Endometrial (Uterine) Cancer

Topic Overview

Is this topic for you?

This topic provides information about cancer of the lining of the uterus ( endometrium ). This topic focuses on type I endometrial cancer, which is the most common kind.

If you are looking for information about cancer of the cervix , see the topic Cervical Cancer.

What is endometrial cancer?

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

What causes endometrial cancer?

The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:

Is obese . Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
Takes estrogen without taking a progestin .
Has polycystic ovary syndrome , which causes hormone imbalance.
Starts her period before age 12 or starts menopause after age 55.
Has never been pregnant or had a full-term pregnancy.
Has never breast-fed.

What are the symptoms?

The most common symptom of endometrial cancer is unexpected (abnormal) bleeding from the vagina after menopause . (If you are taking hormone therapy, some vaginal bleeding is expected.) About 20 out of 100 women who have abnormal bleeding after menopause have endometrial cancer.¹ That means that 80 out of 100 women with abnormal bleeding after menopause don't have this cancer.

A woman with advanced endometrial cancer may have other symptoms, such as losing weight without trying.

How is endometrial cancer diagnosed?

Endometrial cancer is usually diagnosed with a biopsy . In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

How is it treated?

Endometrial cancer in its early stages can be cured. The main treatment is surgery to remove the uterus plus the cervix , ovaries , and fallopian tubes . The doctor will also remove pelvic and aortic lymph nodes to see if the cancer has spread.

A woman whose cancer has spread may also have:

Chemotherapy to kill cancer cells.
Hormone therapy to block cancer growth.
Radiation therapy to kill cancer cells.

It’s common to feel scared, sad, or angry after finding out that you have endometrial cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area.

Frequently Asked Questions

Learning about endometrial cancer:	What is endometrial cancer? What causes it? What are the symptoms? What increases my risk for this cancer? How common is it?
Being diagnosed:	How is it diagnosed? What does stage and grade of endometrial cancer mean? What is an endometrial biopsy?
Getting treatment:	What is the treatment for endometrial cancer? Will I need surgery? Will I need to take medicines? Will I need radiation therapy?
Ongoing concerns:	How often will I need to see my doctor? When should I call my doctor?
Living with endometrial cancer:	How will this cancer affect my daily life? Will it affect my body image and sexuality? Is cancer treatment painful? What side effects will treatment cause? How will I feel after treatment?
End-of-life decisions:	What is care at the end of life? What is hospice care?

Health Tools

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	Cancer: Controlling nausea and vomiting from chemotherapy

Cause

The main cause of most endometrial cancer is too much of the hormone estrogen compared to the body's progesterone level.²

Estrogen makes the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen—your progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what you know as menstrual bleeding.

When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. Over time, the endometrium cells can become cancerous.

Symptoms

The most common symptom of endometrial cancer is abnormal vaginal bleeding after menopause . Up to 20% of women who have abnormal bleeding after menopause will have endometrial cancer.¹ "Abnormal" bleeding means unexpected bleeding. If you are taking hormone therapy after menopause, you can expect some bleeding. But if you have irregular bleeding that continues for 3 months or more, call your doctor.

Abnormal bleeding in women older than 35 who have not started menopause may also be a symptom of endometrial cancer, though this is less common. In rare cases, an unexplained abnormal vaginal discharge may be an early symptom.

Symptoms of more advanced endometrial cancer include:

Difficult or painful urination.
Pain in the pelvic area.
A pelvic lump.
Weight loss.

Other conditions with similar symptoms include cervical cancer and dysfunctional uterine bleeding .

What Happens

Normally, the lining of the uterus (endometrium) builds up and then sheds every month. You know this shedding as menstrual bleeding. In most cases of endometrial cancer , the endometrium has built up, or thickened, and has stayed that way. This is called endometrial hyperplasia . From this "precancer" stage, the cells can grow quickly and out of control. These fast-growing cells are cancer cells.

As the cancerous cells multiply, they form a mass of tissue. Some of this tissue mass passes out of the uterus through the cervix and vagina as part of abnormal bleeding. Abnormal bleeding occurs in 90% of women with endometrial cancer .³

If endometrial cancer is not treated, it may spread from the uterus into deeper layers of the connective tissue around the uterus. As it progresses, it may spread to the pelvic lymph nodes and other pelvic organs. Advanced-stage cancer may spread to lymph nodes, to other organs in the pelvis, causing problems with kidney and bowel function, or to other organs in the body, such as the liver and lungs. The most common sites for spread (metastasis) of endometrial cancer are the vagina, lungs, and abdominal cavity.⁴

The stage and grade of your cancer is one of the most important factors in selecting the treatment option that is right for you. The long-term outcome (prognosis) depends on the stage of your cancer. The stage of you cancer will be determined by what your doctor finds at the time of surgery. The grade of your cancer is determined by how the cancer cells look under the microscope.

Endometrial cancer is the most common type of women's pelvic cancer.² Uterine sarcoma is a less common type of uterine cancer. For more information, see the following topics:

What Increases Your Risk

The biggest risk factor for endometrial cancer is having too much estrogen and not enough progesterone . This is called "unopposed estrogen." (Your body makes progesterone. Man-made progesterone, as in birth control pills or hormone therapy, is called a progestin .)

Long-term exposure to unopposed estrogen may occur as a result of:

Being obese .¹ Fat cells make extra estrogen, but your body doesn't make extra progesterone to balance it out.
Taking estrogen without taking a progestin.
Polycystic ovary syndrome .
Beginning your menstrual cycle before age 12 or starting menopause after age 55.
Not ever being pregnant or not ever completing a full-term pregnancy (nulliparity).
Not ever breast-feeding.

Additional factors that increase your risk include:

Being older than 50. Endometrial cancer is most common in women older than 50.
Having a history of breast , ovarian , or colon cancer.
Taking tamoxifen, a breast cancer treatment that acts like estrogen in the uterus.¹ If you are taking tamoxifen for breast cancer, keep taking it as directed by your doctor. But be sure to have a pelvic exam each year. The risk of endometrial cancer is small compared to the risk of getting breast cancer again.⁵ If you are worried about endometrial cancer risk, talk to your doctor. You might be able to use another medicine, instead of tamoxifen, for breast cancer.
Having endometrial hyperplasia .
Having diabetes .
Having hypertension .
Having previous radiation therapy to the pelvis.

Endometrial cancer has been linked to hereditary nonpolyposis colon cancer (HNPCC) . In women, this cancer often starts in the uterus and ovaries before it grows in the colon. The American Cancer Society recommends that a woman with a family history of HNPCC talk to her doctor about annual screenings with endometrial biopsy, starting at age 35.⁶

Reducing your risk

There are some measures that can lower your risk for developing endometrial cancer.

Taking birth control pills that contain both estrogen and progestin for longer than 1 year. Similarly, taking estrogen with progestin for menopausal symptoms lowers your endometrial cancer risk. (You have no risk for endometrial cancer if you have had your uterus removed, or hysterectomy .)
Staying at a healthy body weight.
Being physically active.
Eating a diet rich in fruits, vegetables, and fiber.
Lowering the amount of animal fats you eat.

When To Call a Doctor

Schedule an appointment with your doctor if you have:

Abnormal vaginal bleeding or discharge, especially if it occurs after menopause .
Difficult or painful urination.
Pain during intercourse.
Pain in the pelvic area.
Irregular bleeding that continues for 3 months or more while taking hormone therapy .

Symptoms of endometrial cancer can be mistaken for those of another condition, such as endometriosis .

Watchful Waiting

If you are concerned about your symptoms or think you may have an increased risk for endometrial cancer, call and make an appointment with your doctor.

Watchful waiting is not appropriate if you have symptoms that do not go away.

Who To See

Health professionals who can evaluate your symptoms and your risk for endometrial cancer include:

Doctors who can manage your cancer treatment include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Most cases of endometrial cancer are diagnosed in an early stage. This is because women who have reached menopause usually see their doctors when they have vaginal bleeding. To check your symptoms, your doctor will perform a medical history and physical exam. The physical exam will include a pelvic exam and Pap test.

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) for examination under a microscope.

Additional tests may include:

A transvaginal pelvic ultrasound, which uses sound waves to create images of the uterus. The images can show how thick the endometrium is. A thick endometrium can be a sign of cancer in postmenopausal women. Ultrasound also can help show whether cancer has grown into the uterine muscle (myometrium).
A hysteroscopy, which allows your doctor to view the inside of the uterus and obtain an endometrial tissue sample.
Dilation and curettage (D&C), which is done to obtain a sample of tissue from the inside of the uterus. A D&C is sometimes done at the same time as a hysteroscopy.

Testing for endometrial cancer may show that you have endometrial hyperplasia . This is not cancer but may develop into cancer. One type of hyperplasia, atypical adenomatous hyperplasia, progresses to cancer in about 1 out of 3 women.⁷

Tests to determine the extent (stage) of endometrial cancer include:

Your doctor will determine the stage of your cancer at the time of your surgery. Other tests done before surgery may include:

A complete blood count (CBC) to check for anemia and other abnormal blood values.
A cancer antigen (CA) 125 test. The CA-125 test helps to identify cancer that has or may spread (metastasize).
An intravenous pyelogram to check kidney function.
A chest X-ray to check for cancer cells that have metastasized from the cervix.

An imaging test may be done before surgery to look for spread (metastasis) of cancer in the abdomen and pelvis. This helps with planning for treatment. Imaging tests include the following:

A computed tomography (CT) scan of the abdomen and pelvis uses X-rays to make a picture of the inside of the body.
A magnetic resonance imaging (MRI) of the abdomen and pelvis uses a magnetic field and pulses of radio wave energy to make pictures of the inside the body.

After endometrial cancer is confirmed, surgery is usually done to remove the uterus, cervix , ovaries , and fallopian tubes . This is called a hysterectomy with bilateral salpingo-oophorectomy. Sometimes the pelvic lymph nodes are also removed. The removed tissue is examined to find out the stage and grade of cancer.

Early Detection

There is no early detection test for endometrial cancer. If you have abnormal vaginal bleeding, schedule an appointment with your doctor for a medical evaluation. Unexpected bleeding, or more bleeding than normal, can be a symptom of endometrial cancer.

The American Cancer Society advises women who are nearing menopause to learn about the risks and symptoms of endometrial cancer.⁶

Women are advised to report to their doctors any unexpected bleeding or spotting or unusual vaginal discharge.
Women at risk for hereditary nonpolyposis colon cancer (HNPCC) are advised to get checked every year starting at age 35.⁶ These women also have a high risk of getting ovarian and uterine cancer. High-risk women who have no pregnancy plans can avoid these cancers by having the uterus, fallopian tubes, and ovaries removed. This is called a hysterectomy with bilateral salpingo-oophorectomy.⁸

Treatment Overview

Endometrial cancer detected in its early stages can be cured with surgery and close follow-up. Treatment choices depend on where the cancer is and how much it has grown. Treatment may include one or more of the following:

Hysterectomy with bilateral salpingo-oophorectomy surgery to remove the uterus, ovaries, fallopian tubes, and sometimes the pelvic lymph nodes
Lymphadenectomy surgery to remove lymph nodes
Radiation therapy to kill cancer cells
Progestin hormone therapy to block cancer growth
Chemotherapy to kill cancer cells

Initial treatment

After a diagnosis of endometrial cancer is confirmed, your doctor may recommend surgery to remove the uterus, ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). All tissues removed in surgery will be examined to determine the stage and grade of the cancer. Lymph nodes near the uterus will be examined to find out if cancer has spread outside of the uterus.⁴

Treatment for endometrial cancer depends on the size of the cancer, the extent of the cancer's growth, and how the cancer cells look under the microscope.

Stage 1 is curable with a hysterectomy, bilateral salpingo-oophorectomy, and lymph node biopsy. If you are premenopausal and your cancer is in a very early stage and grade, you may be able to have progestin hormone therapy rather than a hysterectomy and thus retain your ability to have children.⁹ But the effectiveness of hormone therapy is not fully known, so it is not considered a standard treatment for stage 1 cancer. If you choose this form of treatment, your doctor will probably recommend a hysterectomy when you are done having children. If cancer is found deep in the uterine muscle (myometrium), a hysterectomy may be followed by radiation therapy.
Stage 2 is treated with a radical hysterectomy. This removes the uterus, cervix, ovaries, structures that support the uterus, and pelvic lymph nodes (lymphadenectomy). If cancer is found in the connective tissue of the cervix (stroma), radiation therapy may be used after surgery. Radiation therapy may be used if you cannot have surgery, but the cure rate is lower.
Stage 3 is treated with a hysterectomy and radiation therapy. Sometimes, chemotherapy is used instead of radiation.¹⁰ When cancer has spread to the wall of the pelvis and cannot be removed during surgery, radiation therapy alone may be used. In the rare case that radiation therapy is not recommended, progestin hormone therapy may be used. Women with stage 3 endometrial cancer may be candidates for clinical trials of new treatment options.
Stage 4 is treated with radiation therapy if the spread of cancer (metastasis) is confined to the pelvic area. If the cancer is in distant areas of the body, progestin hormone therapy may be used. Chemotherapy may also be used for treating stage 4 endometrial cancer.

Women who have a hysterectomy or radiation therapy to treat endometrial cancer can no longer become pregnant.

Use home treatment measures to help manage the side effects of treatment. For more information, see the Home Treatment section of this topic. Your doctor also may prescribe medicines to control nausea and vomiting.

Cancer: Controlling nausea and vomiting from chemotherapy

If you have recently been diagnosed with endometrial cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have endometrial cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

What to think about during initial treatment

Most treatments for endometrial cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

Your surgeon and oncologist will explain the possible side effects of your surgery. A hysterectomy means you will no longer be able to become pregnant. Surgery to your lower abdomen may cause difficulty with urination or bowel problems, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.
Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, anemia, or infections.

Your quality of life becomes a critical issue when considering your treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

Some women with endometrial cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of endometrial cancer.

Ongoing treatment

After your initial treatment for endometrial cancer , it is important to receive follow-up care.

Schedule checkups every 3 to 4 months for the first 2 years following your diagnosis. This will ensure that changes in your health are noted and problems are treated early. Most experts recommend checkups every 6 months thereafter for up to 5 years after diagnosis.
Checkups include physical exams and pelvic exams and may include blood and urine tests, chest X-rays, and other laboratory tests. A Pap test may indicate recurrence of cancer in the vagina, which is highly curable.

Treatment if the condition gets worse

Endometrial cancer may come back (recur). But this is not likely when the first cancer is caught early and is low-risk. Of those cancers that do come back, nearly all do so within 3 years of the first diagnosis. This is why regular follow-up is extremely important after initial treatment.⁷

Cancer that comes back only in the pelvic area sometimes is treated with radiation therapy . This may stop the progress of cancer and may even cure it if it is only in the vagina. If cancer has spread to other parts of the body, radiation therapy often provides relief ( palliation ) from symptoms. Chemotherapy may also be used.¹⁰ And progestin hormone therapy often is used to slow the growth of cancer that has recurred or spread. Survival is significantly improved in up to 30% of women who receive progestin hormone therapy.¹¹

Participation in clinical trials to test new treatments may be appropriate if cancer has spread to other parts of the body and hormonal therapy is ineffective in stopping the growth.

What To Think About

If you are perimenopausal or have not yet reached menopause , your menstrual period will end immediately after most treatments for endometrial cancer. If your uterus and ovaries have been removed or have had radiation therapy, your body will have a decrease in estrogen . Estrogen normally prevents:

Your bones from becoming thin and brittle ( osteoporosis ). Several medicines are available to prevent or treat osteoporosis. For more information, see the topic Osteoporosis.
Menopausal symptoms, such as hot flashes and insomnia. Talk with your doctor about how to manage your symptoms if they are bothersome. For more information, see the topic Menopause and Perimenopause.

Complementary therapies

Complementary therapies are not a substitute for the standard treatment recommended for endometrial cancer. But for some people, they can play an important part in managing stress and pain.

In addition to conventional medical treatment, you may wish to try complementary therapies, such as:

Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Visualization.
Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the hope of cure or relief. But this isn't the end of treatment. Palliative care of cancer can improve your quality of life.

It can be difficult to decide when to stop treatment aimed at prolonging life and shift the focus to end-of-life care. For more information, see the topics:

Prevention

While some risk factors for endometrial cancer are inherited, such as a family history of endometrial or colon cancer , other risk factors are under your control. You can reduce your risk for developing endometrial cancer if you:

Use birth control pills that contain both estrogen and progestin , if you need birth control. Protection from combined hormonal pills lasts for 10 or more years after you stop taking the medicine if the medicine is taken for 1 year or longer.¹
Use progestin along with estrogen if you decide to try hormone therapy for symptoms of menopause . Taking progestin with estrogen will not increase your risk for endometrial cancer, but it has other risks you may want to consider. For more information, see the topics Menopause and Perimenopause and Osteoporosis.
Stay at a healthy body weight. Overweight women are more likely to have high levels of estrogen in their bodies, because some estrogen is produced in the body's fat cells. For more information on controlling your weight, see the topic Weight Management.
Breast-feed if you are able. This decreases ovulation and estrogen activity.
Recognize and get treatment for abnormal or unexpected bleeding. ( Endometrial hyperplasia , which may develop into endometrial cancer, is one cause of abnormal bleeding.) Heavy menstrual periods, bleeding between periods, and bleeding after menopause are symptoms of hyperplasia.
Exercise regularly. Physical activity may reduce unhealthy weight and may reduce estrogen levels.
Eat a diet rich in fruits, vegetables, fiber, and phytoestrogens , such as soy.¹²
Decrease your intake of animal fats.

You have no risk for endometrial cancer if you have had your uterus removed ( hysterectomy ).

Home Treatment

During medical treatment for any stage of endometrial cancer , you can use home treatment to help manage the side effects that may accompany endometrial cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment includes the following:

For nausea or vomiting, watch for and treat early signs of dehydration , such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Your doctor also may prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:

Cancer: Controlling nausea and vomiting from chemotherapy.
For diarrhea, rest your stomach, get enough fluids, and be alert for signs of dehydration . Check with your doctor before using any nonprescription medicines for your diarrhea.
Constipation includes ensuring that you drink enough fluids and include fruits, vegetables, and fiber in your diet each day. Do not use a laxative without consulting your doctor.

Other issues that may arise include:

Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.
Urinary problems, which can be caused by both endometrial cancer and its treatment. It may help to eliminate caffeinated drinks from your diet and to establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
Hair loss. Hair loss may be unavoidable, but using mild shampoos and avoiding damaging hair products will decrease irritation of your scalp.

Many women with endometrial cancer face emotional issues as a result of their disease or its treatment.

Finding out that you have cancer and undergoing treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.
Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly about your feelings with your partner and to discuss your concerns with your doctor. Your doctor may be able to refer you to groups that can offer support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to discuss any home treatment you use for pain with your doctor.

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. Palliative care of cancer can improve your quality of life.

It can be difficult to decide when to stop treatment aimed at prolonging life and shift the focus to end-of-life care. For more information, see the topics:

Medications

Medicines, such as chemotherapy , may be given after surgery for endometrial cancer , depending on the stage and grade of the cancer and the risk for the cancer to spread (metastasis) or recur. Progestin hormone therapy may be used if your cancer has recurred or spread or you are unable to have surgery or radiation therapy.

Medication Choices

Medication treatment for endometrial cancer may include hormone therapy or chemotherapy.¹³

Progestin hormone therapy. Examples include:

Hydroxyprogesterone (Delalutin).
Megestrol (Megace).
Medroxyprogesterone (Provera).

Chemotherapy, used alone or in combination. Examples include:

Treatment can often cause nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting. These medicines may include:

Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril, Sancuso), or dolasetron (Anzemet). These medicines more effectively prevent nausea and vomiting caused by chemotherapy when they are combined with corticosteroids, such as dexamethasone.
Aprepitant (Emend), which is used in combination with ondansetron and dexamethasone as part of a 3-day program.
Phenothiazines, such as promethazine or prochlorperazine.
Metoclopramide (Reglan).

Cancer: Controlling nausea and vomiting from chemotherapy

What To Think About

A premenopausal woman whose cancer is in a very early stage and is slow-growing (low-grade) may be a candidate for progestin hormone therapy rather than hysterectomy and thus may be able to keep her uterus for childbearing.⁹

There is limited information on the effectiveness of progestin therapy compared to other treatments, so currently it is not considered a standard treatment.

One study has shown that chemotherapy may work better than radiation against stage 3 and stage 4 endometrial cancer. Chemotherapy can have severe side effects.¹⁰

Surgery

Surgery to remove the uterus (hysterectomy) is the most common treatment for endometrial cancer . The surgeon will also remove the fallopian tubes, ovaries, and often the pelvic lymph nodes , which are examined to find out the extent of the cancer and to help plan your treatment. If examination of tissue determines that more aggressive cancer still may be in the lymph system, a lymphadenectomy may be done to remove and examine additional lymph nodes. Surgery has the highest cure rate of all treatments for endometrial cancer.

Surgery Choices

Hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy)

Lymphadenectomy (removal of lymph nodes)

What To Think About

Laparoscopic surgery is an option for treating your endometrial cancer. This surgery is done with a tiny camera and special instruments. The surgeon puts these tools through several small incisions (cuts) in the belly. Some surgeons do this surgery by guiding robotic arms that hold the surgery tools. This is called robot-assisted laparoscopy.

Most women have their ovaries removed after a diagnosis of endometrial cancer to make sure the cancer has not spread to the ovaries, to reduce the production of estrogen , and to slow cancer growth. And some women who have had endometrial cancer may be at greater risk of developing ovarian cancer .

You will not be able to become pregnant or continue to menstruate after a hysterectomy. If you have not yet gone through menopause , it will begin as soon as your ovaries are removed. For more information, see the topic Menopause and Perimenopause.

Other Treatment

Radiation therapy may be used to treat endometrial cancer . Radiation may be given internally by placing radioactive substances in the uterus or area of cancer (brachytherapy). Or it may be given externally by delivering radiation from an outside source (external beam X-ray).

Radiation treatment of premenopausal ovaries will cause menopause and infertility. Other side effects of radiation can include:¹⁴

Bowel obstruction.
Abdominal cramps.
Frequent bowel movements or diarrhea.
Chronic bladder irritation.
Vaginal scarring (vaginal fibrosis).

Studies called clinical trials are being conducted to find ways to prevent, detect, diagnose, and treat endometrial cancer. Talk with your doctor to see whether clinical trials are available and whether you are a good candidate.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 toll-free
Web Address:	www.cancer.org

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.

National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:	1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:	1-800-332-8615
E-mail:	cancergovstaff@mail.nih.gov
Web Address:	www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.

Related Information

References

Citations

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American College of Obstetricians and Gynecologists (2005, reaffirmed 2007). Management of endometrial cancer. ACOG Practice Bulletin No. 65. Obstetrics and Gynecology, 106(2): 413–425.

Burke TW, et al. (2001). Cancers of the uterine body. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 6th ed., chap. 36-3, pp. 1573–1594. Philadelphia: Lippincott Williams and Wilkins.

American Joint Committee on Cancer (2002). Corpus uteri. In AJCC Cancer Staging Manual, 6th ed., pp. 267–273. New York: Springer-Verlag.

Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.

Smith RA, et al. (2008). Cancer screening in the United States, 2008: A review of current American Cancer Society guidelines and cancer screening issues. CA: A Cancer Journal for Clinicians, 58: 161–179.

Chu CS, et al. (2008). Cancers of the uterine body. In VT DeVita et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 7th ed., vol. 2, pp. 1543–1563. Philadelphia: Lippincott Williams and Wilkins.

Schmeler KM, et al. (2006). Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. New England Journal of Medicine, 354(3): 261–269.

Ramirez PT, et al. (2004). Hormonal therapy for the management of grade I endometrial adenocarcinoma: A literature review. Gynecologic Oncology, 95: 133–138.

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Credits

Author	Bets Davis, MFA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Kevin Holcomb, MD - Gynecologic Oncology
Last Updated	November 26, 2008