparoscope, which is inserted through a small incision (cut) in the abdomen (belly).

Chemotherapy for Endometrial Cancer

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation Therapy for Endometrial Cancer

Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. In treating vaginal cancers, radiation is delivered from outside the body in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. It is sometimes used along with chemotherapy to treat more advanced cancers to shrink them so they can be removed with surgery. Radiation alone may be used to treat lymph nodes in the groin and pelvis. Another way to deliver radiation is to place radioactive material inside the vagina. One way to do this is called intracavitary brachytherapy. The 2 main types of intracavitary brachytherapy are low-dose rate (LDR) and high-dose rate (HDR). With these intracavitary methods, radiation mainly affects the tissue in contact with the cylinder. This often means less bladder and bowel side effects than what is seen with external beam radiation therapy.

Hormone Therapy for Endometrial Cancer

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.

Contact Us

Need more information? Our friendly staff can assist you. To get in touch, request information or call 717-221-5940 for more information or to make an appointment.