EC Basics

Endometrial cancer (EC), sometimes also called uterine cancer, is a type of cancer that affects the uterus or womb and originates from the cells of the endometrium, which is the lining of the uterus. 

EC is the 15th most common type of cancer in women worldwide. In the U.S., it is the most common type of cancer affecting the female reproductive system.

EC mainly affects women after menopause, and 60 is the average age of diagnosis. It is also more common among Black women compared to White women.

The incidence of EC started to increase in the mid-1960s and reached its peak in 1975. Later, it was discovered that this rise was associated with estrogen replacement therapy. As the therapy was prescribed less, the incidence rate of the disease has also fallen.

What causes EC?

It is not known exactly what causes EC. However, certain factors may increase the risk of EC. These include an imbalance in female hormone levels, more years of having periods, never having been pregnant, advanced age, obesity, hormone therapy to treat breast cancer and a genetic disease called Lynch syndrome.

What are the symptoms of EC?

The most common symptom of EC is abnormal vaginal bleeding. Other symptoms may include spotting and other discharge.

Symptoms in the later stages of EC may include pelvic discomfort and unintentional weight loss.

How do doctors diagnose EC?

EC can be diagnosed through a manual pelvic exam or using imaging tests such as a a trans-vaginal ultrasound in which a device resembling a wand that produces an image of the womb is inserted into the vagina to check for any changes in the uterine lining. Other imaging tests include a magnetic resonance imaging (MRI) or computed tomography (CT) scan.

A hysteroscopy can also be used to diagnose EC. During this test, a thin, flexible tube with a lens on the end is inserted into the womb through the vagina to look for any signs of EC.

Other ways in which doctors may diagnose EC include endometrial biopsy, where a sample of tissue is taken from the lining of the uterus and examined in the laboratory. If the biopsy results are not clear or if enough tissue can not be obtained during a biopsy, a doctor may recommend a surgical option called dilation and curettage, in which tissue is scraped from the lining of the uterus and examined for cancer cells.

How is EC treated?

There are six primary approaches to treating EC. These include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapies and immunotherapy. 

The most common treatment for EC is surgery or hysterectomy, where the uterus, the ovaries and/or nearby tissues are removed to stop the spread of the cancer to other parts of the body.

Radiation therapy uses high-energy X-rays or other types of radiation to kill the cancer cells. This can be done externally or internally.

Chemotherapy involves the use of drugs to kill the cancer cells. These could either be taken orally or injected into the bloodstream. Chemotherapy can also be regional and be placed directly into the uterus to kill the cancer cells.

Hormone therapy focuses on reducing the production or blocking the activity of hormones that are known to be involved in EC. 

Targeted therapies include monoclonal antibodies, mTOR inhibitors and signal transduction inhibitors that attack specific cancer cells.

Finally, immunotherapy may be prescribed, which can help the body’s own immune system recognize and attack cancer cells.