Endometrial Cancer

What is endometrial cancer?

The womb (also known as the uterus) is a pear-shaped organ where a baby is carried during pregnancy. Endometrial cancer (which might also be called womb or uterine cancer) is cancer that starts in the lining of the womb, which is called the ‘endometrium’.

Endometrial cancer is one of the most common cancers in women, with over 380,000 women being diagnosed in 2018. It mainly affects women who have gone through the menopause and is most commonly diagnosed in women over the age of 40.

What are the risk factors for endometrial cancer?
The reason that some women get endometrial cancer is not completely clear. However, there are some factors that are known to increase the likelihood of a woman developing this disease, called ‘risk factors’. Having a risk factor does not mean that you will definitely get the disease. Some risk factors for endometrial cancer include:

• Being older than 40 years of age
• Having gone through the menopause
• Higher levels of a hormone called oestrogen
• More years of periods, for example starting your periods at a younger age or going through the menopause at a later age
• Never having been pregnant
• Being overweight
• Having tamoxifen as treatment for breast cancer
• Having diabetes
• Having a genetic condition called Lynch syndrome (this is also called ‘hereditary nonpolyposis colorectal cancer’ or HNPCC).

What are the symptoms of endometrial cancer?
The most common symptom of endometrial cancer is unusual bleeding from the vagina. Any type of vaginal bleeding is unusual in women who have been through the menopause, but pre-menopausal women may experience heavier periods or bleeding between periods. Other less common symptoms to watch out for include:

• Pain in the tummy
• Pain during sex
• Pain in the back, legs or pelvis
• Loss of appetite
• Tiredness
• Nausea.

How is endometrial cancer diagnosed?
If your doctor thinks you might have endometrial cancer, they will do a physical examination and then send you for some further tests that might include:

• Blood or urine tests
• Pelvic examination – an internal examination of your vagina
• Ultrasound of your womb
• Biopsy – a tissue sample will be taken from your womb to check for cancer cells.

Once your diagnosis is confirmed, you may be sent for scans (like MRI or CT, which give a detailed picture of the inside of the body) or a chest x-ray to help doctors to understand the type, stage and grade of your ovarian cancer (more information on these can be found below).

What are the types of endometrial cancer?
There are many different types of endometrial cancer but the most common is adenocarcinoma (95 out of 100 endometrial cancers are this type). Adenocarcinoma means that the cancer started in the glands of the lining of the womb. Endometrial cancer can look very different from one patient to another when studied through a microscope, so doctors sometimes divide endometrial cancers into 2 types:

• Type 1 – This includes the most common types of endometrial cancer (like adenocarcinomas) that are usually caused by too much of the hormone called oestrogen in the body. Type 1 cancers grow slowly and are less likely to spread.
• Type 2 – This includes types of endometrial cancer that are not caused by the hormone called oestrogen. Type 2 cancers grow faster and are more likely to spread.

What are the stages of endometrial cancer?
The stage of your endometrial cancer describes where the cancer is and how far it has spread into nearby tissues and/or around the body.

• Stage 1 – the cancer is only in the womb and has not spread.
• Stage 2 – the cancer is in the womb and has spread to the cervix.
• Stage 3 – the cancer has spread to the vagina, ovaries or lymph nodes.
• Stage 4 – the cancer has spread to nearby organs like the bladder or rectum (back passage), or other organs such as the lungs or bones.

What are the grades of endometrial cancer?
The grade of your endometrial cancer describes how fast it is likely to grow and spread around the body.

• Grade 1 – the cancer cells look similar to normal cells and are less likely to spread and come back after treatment.
• Grade 2 – the cancer cells look different to normal cells and are more likely to spread and come back after treatment.
• Grade 3 – the cancer cells look very different to normal cells and are the most likely to spread and come back after treatment.

What treatment options are available for endometrial cancer?
The most common treatments for endometrial cancer are surgery (to remove as much of the cancer as possible), radiotherapy and chemotherapy (to kill cancer cells). Treatment will vary based on the type, stage and grade of your endometrial cancer, and will depend on what is approved in your country.

Surgery
During your surgery, the surgeons will try to remove as much of the cancer as they can to give you the best possible outcome and reduce the likelihood that your cancer will come back after treatment. This may involve removing some of the reproductive organs, including the ovaries, fallopian tubes, womb and cervix. If your cancer has spread, they will also assess the possibility of removing as much cancer from those organs as possible.

Radiotherapy
You may be given radiotherapy after your surgery to try to kill any remaining cancer cells that were unable to be removed during surgery. You may be given external radiotherapy (given from outside the body) or internal radiotherapy (given from inside the body).

• External radiotherapy – This treatment is given by aiming x-rays at the cancer from outside your body. You will have to go to your local hospital for treatment 5 days a week for a few weeks, but each treatment usually only lasts a few minutes. The exact timing of your visits will be decided by your doctor.
• Internal radiotherapy (Brachytherapy) – This treatment is given by placing an internal radiation device into the top of the vagina, next to the cervix, before releasing radiation directly towards the tumour. The device will be placed while you are under anaesthetic (you will either be asleep or numb from the waist down). You may have several treatments over 1–2 days (the device will be left inside you) or you may have several treatments a few days apart (the device will be removed at the end of each treatment). The exact timing of your visits will be decided by your doctor.

Chemotherapy
Chemotherapies are drugs that aim to stop cancer cells from growing. Sometimes chemotherapy is given with radiotherapy to help the radiotherapy work better. This is called chemoradiotherapy. Chemotherapy may be given as a mixture of drugs as this sometimes works better than one type of chemotherapy on its own. Chemotherapy is given as an infusion into your vein over a few hours. You will need to go to your hospital or clinic regularly to be given chemotherapy treatment, and the exact timing of your visits will be decided by your doctor.

Hormone therapy
Depending on the type of your endometrial cancer, your doctor may recommend for you to have hormone therapy. These therapies help to slow or stop the growth of cancer cells by cutting off or lowering the levels of certain hormones in the body.

There are new treatments being developed for endometrial cancer. Clinical trials investigate these new drugs and compare them with the current therapies already available. If you would like to know more about clinical trials, or are interested in taking part in a clinical trial, speak to your doctor or visit the clinical trials page on the Roche ForPatients platform (https://forpatients.roche.com/en/faq/what-is-a-clinical-trial.html).

What is the outlook for a person with endometrial cancer?
The outlook for endometrial cancer depends on the type, stage and grade of the cancer when it is diagnosed. Please talk to your doctor about the outlook for your endometrial cancer.