Tag Archives: endometrial cancer

Endometrial cancer: what you need to know

Other Cancers, Prevention,
By Laurén Doamekpor, M.P.H.

What is endometrial cancer?

Endometrial cancer—also called uterine cancer—is the most common cancer affecting a woman’s reproductive system. It is diagnosed when tumors start growing in the lining of the uterus, which is called the endometrium. Studies show that endometrial cancer is much more likely to occur in women who have already reached menopause, and most endometrial cancer is diagnosed around age 70.1 When physicians and medical experts talk about endometrial cancer, they often refer to it as type I or type II. Type I endometrial cancer is more common, and is influenced by levels of the female hormone estrogen in a woman’s body.2 Anything that affects a woman’s estrogen levels can potentially raise or lower a woman’s risk of developing type I endometrial cancer.3 Type II is less common and does not seem to be related to estrogen.4

In 2013, 49,560 new cases of endometrial cancer were diagnosed in the U.S., and about 8,000 women are expected to die from it this year.5

What are common symptoms of endometrial cancer?

Abnormal vaginal bleeding or discharge are frequently reported symptoms, as is pain in the pelvic area, and pain during intercourse.6  However, a woman can have endometrial cancer without having any of these symptoms, and women can have these symptoms without having cancer. You know your body best, so it is important to see your doctor if you experience any symptoms that seem out of the ordinary.

Who is at risk?

Some of the factors that increase a woman’s chances of getting endometrial cancer are out of her control, but she can reduce her risks.  These factors increase a woman’s risks of endometrial cancer:

  • Had her first menstrual period before age 126
  • Has a family history of endometrial cancer6
  • Has or had trouble getting pregnant6
  • Has used or is using tamoxifen, a drug used to treat or prevent some types of breast cancer. Tamoxifen blocks estrogen to the breast, starving cancer cells that like to feed off of estrogen, but it acts like estrogen on the uterus.6
  • Had menopause after age 557
  • Is obese – Studies suggest that obesity may be the largest risk factor for endometrial cancer.4

The more menstrual cycles a woman has in her life, the greater her risk.  That is why either early menstruation or late menopause (or both) can increase a woman’s risk of getting endometrial cancer.  And that is why taking birth control pills lowers a woman’s risk of endometrial cancer. Oral contraceptives eliminate “real” menstruation, replacing it with “withdrawal bleeding.”8

Screening and diagnosis

For women without symptoms, there are no accepted guidelines for a routine screening test.  That is why it is important to see your doctor if you experience any symptoms.  Most cases (80%) are diagnosed at an early stage because of symptoms, and as a result survival rates are high9. Most women with symptoms that are consistent with endometrial cancer will receive one or more of the following tests, in addition to a physical exam and blood tests:

  • Pelvic exam: A pelvic exam will allow your doctor to check your vagina and uterus for any unusual changes in size or shape.
  • Transvaginal ultrasound: This type of ultrasound (sound waves) makes a picture of the uterus, and can be used to detect small masses.
  • Biopsy: A biopsy involves the removal of tissue from the uterus to test whether cancer cells are present. 9

However, screening all women instead of only screening women with symptoms will often result in unnecessary biopsies because of false-positive transvaginal ultrasound results. for that reason, screening should be limited to symptomatic women to minimize anxiety and complications from biopsies.9

What are the treatment options?

If you have been diagnosed with endometrial cancer, treatment depends on the type of uterine cancer you have and how far it has spread, your age, and how fast the tumor is likely to grow.10 Treatment usually includes:

  • Surgery to remove the tumors
  • Chemotherapy
  • Radiation therapy
  • Hormone therapy to block hormones and keep them from feeding cancer cells 10
  • Immunotherapy12-15

The effectiveness of treatments can vary. For example, a 2023 study found that adding radiation to chemotherapy treatment did not increase how long endometrial cancer patients lived12 However, immunotherapy in addition to chemotherapy, has been shown to significantly improve outcomes according to the results of two different randomized clinical trials.13,14 Experts have predicted that these studies will convince doctors and patients to incorporate immunotherapy into the treatment of all patients with endometrial cancer,

How can you lower your risk of endometrial cancer?

Did you know that being overweight or obese increases your risk of many types of cancer, including endometrial cancer?  Keeping your weight down is the number one way you can reduce your risk, so limit the number of calories you eat and drink and stay (or get) active.  You can read more about the link between excess weight and cancer here. Scientists have proposed a few different explanations for this link, but one of them is that fat tissues secrete hormones, including estrogen. Abnormal amounts of estrogen circulating in the body increase a woman’s chances of developing type I endometrial cancer.

Dropping pounds (or at least not gaining weight) offers many health benefits in addition to lowering your risk of endometrial cancer. Shedding pounds can be a challenge. One of the easier ways is to cut down on sodas and other sweetened drinks that are high in calories with zero nutritional value.  A 2013 study found that women who drank a lot of sugar-sweetened beverages, such as Coke, Pepsi, and other carbonated beverages (such as 7-Up, Sprite), or non-carbonated drinks such as lemonade or Hawaiian Punch, were more likely to develop type I endometrial cancer than women who didn’t drink them, regardless of their body mass index (BMI), how physically active they were, or whether they had a history of diabetes or smoking. The study was based on postmenopausal, mostly white women who participated in the Iowa Women’s Health Study.  We don’t know if the results would be identical for younger women, or women of color, but we do know that these types of sugary beverages are generally harmful because they cause weight gain and do not provide nutrition.11 (Although the drinks are called “sugary,” most are made with corn syrup, not sugar.)

Physical activity is another way to control or reduce your weight and is one of the NRC’s seven recommended ways to maximize your health. Everyone can benefit from regular exercise, because it reduces the risk of heart disease and diabetes and can help you sleep better and improve your mood.12 Simple changes to your daily routine can make a difference. Read here to learn how to begin an exercise routine that works for your schedule.

The bottom line

If you’re having any pain in the pelvic area or experiencing unusual bleeding or discharge, be sure to tell your doctor.  Many of the factors that increase your risk of endometrial cancer are out of your control. What you can control is what you eat and drink. You can lower your chances of endometrial cancer and many other cancers by keeping your weight down and staying active.

 

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  2. Setiawan, VW, Yang HP, Pike MC, McCann SE, Yu H, Xiang Y, Wolk A et al. Type I and II Endometrial Cancers: Have They Different Risk Factors? Journal of Clinical Oncology. 2013;31(20): 2607-2620.  ▲
  3. Doll A, Abal M, Rigau M, Monge M, Gonzalez M, Demajo S, et al. Novel molecular profiles of endometrial cancer-new light through old windows. J Steroid Biochem Mol Biol. 2008;108(3–5):221–229.  ▲
  4. Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F. Factors associated with Type I and Type II endometrial cancer. Cancer Causes & Control. 2010;21(11):1851-1856.  ▲
  5. National Cancer Institute SEER Cancer Statistics Factsheets: Endometrial Cancer. National Cancer Institute. Available at: http://seer.cancer.gov/statfacts/html/corp.html. Accessed November 26, 2013.  ▲
  6. National Cancer Institute. What you need to know about cancer of the uterus. Risk Factors. Available at: http://www.cancer.gov/cancertopics/wyntk/uterus/page4. Accessed November 26, 2013.  ▲
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  8. Combination oral contraceptive use and the risk of endometrial cancer. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. JAMA. 1987;257(6):796-800.  ▲
  9. Trojano, G., Olivieri, C., Tinelli, R., Damiani, G. R., Pellegrino, A., & Cicinelli, E. (2019). Conservative treatment in early stage endometrial cancer: a review. Acta bio-medica : Atenei Parmensis, 90(4), 405–410. https://doi.org/10.23750/abm.v90i4.7800
  10. National Cancer Institute. What You Need To Know About Cancer of the Uterus- Diagnosis. 2010. Available at:http://www.cancer.gov/cancertopics/wyntk/uterus/page6. Accessed November 25, 2013.  ▲
  11. National Cancer Institute. What You Need To Know About Cancer of the Uterus- Treatment. 2010. Available at:http://www.cancer.gov/cancertopics/wyntk/uterus/page8. Accessed November 26, 2013.  ▲
  12. Nelson, R. (2023).No Survival Benefit to Radiation Add-on in Endometrial Cancer. Medscape. https://www.medscape.com/viewarticle/990236?ecd=WNL_confwrap_230405_MSCPEDIT&uac=140425SY&impID=5307712#vp_1
  13. Eskander, R., Sill, M., Beffa, L., et al. (2023).Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2302312
  14. Mirza, M., Chase, D., Slomovitz, B., et al. (2023).Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2216334
  15. Nelson, R. (2023)’Home Run’: Immunotherapy Add-on for Advanced Endometrial Cancer. Medscape. https://www.medscape.com/viewarticle/990179?ecd=WNL_confwrap_230405_MSCPEDIT&uac=140425SY&impID=5307712
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  17. Centers for Disease Control and Prevention. Physical Activity and Health. Available at:http://www.cdc.gov/physicalactivity/everyone/health/. Accessed December 2, 2013.  ▲