Endometrial Cancers

Signs and Symptoms

Endometrial cancers develop in the uterus, though most develop in the endometrial glands that line the inner wall of the uterine cavity rather than in the uterus' muscular wall.

Although endometrial cancer usually occurs after menopause, it also may occur around the time that menopause begins. Abnormal vaginal bleeding is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Women should not assume that abnormal vaginal bleeding is part of menopause.

You should see your doctor if you have any of the following symptoms:

• Unusual vaginal bleeding or discharge
• Difficult or painful urination
• Pain during intercourse
• Pain in the pelvic area

Diagnosis

If you have symptoms that suggest endometrial cancer, your doctor may check general signs of your health and order blood and urine tests. Your doctor also may perform one or more of the exams or following tests:

• A pelvic exam is done to check a woman's vagina, uterus, bladder and rectum. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.

• A Pap test is when the doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells. Although the Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why the doctor collects samples of cells from inside the uterus in a procedure called a biopsy.

• Transvaginal ultrasound involves a doctor inserting an instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor can do a biopsy.

• Biopsy is when the doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor's office.

Treatment

There are a number of ways to treat endometrial cancer, including:

• Surgery -- Most women with uterine cancer have surgery to remove the uterus through an incision in the abdomen -- this procedure is called a hysterectomy. If the doctor also removes the fallopian tubes and the ovaries, this procedure is called a bilateral salpingo-oophorectomy.

• Hormonal Therapy -- If the cancer has spread to other parts of your body, synthetic progestin, a form of the hormone progesterone, may stop it from growing. The progestin used in treating endometrial cancer is in different doses than the progestin used in hormone replacement therapy for menopausal women. Some different medications may be used as well. Treatment with progestin may be an option for women with early endometrial cancer who want to have children and therefore do not want to have a hysterectomy. However, this approach is new and does not guarantee that the cancer will not return.

• Radiation Therapy -- Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. It is a localized treatment, which means that it works to attack cancer cells in one area. The radiation may come from a large machine, called external radiation, or from radioactive materials placed directly into the uterus, called implant radiation. Some patients receive both types of radiation therapy.