What to Know About Endometrial Cancer

You know that ovarian cancer starts in the ovaries and cervical cancer starts in the cervix. But where does endometrial cancer begin? For Gynecologic Cancer Awareness Month, I am sharing information about the most common, but perhaps least known, gynecologic cancer and what you can do to prevent this cancer and catch it early, when it is easiest to treat.

The basics. The endometrium is the inner lining of the uterus. Cancer—mutated cells multiplying out of control—that begins in that lining is called endometrial cancer. (Endometial cancer is actually a type of uterine cancer. People sometimes use the terms “endometrial cancer” and “uterine cancer” interchangeably, even though there are a few other rarer types of uterine cancer.)

The risk factors. Endometrial cancer affects 3 percent of women in their lifetimes. It is more common in women over the age of 50 and among people who have a genetic predisposition. People who are obese, have diabetes, and who have certain ovarian tumors are also at increased risk.

Endometrial cancer risk increases with increases in estrogen, so conditions associated with increased estrogen—like starting your period before age 12, late menopause, or having no pregnancies—are signs of greater risk. Taking oral contraceptives regulates estrogen and can decrease risk.

What you can do. There is no screening test for this type of cancer. (Pap tests check for cervical cancer.) But that doesn’t mean that you can’t take steps to prevent endometrial cancer. 

1. If you have diabetes, keep it under control. Maintain a healthy diet and exercise regularly, which will help you maintain a healthy weight.
2. Keep an annual visit with your OB/GYN or nurse midwife. During the visit, your provider will take a patient history and ask questions to help determine your risk. The provider will also conduct a physical and pelvic exam, which can help catch endometrial cancer early.
3. Hormonal contraceptives can help regulate hormones in ways that reduce risk over the long term. Especially if you are at increased risk, you may choose to ask your doctor about oral contraceptives.
4. Know the symptoms. Symptoms include vaginal bleeding between periods before menopause, vaginal bleeding or spotting after menopause, lower abdominal pain or cramping in your pelvis, thin white or clear vaginal discharge after menopause, and extremely prolonged, heavy, or frequent vaginal bleeding if you’re over age 40.
5. Call your provider’s office and get an appointment, if you notice symptoms.

Diagnosis and treatment. There are several steps to confirming an endometrial cancer diagnosis, including lab and imaging tests. Sometimes doctors use an internal camera or a type of surgery to make a better diagnosis. People who are diagnosed learn the type of endometrial cancer they have and the stage, which indicates how far it has spread. They can use this information to make important treatment decisions.

There are also lots of treatments, including surgery, chemotherapy, radiation therapy, hormone therapy (which gives or blocks hormones to fight cancer), immune therapy (which helps the immune system fight cancer), and targeted therapy (which uses medications to target specific cancer cells and stop them from multiplying). Additional research into endometrial cancer treatments helps to bring more treatments to patients every year.

The endometrial cancer survival rate after 5 years is 81 percent, meaning 81 percent of people diagnosed with the disease are alive 5 years later. That rate is even higher when the cancer hasn’t spread. Then, survival rates are high as 95 percent. By having the important information you need and working with your OB/GYN or midwife, you can help prevent endometrial cancer or stop it.

Kimberley Sampson, MD, FACOG, DABOM, is the chair of the Department of OB/GYN at Southwestern Vermont Medical Center, part of Southwestern Vermont Health Care, in Bennington.