Endometrial (Uterine) Cancer Overview potx

Endometrial (Uterine) Cancer Overview The information that follows is an overview of this type of cancer. It is based on the more detailed information in our document, Endometrial (Uterine) Cancer. This document and other information can be obtained by calling 1-800-227-2345 or visiting our Web site at www.cancer.org. What is cancer? The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly way. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out, damaged, or dying cells. Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of this out-of-control growth of abnormal cells. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells keep on growing and form new cancer cells. These cancer cells can grow into (invade) other tissues, something that normal cells cannot do. Being able to grow out of control and invade other tissues are what makes a cell a cancer cell. In most cases the cancer cells form a tumor. But some cancers, like leukemia, rarely form tumors. Instead, these cancer cells are in the blood and bone marrow. When cancer cells get into the bloodstream or lymph vessels, they can travel to other parts of the body. There they begin to grow and form new tumors that replace normal tissue. This process is called metastasis (muh-tas-tuh-sis). No matter where a cancer may spread, it is always named for the place where it started. For instance, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is called metastatic prostate cancer, not bone cancer. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their own kind of cancer. Not all tumors are cancerous. Tumors that aren't cancer are called benign (be-nine). Benign tumors can cause problems they can grow very large and press on healthy organs and tissues. But they cannot grow into other tissues. Because of this, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening. What is endometrial cancer? Endometrial cancer is a cancer that starts in the inner lining of the womb (uterus). This lining is called the endometrium. The pictures below show where the uterus is found and then provide a closer look at the uterus. The uterus (womb) is a hollow organ, about the size and shape of a medium-sized pear. The uterus is where a fetus grows when a woman is pregnant. It has 2 main parts. The lower part, which extends into the vagina, is called the cervix. The upper part is the body of the uterus (also called the corpus). The body of the uterus has 2 layers. The inner layer is the endometrium. The outer layer of muscle is known as the myometrium. This thick layer of muscle is needed to push the baby out during birth. The tissue coating the outside of the uterus is the serosa. During a woman's menstrual cycle this inner layer changes. In the early part of the cycle it gets thicker in case the woman becomes pregnant. If she does not become pregnant, the tissue is shed from the uterus and becomes the menstrual flow (period). This cycle repeats throughout a woman's life until change of life (menopause). Types of cancers of the uterus and endometrium Nearly all cancers of the uterus start in the endometrium. They are called endometrial carcinomas. Cancers can also start in the muscle layer of the uterus. These cancers belong to the group of cancers called sarcomas. Carcinomas Endometrial carcinomas are cancers that start in the cells that form the glands in the lining of the uterus. Most of these are adenocarcinomas. The most common type is called endometrioid adenocarcinoma. There are other types that are far less common. The grade of an endometrioid adenocarcinoma is based on how much the cancer cells form glands that look like the glands found in normal, healthy endometrium. In lower- grade cancers (grades 1 and 2), more of the cancer cells form normal-looking glands. In higher-grade cancers (grade 3), more of the cancer cells are kind of jumbled up and do not form normal glands. Higher grade cancers tend to grow faster and are more likely to spread than lower grade cancers. Uterine carcinosarcoma (CS) is another cancer that starts in the endometrium and is covered here. When looked at under the microscope, this cancer looks like both endometrial carcinoma and sarcoma. Uterine sarcomas Less common uterine cancers that do not come from glandular tissue of the endometrium are called uterine sarcomas. These types of cancer are not covered here because their treatment and outlook for survival are different from the most common cancers of the endometrium. If you would like to know more about this type of cancer please see our document called Uterine Sarcoma. Cervical cancers Cancers that start in the cervix and then spread to the body of the uterus are different from cancers that start in the body of the uterus. They are described in our document, Cervical Cancer. How many women get endometrial cancer? The American Cancer Society's most recent estimates for uterus cancer (both endometrial cancer and uterine sarcomas) in the United States are for 2012: • About 47,130 new cases of cancer of the body of the uterus • About 8,010 deaths from cancers of the uterine body These numbers include both endometrial cancers and uterine sarcomas. About 2% of uterine body cancers are sarcomas, so the actual numbers for endometrial cancer cases and deaths are slightly lower than the numbers above. In this country, cancer of the endometrium is the most common cancer found in women's reproductive organs. The chance of a woman having this cancer during her lifetime is about one in 38. What are the risk factors for endometrial cancer? We do not yet know what causes most cases of endometrial cancer. But we do know that certain risk factors are linked to this disease. A risk factor is anything that changes a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, being in strong sunlight without protection is a risk factor for skin cancer. Smoking is a risk factor for many cancers. Some risk factors, like your age or race, can't be changed. Others, like smoking and diet are under your control. But risk factors don't tell us everything. Someone can have several risk factors and still not get a disease. Also, not having any risk factors doesn't mean that you won't get the disease. Even if a woman with endometrial cancer has one or more risk factors, there is no way to know which, if any, of these factors played a part in her cancer. Risk factors for endometrial cancer Hormone factors A woman's hormone balance plays a part in most endometrial cancers. Many of the risk factors for endometrial cancer affect estrogen levels. Before change of life, the ovaries are the main source of the 2 main types of female hormones estrogen and progesterone. The balance between these hormones changes during a woman's menstrual cycle each month. A shift in the balance of these 2 hormones toward more estrogen increases a woman's risk for getting endometrial cancer. After change of life, the ovaries stop making these hormones, but a small amount of estrogen is still made in fat tissue. Female hormones can also be taken as birth control pills to prevent pregnancy and as hormone therapy to treat symptoms of menopause. Estrogen therapy: Using estrogen to treat symptoms of change of life is known as estrogen therapy or menopausal hormone therapy. Estrogen treatment can reduce hot flashes, improve vaginal dryness, and help prevent the weakening of the bones (osteoporosis) that can happen with menopause. But the use of estrogen by itself increases a woman's risk of getting endometrial cancer in women who still have a uterus. Estrogen therapy also increases a woman's chance of developing serious blood clots and heart disease. Studies show that giving progesterone-type drugs along with the estrogens helps lower the risk of endometrial cancer. But studies also show that giving this combination of the hormones increases a woman's chance of getting breast cancer and blood clots. It is important to discuss the pros and cons of estrogen therapy with your doctor. If you choose to take it, you should use the lowest dose that is needed for the shortest period of time. You should also have follow-up pelvic exams at least every year. Let your doctor know right away if you have any vaginal bleeding or discharge that isn't normal. Birth control pills: Using birth control pills lowers the risk of endometrial cancer. The risk is lowest in women who take the pill for a long time. And this protection goes on for at least 10 years after a woman stops taking this form of birth control. But you need to look at all of the pros and cons when choosing a birth control method endometrial cancer risk is only one factor to think about. It's a good idea to talk to your doctor about the different methods of birth control to find the one that is best for you. Total number of menstrual cycles (periods): Having more periods during a woman's lifetime raises her risk of endometrial cancer. Starting periods before age 12 or going through change of life late raises the risk. Starting periods early is less a risk factor for women with early change of life. Likewise, late change of life may not lead to a higher risk in women whose periods began later in their teens. Pregnancy: During pregnancy, the hormone balance shifts toward more progesterone. So having many pregnancies reduces endometrial cancer risk. Women who have never been pregnant have a higher risk. Obesity (being very overweight): Most of a woman's estrogen is made by her ovaries, but fat tissue can change some other hormones into estrogens. Having more fat tissue can increase a woman's estrogen levels and, as a result, increase her endometrial cancer risk. Tamoxifen: Tamoxifen is a drug that is used to treat women with breast cancer. It is also used to reduce the risk in women who are at a high risk of getting breast cancer. The drug acts like estrogen in the uterus. It can cause the uterine lining to grow and increase the risk of endometrial cancer. The risk of getting endometrial cancer in women taking tamoxifen is fairly small (about 1 in 500). It must be balanced against the value of this drug in treating and preventing breast cancer. This is something women may want to talk about with their doctors. If you decide to take tamoxifen, you should have yearly pelvic exams. You should also be sure to tell your doctor if you have any endometrial cancer symptoms, such as discharge or bleeding that isn't normal. Ovarian tumors: A certain type of ovarian tumor makes estrogen. Women who have these tumors have higher than normal estrogen levels. The increase in estrogen compared to progesterone can increase a woman's chance of getting endometrial cancer. Polycystic ovarian syndrome: Women with polycystic ovarian syndrome (PCOS) have hormone levels that are not normal, such as higher androgen (male hormones) and estrogen levels and lower levels of progesterone. The increase in estrogen compared to progesterone can increase a woman's chance of getting endometrial cancer. Use of an IUD (intrauterine device) Women who used an IUD for birth control seem to have a lower risk of getting endometrial cancer. This only applies to IUDs that do not contain hormones. Researchers have not yet studied whether newer types of IUDs that release hormones have any effect on endometrial cancer risk. Age The risk of endometrial cancer goes up as a woman gets older. Diet and exercise A: high-fat diet can increase the risk of many cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity, which is also an endometrial cancer risk factor. Some doctors think that fatty foods may have a direct effect on estrogen levels, which can increase risk, too. Exercise protects against endometrial cancer. Studies found that women who exercised more had a lower risk of this cancer, while one study showed that women who spent more time sitting had a higher risk. Diabetes Diabetes is more common in people who are overweight. This could be why diabetes is a risk factor for endometrial cancer. But some studies suggest that diabetes by itself, even when the person is not overweight, could be a risk factor. Family history Endometrial cancer appears to run in some families who also tend to get colon cancer. This is called HNPCC (hereditary nonpolyposis colon cancer), also known as Lynch syndrome. This results in a very high risk of colon cancer, as well as a high risk of endometrial cancer. There are some families that have a high rate of only endometrial cancer. These families may have a different genetic disorder that hasn't been discovered yet. Breast or ovarian cancer Women who have had breast cancer or ovarian cancer may have a higher risk of getting endometrial cancer. Some of the risk factors for breast and ovarian cancer also increase endometrial cancer risk. Earlier pelvic radiation therapy Radiation used to treat some other cancers can damage the DNA of cells. This could increase the risk of getting a second type of cancer, such as endometrial cancer. Endometrial hyperplasia Endometrial hyperplasia is an increased growth of the endometrium. The most common type has a very small risk of becoming cancer. It may go away on its own or after treatment with hormones. If the hyperplasia is called “atypical,” it has a higher chance of becoming a cancer. It is important to keep in mind that although these factors may increase a woman's risk for getting endometrial cancer, they do not always cause the disease. Many women with one or more of these risk factors never get endometrial cancer, and some women with endometrial cancer do not have any of these risk factors. Can endometrial cancer be prevented? Although most cases of endometrial cancer cannot be prevented, there are some things that may lower your risk of getting this disease. One thing you can do is to change risk factors whenever possible. Women who are overweight or obese have up to 3½ times the risk of getting endometrial cancer as compared to women with a healthy weight. Getting to and maintaining a healthy weight is one way to lower the risk of this cancer. Regular physical activity (exercise) may also be a way to help lower endometrial cancer risk. Estrogen to treat the symptoms of menopause comes in many different forms like pills, skin patches, and creams. If you are thinking about using estrogen to ease symptoms of menopause, ask your doctor about how it will affect your risk of endometrial cancer. Getting treatment of an endometrium problem before it becomes cancer is another way to lower the risk of endometrial cancer. Most endometrial cancers develop over many years. Many are known to follow, and maybe start from, less serious problems of the lining of the uterus, such as increased growth of this lining (hyperplasia). Some cases of hyperplasia will go away without treatment. But sometimes it needs to be treated with hormones or even surgery. Treatment can prevent hyperplasia from becoming cancer. Women with hereditary nonpolyposis colon cancer (HNPCC, Lynch syndrome) have a very high risk of endometrial cancer. A woman with HNPCC may choose to have her uterus removed (a hysterectomy) after she has finished having children to prevent endometrial cancer. How is endometrial cancer found? Most women are diagnosed with endometrial cancer because they have symptoms. Watching for any signs and symptoms of this cancer (like abnormal vaginal bleeding or discharge) and telling your doctor about them right away allows the cancer to be found at an early stage. Finding it early improves the chances that it will be treated with success. But sometimes this cancer can reach an advanced stage before it causes any symptoms. Tests to find cancer early Early detection refers to the use of tests to find a disease such as cancer in people who do not have symptoms of that disease. Women at average endometrial cancer risk At this time, there are no screening tests or exams to find endometrial cancer early in women who are at average endometrial cancer risk and who have no symptoms. Women should talk to their doctors about getting regular pelvic exams, including Pap tests. Although the Pap test can find some female cancers early, most cases of endometrial cancer are not found by this test. But the Pap test is very good at finding early cancer of the cervix (the lower part of the uterus). After menopause you should tell your doctor if you have any discharge or bleeding that is not normal. This could be a sign of endometrial cancer. Women who have a higher risk of endometrial cancer Women at high risk for this cancer should also see their doctor whenever they have any vaginal bleeding that is not normal. This includes women who: • Are older • Had late menopause • Never gave birth • Are unable to get pregnant (infertile) • Are obese • Have diabetes • Have high blood pressure • Are using estrogen treatment • Are taking tamoxifen If several family members have had colon or endometrial cancer, you might want to think about having genetic counseling to learn about your family’s risk of having hereditary nonpolyposis colon cancer (HNPCC). If you (or a close relative) have genetic testing and are found to have a change in one of the genes for HNPCC, you have a high risk of getting endometrial cancer. To find out more about genetic testing, please see our document, Genetic Testing: What You Need to Know. The American Cancer Society recommends that women who have (or may have) HNPCC be offered yearly testing with an endometrial biopsy beginning at age 35. Their doctors should discuss this test with them, including its risks, benefits, and limits. This applies to women known to carry HNPCC-linked gene changes (mutations), women who are likely to carry such a change (those with a mutation known to be present in the family), and women from families which tend to get colon cancer where genetic testing has not been done. Another option for a woman who has (or may have) HNPCC would be to have a hysterectomy once she is finished having children. Signs and symptoms of endometrial cancer Unusual bleeding, spotting, or other discharge About 9 out of 10 women with endometrial cancer have some type of abnormal vaginal bleeding. For a woman who has gone through the change of life (menopause), this can mean bleeding or spotting after she has stopped having periods. Before menopause, this means a change in your periods or bleeding or spotting between periods. Less often, women with endometrial cancer have a discharge that does not look like it contains blood. Abnormal discharge is more often caused by something other than cancer, but it still needs to be checked out. If you have abnormal vaginal bleeding or discharge, you should see a doctor. Pelvic pain or a mass and weight loss Pain in the pelvis, feeling a lump (mass), and losing weight without trying can also be symptoms of endometrial cancer. These symptoms usually happen in the later stages of the disease. Still, you should see the doctor right away because a delay in getting treatment can allow the cancer to get worse. This lowers the chance that treatment will work. What will happen next? History and physical exam: The doctor will ask about your symptoms, risk factors, and the health of your family members. The doctor will also do a physical and a pelvic exam. Seeing a specialist: If the doctor thinks you might have endometrial cancer, you should see a gynecologist a doctor with special training in finding and treating diseases of the female reproductive system. These doctors can help diagnose endometrial cancer and treat some early cases. You may also need to see a gynecologic oncologist a doctor with special training in treating cancers of the endometrium and other female reproductive organs. These doctors treat both early and advanced cases of endometrial cancer. Getting a sample of endometrial tissue To find out whether the problem is endometrial hyperplasia or endometrial cancer, the doctor must remove some tissue so that it can be looked at under the microscope. Tissue [...]... to see if they contain any cancer cells This method is often used for some other tumors, such as breast cancer, but it is still new in the treatment of endometrial cancer It is not yet known whether sentinel lymph node biopsy is as good as taking out the lymph nodes for staging and treatment of endometrial cancer More information about endometrial cancer From your American Cancer Society The following... There are 4 basic types of treatment for women with endometrial cancer Surgery is the main treatment for most women with endometrial cancer But sometimes one or more of these treatments is combined • Surgery • Radiation treatment • Hormone treatment • Chemotherapy (chemo) Surgery for endometrial cancer Hysterectomy The main treatment for endometrial cancer is an operation to take out the uterus and cervix... happen Rarely, serious blood clots might form Sometimes endometrial hyperplasia and early endometrial cancers can be treated with an intrauterine device that contains a progestin and possibly another hormone drug Tamoxifen: Tamoxifen is a drug often used to treat breast cancer It may also be used to treat advanced endometrial cancer or endometrial cancer that has come back (recurred) It can cause hot... own questions below: Moving on after treatment for endometrial cancer For many women with endometrial cancer, treatment may remove or destroy the cancer It can feel good to be done with treatment, but it can also be stressful You may find that you now worry about the cancer coming back This is a very common concern among those who have had cancer (When cancer comes back, it is called a recurrence.) It... tissue is most often ordered in patients who are found to have endometrial cancer at an earlier than usual age or who have a family history of endometrial or colon cancer Imaging tests for endometrial cancer Ultrasound: Ultrasound is the use of sound waves to take pictures of the inside of the body When this test is done for possible endometrial cancer, a probe is placed into the vagina It gives off sound... 125 levels may also be watched to see if the cancer has come back after treatment is done Staging of endometrial cancer Staging is the process of finding out how widespread the cancer is and whether it has spread to other parts of the body The stage of the cancer is an important factor in making treatment choices The 2 systems used for staging endometrial cancer are the FIGO (International Federation... about the outlook of someone with cancer The 5-year relative survival rate compares the 5-year survival of people with the cancer to the survival of others the same age who don't have cancer This is a better way to see the impact of the cancer When all cases of endometrial cancer are looked at together, the 5-year relative survival rate is about 69% But most of these cancers are found at an early stage,... of this lining to check for cancer cells Tumor debulking If cancer has spread throughout the abdomen, the surgeon may try to remove as much of the tumor as possible This is called debulking Debulking a cancer can help other treatments work better Tumor debulking is helpful for other types of cancer, and it may also be helpful in treating women some women with endometrial cancer Recovery after surgery... Hormone therapy for endometrial cancer Hormone therapy is the use of hormones or hormone-blocking drugs to fight cancer This type of hormone treatment is different from the hormones given to treat the symptoms of menopause Below are some of the types of hormone treatment that might be used to fight endometrial cancer Progestins: Progesterone-like drugs can be used to slow the growth of cancer cells The... of 3 Grade 2 tumors fall somewhere in between The grade is important because women with lower grade cancers are less likely to have cancer that has spread or have the cancer come back after treatment If the doctor suspects that hereditary nonpolyposis colon cancer (HNPCC) is linked to your endometrial cancer, the tumor tissue can be tested for certain changes that can happen when one of the genes that . Endometrial (Uterine) Cancer Overview The information that follows is an overview of this type of cancer. It is based on the. women with endometrial cancer do not have any of these risk factors. Can endometrial cancer be prevented? Although most cases of endometrial cancer cannot