For many types of cancer, the number of cases and the number of deaths is declining, thanks to screenings and improved treatments. One notable exception is endometrial cancer of the uterine lining.
Endometrial cancer is the fourth most common cancer for women in the United States, and rates have been steadily increasing in the past decades. In addition to a rise in cases, there has also been an increase in deaths from the disease.
We talked to UNC Health gynecologic oncologist Olivia Lara, MD, about what you need to know.
1. Anyone with a uterus is at risk.
Fewer women have pursued hysterectomies, surgeries that remove the uterus, in recent decades, thanks to other minimally invasive options for gynecological problems. If you haven’t had a hysterectomy, it’s important to remember that any form of uterine cancer is possible.
“As long as you have a uterus, you can develop uterine cancer,” Dr. Lara says.
But that doesn’t mean you have to get a hysterectomy if you don’t want one.
“What matters most is understanding and managing your individual risk factors over time,” Dr. Lara says.
While it’s possible to have a cancerous tumor called a sarcoma in the muscular walls of the uterus itself, it’s much more common to have cancer in your endometrium, the inner lining of the uterus.
The uterus is the pear-shaped organ where a baby grows during pregnancy. This lining is what sheds during a menstrual period.
2. Obesity is a major risk factor.
Excess weight can affect the balance of your hormones, causing higher levels of estrogen that can overstimulate growth in the uterine lining.
“The rise in endometrial cancer closely parallels the obesity epidemic,” Dr. Lara says. “Excess body weight is one of the strongest and most modifiable risk factors we see in clinical practice.”
Other risk factors include a family history of the disease, health conditions that create excess estrogen, such as polycystic ovary syndrome, pelvic radiation for other cancers, and a history of breast or ovarian cancer. Taking the breast cancer drug Tamoxifen increases your risk of endometrial cancer.
Endometrial cancer tends to mostly affect postmenopausal women—the average age at diagnosis is 60—but it can affect anyone.
“We’re increasingly diagnosing endometrial cancer in younger women, which is particularly concerning because many don’t realize they’re at risk,” Dr. Lara says.
3. Abnormal bleeding is the most common symptom.
The primary symptom of endometrial cancer is bleeding after menopause, bleeding between periods or changes to the menstrual period.
“Abnormal bleeding is by far the most common symptom we see in patients with endometrial cancer,” Dr. Lara says. “This includes any bleeding after menopause, which should be evaluated. Persistent, heavy, or otherwise unexplained abnormal bleeding at any age should also be evaluated.”
Postmenopausal bleeding or changing periods aren’t always cancer, but it’s important to rule out that possibility promptly.
“Abnormal bleeding is never something to ignore,” Dr. Lara says. “Identifying the cause early allows us to address problems before they become serious.”
Other symptoms can include pelvic pain or pressure, urinary symptoms or changes in vaginal discharge, but most women experience abnormal bleeding, Dr. Lara says.
4. There is no screening or vaccine for endometrial cancer.
There is no standard screening or vaccine for endometrial cancer, the way that Pap tests screen for cervical cancer and the HPV vaccine can prevent it. That’s why it’s so important to see your doctor if you notice any abnormal bleeding.
If your provider is concerned about endometrial cancer, they will perform a transvaginal ultrasound to look at the uterus and the endometrium. Then, they may need to do an endometrial biopsy, taking cells from the lining to look at under a microscope.
5. Early endometrial cancer treatment is very effective.
There is some good news when it comes to endometrial cancer: When it’s identified early, treatment is very effective.
“Early uterine cancer is very curable with a total hysterectomy, removing the uterus, cervix, both fallopian tubes and the ovaries,” Dr. Lara says. “We also take one lymph node on either side of the uterus to evaluate if cancer has spread.”
If you don’t desire any future pregnancies but haven’t gone through menopause, your doctor may consider leaving the ovaries, depending on your risk for ovarian cancer, as they can provide some protection against heart disease and osteoporosis.
If you still want children and the cancer is caught early, there is an additional option.
“For women who still desire children with early cancer, we can try treatment with a hormonal IUD, which thins the uterine lining,” Dr. Lara says. “In carefully selected patients, remission rates can approach 80 percent, but response varies, and close surveillance with repeat biopsies is required.”
Depending on your specific case, a hysterectomy may be the whole treatment; some people require radiation or chemotherapy to reduce the risk of recurrence, or if the cancer has spread or is particularly aggressive.
6. There are ways to reduce your risk for endometrial cancer.
There are steps you can take to reduce your risk. Talk to your doctor about any family history of gynecologic cancers. They may recommend genetic testing to better understand your specific risk.
Your risk for endometrial cancer should also be considered when your doctor makes decisions about medications with hormones.
“Progesterone-containing IUDs are among the most effective contraceptive options, and they also protect the uterine lining, lowering the risk of endometrial cancer,” Dr. Lara says. “For women on menopause hormone therapy, taking estrogen without progesterone can increase your risk of a thickened endometrium, so have a discussion about progesterone if you still have a uterus.”
You can also reduce your risk for endometrial cancer by maintaining a healthy weight. If you need help with this, talk to your primary care provider.
“Obesity increases the risk of several cancers, including endometrial cancer,” Dr. Lara says. “Even modest weight loss can have meaningful health benefits.”
If you’re concerned about your risk for cancer, talk to your doctor. If you need a doctor, find one near you.