Endometrial Cancer: A Risk for Women

Endometrial Cancer:

Affects the endometrium, the lining of the uterus.

Most commonly occurs among women over the age of 40.

High Risk Women

Certain women who have experienced menopause are at higher risk of endometrial cancer, including those who:

  • used estrogen alone for more than three years,
  • had irregular periods,
  • have hyperplasia (abnormal cell production) of the uterus lining,
  • have never been pregnant or given birth,
  • have had breast, ovary or colon cancer,
  • are overweight,
  • have diabetes, or
  • have high blood pressure.

Incidence

The rate of endometrial cancer among women who have experienced menopause but have not used estrogen is about one in one thousand each year. However, research has shown that the rate is four to eight times higher among women who have used estrogen during menopause.

There is also evidence that a woman's risk increases with the amount of estrogen taken and the length of use, and decreases rapidly after she stops taking estrogen. Of course, a woman who has had a hysterectomy is not at risk because her uterus has been removed.

Estrogen Use and Endometrial Cancer

During menopause, the ovaries slow and eventually stop their production of estrogen. Decreased estrogen may cause hot flashes or vaginal dryness and may contribute to osteoporosis or reduced bone mass. Man- made estrogen can be used to replace the natural estrogen no longer produced by the body and to help eliminate these conditions.

Detection

Ninety percent of women with early endometrial cancer can be treated successfully. As with most medical problems, the earlier the diagnosis, the better the outcome. All women who are experiencing menopause should see their health care providers at least once a year, especially if they use estrogen alone for more than three years.

The first sign of endometrial cancer is usually abnormal vaginal bleeding. Bleeding may start as a watery, blood- streaked flow that gradually contains more blood. Vaginal bleeding should not be considered simply part of menopause; it should always be checked by a health care provider.

A woman should also see her health care provider if she has any of the following symptoms:

  • other unusual vaginal discharge,
  • difficult or painful urination,
  • pain during intercourse, or
  • pain in the pelvic area.

Health care providers can determine the condition of the endometrium by studying a tissue sample obtained by a biopsy, a procedure that can be performed in a health care provider's office, or by a D and C (dilation and curettage) which is performed in the hospital. While Pap smears will usually detect cervical cancer, they will not detect endometrial cancer.

Treatment

Depending on the test results, a woman's age and health, and whether abnormal vaginal bleeding is present, a health care provider will advise a woman of her options. Together, they can make a decision for the best course of treatment.

Initially, a health care provider may decide to simply observe the situation closely. Or, he/ she may prescribe progestin, a hormone which causes a woman to have regular vaginal bleeding - even if she is experiencing menopause. During a woman's period, the lining of the uterus, including any abnormal cells, is cast off. Another option is to remove the lining of the uterus in a D and C.

If cancer is diagnosed, a health care provider would perform a hysterectomy. For early endometrial cancer, this is usually sufficient. More extensive cases may also require radiation treatment and/ or removal of the ovaries and uterine tubes. This is often followed by chemotherapy or progestin therapy.

Treatment Effects

A woman who has had a hysterectomy will no longer have periods, even if she is young. If the ovaries and uterine tubes are also removed, she will experience menopause, which may include hot flashes and other symptoms. A woman who has already experienced menopause will observe no estrogen- related changes after this surgery.

Some patients using progestin may experience breast tenderness, fluid retention, swelling, moodiness and cramps. These side effects seem to be milder for some women who use continuous hormone replacement therapy.

Radiation therapy can cause vaginal itching and, less commonly, burning of the skin. Fatigue, nausea and vomiting can also occur. These side effects are temporary. Similarly, drugs used for chemotherapy may cause nausea and vomiting as well as loss of hair. These side effects usually disappear when treatment is completed.

Remember....

  • Ninety percent of women with early endometrial cancer can be treated successfully.
  • Unusual vaginal bleeding can be one of the first signs of endometrial cancer.
  • A woman who has vaginal bleeding after menopause should call her health care provider immediately.
  • Women who still have occasional periods should also remain alert for any unusual vaginal bleeding

New York State Department of Health

Publication 0456
Version 12/00