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Endometrial/Uterine Cancer Awareness

Symptoms & Risks

Endometrial/Uterine cancer is the 6th most common cancer in people with a uterus worldwide and the 4th most common in the U.S. for people with a uterus. Rates are rising, and with no screening test, knowing the symptoms and risk factors can save your life. So, if you experience:

  • Vaginal bleeding during menopause 3
  • Abnormal vaginal bleeding outside of menstrual period 3
  • Unusual vaginal discharge 3
  • Pelvic pain 13

for more than two weeks, it’s time to speak up!

People with endometrial/uterine cancer reported symptoms that were persistent and represented a change from what was normal for them. The frequency and/or number of such symptoms are key factors in the diagnosis of endometrial/uterine cancer. Even early-stage cancer can produce these symptoms.

Several other symptoms have been commonly reported by people with endometrial/uterine cancer. These symptoms include unexplained weight loss, pain with intercourse, difficulty urinating, or pain with urinating or passing bowel movements.

People with these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early-stage diagnosis is associated with an improved prognosis.

Knowing your own personal risk factors is important. Having a risk factor for endometrial/uterine cancer does not necessarily mean that you will get endometrial/uterine Cancer. We encourage people with risk factors to talk to their doctor. If you have a personal or family history, speak to your doctor about referral for genetic risk assessment by a Certified Genetic Counselor.

  • Age: Your risk increases with your age; the average age when people are diagnosed with Endometrial Cancer is 60, and it is not common to see someone under 45 with this cancer.16
  • Family History: Have a close family member who had uterine, color or ovarian cancer.
  • Personal History: Women who have had cancer of the breast, ovaries, colon, or rectum have a higher risk of endometrial/uterine cancer.
  • Reproductive History: If you have never had children or have a history of difficulty getting pregnant, you are at increased risk3.
  • Early 1st period3 (menstruation)- 10 years old or younger12
  • Late menopause3 (the end of menstrual period indefinitely) -55+ years old14
  • Hormone Therapy: If you have taken estrogen for hormone replacement Therapy or Tamoxifen to treat breast cancer, you may be at higher risk3.
  • Hormonal Condition: Polycystic Ovary Syndrome, aka PCOS3 (cysts develop around the ovary, causing issues with egg release).
  • Genetic Testing: Genetic testing indicating you have BRCA 2, Lynch Syndrome, also known as HNPCC, or Li-Fraumeni syndrome, puts you at a much higher risk for endometrial/uterine cancer3.
  • Obesity: Being obese can put you at higher risk for some types of endometrial/uterine cancer3.

Testing, types, and treatments

If your doctor suspects Endometrial/Uterine Cancer, they will order some tests, including a pelvic exam, transvaginal ultrasound, and endometrial biopsy. Once Endometrial/Uterine Cancer is suspected, it is important to see a Gynecological Oncologist (a specialist in diagnosing and treating ovarian cancer). Studies have shown improved outcomes for people with a uterus who are treated by Gynecological Oncologists compared to those who are cared for by general gynecologists or doctors.

In a review article published in Frontiers in Oncology by authors Minig, et al., from the Valencian Institute of Oncology (IVO) in Valencia, Spain, it states that “When women with gynecological cancers are treated by gynecologic oncologists in referral cancer centers, they are able to live longer and with a better quality of life. Therefore, patients should be ideally referred to high-volume physicians/hospitals to increase their life expectancy as well as its quality.” 15

Gynecological oncologists are doctors who specialize in the treatment of endometrial/uterine cancer. The Society for Gynecologic Oncology (SGO) has a Specialist Finder Tool on its website that you can use to easily find a Gynecological Oncologist near you. The link for it is below.

SGO Specialist Finder Tool

There may be multiple tests that your doctor decides to perform to properly diagnose you. Some of these tests include:

  • Transvaginal ultrasound3
  • Endometrial/uterine biopsy (tissue sample)3
  • Saline infusion sonohysterography- which is rarely used 3.
    • Saline is infused into the endometrial cavity and visualized with an ultrasound.

Once endometrial/uterine cancer is suspected, some tests that may be performed include HER2 protein testing, MMR/MSI testing, and Ca 125 biomarker blood test.

There are many different types of endometrial/uterine cancer and knowing what type you have is important because that tells your doctor what the best treatments for you are. The types are divided into endometrial carcinoma and uterine sarcoma, with many different subtypes of each. The following list includes all the types of endometrial and uterine cancer. 11

  • Endometrial carcinoma (endometrial cancer)11
    • Endometrioid carcinoma (most common)
    • Serous carcinoma
    • Clear cell carcinoma
    • Carcinosarcoma, aka malignant mixed Mullerian tumor (MMMT)
    • Undifferentiated/ dedifferentiated carcinoma
  • Uterine sarcoma (Uterine Cancer)11
    • Endometrial stromal sarcoma (ESS)
    • Adenosarcoma
    • Uterine leiomyosarcoma (uLMS)
    • Undifferentiated uterine sarcoma (USS)
    • Perivascular epithelioid cell tumor (PE-Coma)
    • Inflammatory myofibroblastic tumor (IMT)

Treatments can range from surgery to chemotherapy to radiation. Depending on each person’s medical history and diagnosis, there are surgical and non-surgical options. 3,10.

  • Non-surgical options are for those with low-risk endometrial hyperplasia (precancerous condition) & those who want to preserve their fertility.
  • The traditional treatment for endometrial/uterine cancer is surgery (uterus, cervix, ovaries & fallopian tubes are removed)
  • Pelvic and/ or Para-aortic lymph node dissection (sample taken for testing or removed)
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy

The National Comprehensive Cancer Network (NCCN) is a well-known and great resource for people going through cancer. Each year, the NCCN publishes an updated set of guidelines for multiple different cancers for patients to use. The document of the most up-to-date guidelines for uterine cancer patients is below:

Disclaimer: The information on this website is designed to aid people in making decisions about appropriate gynecologic care and does not substitute for evaluations with qualified medical professionals familiar with you.

Citations

3Braun, M. M., Overbeek-Wager, E. A., & Grumbo, R. J. (2016). Diagnosis and Management of Endometrial Cancer. American family physician, 93(6), 468–474.

7Centers for Disease Control and Prevention. (2023, May 3). Microsatellite instability (MSI) screening. Centers for Disease Control and Prevention. https://www.cdc.gov/genomics/disease/colorectal_cancer/MSI.htm

10Endometrial Cancer Treatment. National Cancer Institute. (n.d.). https://www.cancer.gov/types/uterine/patient/endometrial-treatment-pdq#_92t

11Guidelines For Patients: Uterine Cancer . National Comprehensive Cancer Network . (2023). https://www.nccn.org/patients/guidelines/content/PDF/uterine-esl-patient.pdf

12Lacroix, A. E., Gondal, H., Shumway, K. R., & Langaker, M. D. (2023). Physiology, Menarche. In StatPearls. StatPearls Publishing.

13Mahdy, H., Casey, M. J., & Crotzer, D. (2022). Endometrial Cancer. In StatPearls. StatPearls Publishing.

14Swanner, K. D., & Richmond, L. B. (2023). A 65-Year-Old Woman With No Menopause History: A Case Report. Cureus, 15(9), e44792. https://doi.org/10.7759/cureus.44792

15Minig, L., Padilla-Iserte, P., & Zorrero, C. (2016). The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer. Frontiers in oncology, 5, 308. https://doi.org/10.3389/fonc.2015.00308

16Key Statistics for Endometrial Cancer. American Cancer Society. (n.d.). https://www.cancer.org/cancer/types/endometrial-cancer/about/key-statistics.html#:~:text=The%20American%20Cancer%20Society%20estimates,from%20cancers%20of%20the%20uterus.