Uterine (Endometrial) Cancer

Most uterine cancers begin in the lining of the uterus (womb) called the endometrium (endometrial cancers). Rare uterine cancers that arise in the muscle wall of the uterus are called uterine sarcomas. Many women diagnosed with early stage uterine cancer are treated with surgery alone and cured. Other women with higher risk disease or more advanced stages will require surgery in addition to chemotherapy and/or radiation therapy. Black women are more likely to develop high-risk types of uterine cancer. 

Risk factors for endometrial cancer include:

• Obesity
• Never giving birth, menstruating at an early age or starting menopause at a later age — which leads to prolonged estrogen exposure to the endometrial tissue
• Having metabolic syndrome (a cluster of related abnormalities such as obesity, high blood pressure, elevated cholesterol levels, heart disease and diabetes)
• Taking the drug tamoxifen for breast cancer or taking estrogen (a hormone) without progesterone (another hormone) after menopause     
• Having polycystic ovarian syndrome
• Having a mother, sister or daughter with endometrial cancer
• Having certain genetic conditions such as Lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC)

Obesity is an important risk factor for uterine cancer that can be modified. Extra stored fat in a body increases estrogen levels, causes inflammation and can promote cancer development. Most common endometrial endometrioid cancers are estrogen dependent. Women who are 50 pounds overweight are 10 times more likely to develop endometrial cancer. Managing weight through appropriate diet and increasing physical activity can potentially decrease risk for this cancer.

Signs and symptoms of uterine and endometrial cancer may include:

• Vaginal bleeding or discharge not related to periods
• Vaginal bleeding or irregular vaginal discharge after menopause
• Pelvic pain
• New changes in or pain with bowel or bladder function
• Pain during sexual intercourse

Uterine cancer is most commonly diagnosed with an endometrial biopsy or D&C (dilatation and curettage), which allows us to test a sample of the endometrial lining. The Pap smear, a test to detect precancer and cancer of the cervix, only rarely detects uterine cancer; most women with this cancer have had normal Pap smears. A sample of endometrial tissue must be removed using one of these procedures, and then checked under a microscope to look for cancer cells:

• Endometrial biopsy (pipelle): A simple office procedure in which a thin flexible tube is introduced through the cervix to the endometrial lining to take a sample
• Dilation and curettage (D&C): A minor outpatient surgical procedure using anesthesia in which the cervix is gently dilated (opened) and a curette (spoon-shaped instrument) is inserted into the uterus to remove tissue
• Hysteroscopy: After dilation of the cervix, a small camera is introduced into the uterus for direct observation and targeted removal of tissue or polyps (growths)

Your doctor will use a physical exam and history of health habits, past illnesses and treatments to help diagnose uterine cancer. They may do a transvaginal ultrasound exam, where an ultrasound probe is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs. The resulting echoes form a picture of body tissues (a sonogram), which helps to evaluate uterine size and the thickness of the endometrium.

Treatment options depend on the type and stage of the cancer. Our women's cancer team will work with you to develop a personalized treatment plan, considering desire for fertility preservation, that may include a combination of these options:

• Surgery: The use of surgical procedures, including minimally invasive, robotic and open surgery, to remove the uterus and all cancerous tissue
• Radiation therapy: The use of high-energy rays to damage cancer cells and stop their growth
• Chemotherapy: The use of powerful drugs to stop the growth of cancer cells
• Hormone therapy: The use of medications to reduce the production of cancer-causing hormones or block them from working
• Targeted therapy: The use of drugs or other substances to identify and attack specific cancer cells without harming normal cells in the body
• Immunotherapy: The use of drugs to stimulate the immune system

Like most cancers, uterine cancer is more difficult to treat after it has spread to distant parts of the body (metastasized). Our gynecologic cancer team treats each patient as unique and will help find the best treatment for you. Some early forms of metastatic uterine cancer can be controlled long term. Our gynecologic cancer team is part of the UChicago Medicine Limited Metastatic Cancer Program (LMEC), an effort dedicated to helping patients with limited metastatic cancer achieve long-term survival.

UChicago Medicine researchers are continuously testing new drugs that may be more effective in treating uterine cancer than currently available options. We also have performed many clinical trials combining chemotherapy with radiotherapy with the goal of improving survival for women fighting this disease.