Uterine (Endometrial) Cancer

What it is

The uterus is the womb. Its inner lining is called the endometrium, and it is the layer that builds up and sheds each month during the reproductive years. Uterine cancer almost always starts in that lining, which is why doctors usually call it endometrial cancer. The two names describe the same disease.

Endometrial cancer is the most common gynecologic cancer in the United States, and it is one of the few cancers that tends to give a clear early signal.

The warning sign

The Society of Gynecologic Oncology puts it plainly: the most common symptom of uterine cancer is bleeding after menopause, and postmenopausal bleeding should never be considered normal. [2] It can be a single spot on the tissue, or it can be heavy. The amount does not tell you how serious the cause is. Any bleeding at all after your periods have stopped for a year is a reason to be seen.

Before menopause the signal is less obvious. Periods that become irregular, much heavier, or that come between cycles can also be a symptom, though far more often they turn out to be caused by something benign. [2]

Less common symptoms include pelvic pain, pressure, bloating, or a watery or blood-tinged discharge. [2][3]

What raises the risk

The National Cancer Institute lists several things that raise the chance of endometrial cancer. Carrying extra weight and having metabolic syndrome both increase risk. So does taking estrogen without progesterone, taking tamoxifen for breast cancer, having type 2 diabetes or polycystic ovary syndrome, never having given birth, and going through menopause later than usual. [3]

Some uterine cancer runs in families. Lynch syndrome is an inherited condition that raises the risk of both uterine and colon cancer, and it is worth asking about if cancers cluster on one side of your family or showed up at young ages. [4]

Having a risk factor does not mean you will get this cancer, and plenty of women who get it have none of them. Risk factors change what we watch for, not what will happen to you.

How it is diagnosed

The workup for bleeding after menopause is usually short.

A transvaginal ultrasound measures how thick the lining of the uterus is. A thin lining is reassuring. In a pooled analysis of forty-four studies, a lining of five millimeters or more was the threshold that best balanced catching cancer against sending women for procedures they did not need. [5]

An endometrial biopsy takes a small sample of the lining through a thin flexible tube, in the office, usually in a few minutes. [3] If the sample is not enough to answer the question, the next step is a dilation and curettage, often with a hysteroscopy so we can look inside the uterus while we sample it. [3] That one happens in the operating room, under anesthesia, and you go home the same day.

How it is treated

Surgery is the most common treatment for endometrial cancer. [3] For most women that means removing the uterus and cervix, and usually the tubes and ovaries, along with a check of the lymph nodes to find out whether anything has spread. Most of these operations can be done with the robot through small incisions.

What happens after surgery depends on what the pathology shows. Some women need nothing further. Others are offered radiation, chemotherapy, hormone therapy, or targeted therapy. [3] We will not know the full picture until the final pathology is back, which usually takes about a week. For what those treatments involve, see chemotherapy and radiation.

The recovery instructions above are the same for both operations, because they come from the same set of discharge instructions. What usually differs is how you feel in the first week and how long you stay in the hospital. Which operation is right for you is a conversation, not a formula, and it depends on your imaging, your body, and what we find once we are looking.

Recovery

Pick your procedure below to see what the weeks after surgery generally look like. These timelines are transcribed from the discharge instructions this office gives patients. [6]