How to Diagnose Endometrial Cancer
If you have a uterus and symptoms of endometrial cancer, your doctor will give you a physical exam. They may also order blood and urine tests to help them find out what’s going on.
“The single most important thing to know is that if you have bleeding after menopause, that is never normal and you need to be evaluated,” says Rebecca Stone, MD, a gynecologic oncologist with Johns Hopkins Medicine. “And someone shouldn’t just do an ultrasound and tell you you’re fine. They should do a biopsy.”
To diagnose endometrial cancer, tests you might need include:
Physical exam. Your doctor may do a pelvic exam to check for unusual growths. They may also perform a Pap test, which is mainly used to check for cervical cancer. It’s not a reliable way to diagnose endometrial cancer.
Transvaginal ultrasound. A doctor or technician puts a small wand into your vagina to take pictures of your uterus using sound waves. If needed, they may add salt water (sonohysterogram) into your uterus through the cervix to get a clearer image.
Endometrial biopsy. Your doctor removes a small sample of tissue from your uterus to check for cancer. You might have this done in the doctor’s office, but you might go to the operating room. A biopsy is the best way to diagnose endometrial cancer.
Dilation and curettage (D&C). If your uterine lining (called the endometrium) looks too thick or irregular, your doctor may remove extra tissue in an operating room while you’re asleep.
Other tests. If your biopsy shows cancer cells, your doctor may order:
- A CT scan or MRI to see if the cancer has spread
- A CA-125 blood test to check for signs of ovarian and endometrial cancer
- A colonoscopy to rule out other possible causes
Your doctor may do an exploratory surgery (opening your abdomen) to determine how far the disease has spread.
Endometrial Cancer Treatment
“A lot of very exciting developments are happening in endometrial cancer treatment,” says Elena Ratner, MD, a gynecologic oncologist at Yale Cancer Center. “We are now able to provide truly personalized care depending on the mutations that a particular woman’s cancer carries.”
Treatment depends on the cancer stage and type, as well as your overall health and personal preferences. You may need one or more of the following:
Endometrial cancer surgery
Surgery is the most common treatment, especially if the cancer hasn’t spread. It’s also used to prevent cancer if you’re at high risk.
Types of endometrial cancer surgery include:
Total hysterectomy and bilateral salpingo-oophorectomy. This is the standard procedure for endometrial cancer. It involves removal of the uterus and cervix (a hysterectomy) and often both ovaries and fallopian tubes (a bilateral salpingo-oophorectomy).
Types of hysterectomies include:
- Abdominal. Your doctor takes out the uterus through a big or little cut in the belly.
- Vaginal. Removal of the uterus through the vagina.
- Radical. Your doctor takes out the uterus, nearby tissue, and upper vagina.
A total hysterectomy often cures endometrial cancer, especially if you have early-stage, low-grade disease. “Typically, this is a very treatable type of cancer,” Stone says. “Ninety-five plus percent of cases are curable with hysterectomy alone.”
Whether you keep your ovaries and other reproductive organs depends on a few things, like your age and future pregnancy plans. If you're younger than 45, talk to your doctor to see if there are alternatives to the usual treatment of hysterectomy and tube and ovary removal.
Lymph node removal. At the same time as your hysterectomy, your doctor may also remove nearby lymph nodes and other tissue. They’ll look at the cells under a microscope to see if the cancer has spread.
This information guides your treatment plan and helps your doctor gauge the chances the cancer will come back.
Chemotherapy for endometrial cancer
There’s a good chance you won’t need chemotherapy, especially if you have low-grade, early-stage endometrial cancer. But your doctor may suggest it if you have fast-growing cancer that has spread beyond the uterus.
Chemotherapy is used to kill remaining cancer cells after surgery. It also lessens the chances of recurrence and is often combined with radiation therapy.
Common chemotherapy drugs used to treat endometrial cancer include one or more of the following:
- Paclitaxel
- Carboplatin
- Doxorubicin
- Cisplatin
You get chemo in cycles, with rest periods in between to give your body a chance to recover.
Radiation therapy for endometrial cancer
Radiation therapy uses strong energy rays to destroy cancer cells. You may get it before surgery to shrink tumors so they’re easier to take out or after surgery to lessen the chances cancer will come back.
If surgery isn’t an option, your doctor might suggest radiation therapy as the main treatment.
Types of radiation therapy include:
External beam radiation therapy (EBRT). A machine zaps cancer cells with radiation from outside your body. You’re more likely to get external radiation of your whole pelvis if you have more advanced cancer.
Brachytherapy (internal radiation). Your doctor places a device inside your vagina. It sends out a small dose of radiation that targets cancer cells. It’s often used to prevent cancer from coming back to the part of your vagina left after a hysterectomy (vaginal cuff).
Hormone therapy for endometrial cancer
Hormone therapy slows the growth of endometrial cancer cells by blocking or reducing estrogen. It’s mainly used for advanced cancer or in cases where the cancer has come back. You’ll probably get chemo or other treatments at the same time.
Common hormone therapies used to treat endometrial cancer include:
Progestins. This is the main type of hormone treatment for endometrial cancer. These drugs mimic a natural hormone called progesterone, which counters estrogen’s effects and slows cancer growth.
Common progestins include:
- Medroxyprogesterone (Provera), a shot or pill
- Megestrol (Megace), a pill or liquid
Tamoxifen. This is a common breast cancer drug. It’s sometimes used to treat endometrial cancer that has spread or that comes back. It stops cancer cells from using estrogen to grow and multiply. Your doctor may use it along with progesterone.
Luteinizing hormone-releasing hormone (LHRH) agonists. These reduce estrogen by blocking a signal from the brain that tells the ovaries to make hormones. Your doctor may give you these if you have a hysterectomy but keep your ovaries.
Common LHRH agonists include:
- Goserelin (Zoladex)
- Leuprolide (Lupron)
Aromatase inhibitors. Your body still makes estrogen (like in fat tissue) even if you don’t have ovaries. These drugs lower hormone levels by blocking an enzyme called aromatase, which helps your body make estrogen.
Common aromatase inhibitors
- Anastrozole (Arimidex)
- Exemestane (Aromasin)
- Letrozole (Femara)
Is hormone therapy different from HRT?
Hormone replacement therapy (HRT) puts hormones back in your body, which can ease symptoms of menopause. Hormone therapy for endometrial cancer lowers or blocks estrogen to slow hormone-driven cancer growth.
New treatments for endometrial cancer
Researchers continue to study new ways to treat endometrial cancer, with a big focus on advanced or recurrent cases. Some of the most promising approaches include:
Targeted therapy. This is a type of treatment that targets certain parts of the cancer cells. It usually causes less bothersome side effects than chemotherapy.
Targeted therapy for endometrial cancer includes:
- Bevacizumab (Avastin) a type of angiogenesis inhibitor
- Lenvatinib (Lenvima), a type of kinase inhibitor
Doctors sometimes use a type of drug called an mTOR inhibitor to treat endometrial cancer. These block a protein called mTOR, which helps cancer cells grow and make copies of themselves.
Common mTOR inhibitors include:
- Everolimus (Afinitor), a daily pill
- Temsirolimus (Torisel), a once-weekly drug you get through a vein in your arm
You may be able to try new targeted therapies that aren’t widely available yet. Ask your doctor if a clinical trial is right for you.
Immunotherapy. These drugs help your body fight cancer. Called immune checkpoint inhibitors, they turn parts of your immune system “on” or “off” to help attack cancer cells. They’re often used with chemotherapy to treat advanced or recurrent cancer.
Immunotherapy drugs approved to treat endometrial cancer are:
- Dostarlimab (Jemperli)
- Durvalumab (Imfinzi)
- Pembrolizumab (Keytruda)
Your doctor may check your tumor cells for certain genetic changes to find out which targeted therapy or immunotherapy is right for you. You may also hear this called molecular subtyping of endometrial cancer.
Here are some of the things they can test your cancer for:
- Polymerase epsilon (POLE)
- TP53 gene mutation
- High levels of microsatellite instability (MSI-H)
- Defect in a mismatch repair gene (dMMR)
- High tumor mutational burden (TMB-H)
Ask your doctor if this kind of genomic testing is right for you.
Questions to Ask Your Doctor About Endometrial Cancer Treatment
Make a list of questions before your visit. Put the most important ones at the top so you don't miss them if time runs out. Here are some examples of things to ask.
Before treatment starts:
- What stage is my cancer, and how does that affect treatment?
- Do I have cancer outside my uterus?
- What are all of my treatment choices?
- Is my cancer hereditary? Should I get genetic testing?
- What are the genomics of my cancer?
To find the right treatment plan:
- How do you normally treat people with cancer like mine?
- What targeted options are available to me?
- Will surgery get rid of the cancer completely?
- What are the chances the cancer will come back after treatment?
- How will you know if I have a recurrence?
- How long will I need treatment?
- What are the short and long-term treatment side effects? How can I manage them?
- What types of supportive treatments can help me feel better?
When it comes to surgery:
- Is this a minimally invasive surgery? What does that mean?
- What are the pros and cons of laparoscopic vs. robotic vs. open surgery?
- Should I get sentinel lymph node dissection rather than full lymph node?
- What are you looking for in my lymph nodes?
After treatment:
- How often do I need checkups?
- What are the chances my cancer will come back?
- Are there diet and lifestyle changes that can help me stay healthy?
- If my cancer comes back, what will we do then?
- Am I at risk for other cancers?
Your doctor will want to keep a close eye on you after treatment – most recurrences happen within the first three years after treatment. You’ll likely need checkups every few months for several years, but your doctor will let you know how often to come in.
How Can I Feel Better During Endometrial Cancer Treatment?
A cancer diagnosis can feel overwhelming, but there are ways to take care of yourself during treatment. Try these tips:
- Rest when you need to.
- Eat nourishing foods.
- Move your body when you can.
- Find ways to relax.
- Talk to someone.
To help manage difficult emotions, a support group or counseling may help. Your doctor can connect you with a mental health professional who works with people facing cancer.
Taking care of your mental health can make a big difference in your daily life. Cancer-related distress can even show up weeks or months after treatment, so keep checking in with yourself.
If you need more support, call the American Cancer Society’s support line at 800-227-2345 (available 24/7) or visit the Cancer Survivors Network for community and resources.
What is palliative care for endometrial cancer?
It’s a type of supportive treatment you can get anytime after your diagnosis. The goal is to help you manage physical, mental, and emotional symptoms of cancer or side effects from treatment.
Takeaways
Surgery is the main treatment for endometrial cancer. This usually means removing your uterus, cervix, ovaries, and fallopian tubes (a total hysterectomy and bilateral salpingo-oophorectomy).
If the cancer spreads or comes back after surgery, you may need radiation or chemotherapy, or newer treatments like targeted therapy and immunotherapy.
Surgery cures most people with endometrial cancer, but regular checkups after treatment are still important.
Endometrial Cancer Treatment FAQs
Can endometrial cancer be cured completely?
Yes, endometrial cancer can often be cured with surgery. If caught early, you can usually get rid of the cancer if your doctor removes your uterus (total hysterectomy). If it's spread, treatments like radiation, chemotherapy, or targeted therapies may be needed.
What is the prognosis for stage I endometrial cancer?
The outlook for stage I endometrial cancer is very good. Around 9 out of 10 people are still alive five years after their diagnosis. There’s a good chance you’ll remain cancer-free after surgery, but you’ll need regular follow-ups to catch any possible recurrence.
Does endometrial cancer spread quickly?
It depends on the type. Most people have type 1, which grows slowly and usually stays inside the uterus. Type 2 endometrial cancers are more aggressive and spread quickly, but they’re less common.
Who is at risk for endometrial cancer?
You’re more likely to get endometrial cancer if you have “unopposed” estrogen levels over time. Since fat cells make estrogen, that makes obesity a big risk factor. But you’re also more likely to get endometrial cancer if you:
- Have a family history of endometrial cancer
- Started your period before age 12
- Went through menopause after age 52
- Have type 2 diabetes
- Have never being pregnant
- Have certain gene change (BRCA1, Lynch syndrome)
Talk to your doctor about other risk factors, especially if you have conditions like polycystic ovarian syndrome (PCOS), endometriosis, endometrial hyperplasia, or a personal history of breast, ovarian, or colon cancer.
Does race affect my risk of endometrial cancer?
Sometimes. It's more common in White women, but Black women are more likely to get diagnosed with fast-growing and advanced endometrial cancer.
Does HRT increase my risk of endometrial cancer?
It can. Estrogen-only hormone replacement therapy (HRT) raises your odds of endometrial cancer because unbalanced estrogen can fuel it. You can lower this risk by taking HRT with progesterone (either as pills or an IUD).