Although the diagnosis of endometrial cancer is difficult to receive, the good news is that this type of cancer is often found at its earliest, most treatable stage.

Endometrial cancer, one of the most common cancers in American women, begins in the cells of the endometrium, the lining of your uterus — a hollow, pear-shaped pelvic organ where fetal development occurs. Endometrial cancer is sometimes called uterine cancer, but there are other cells in the uterus that can become cancerous — such as muscle or myometrial cells. These form much less common cancers called sarcomas.

Endometrial cancer is often detected at an early stage because it frequently produces vaginal bleeding between menstrual periods or after menopause. If endometrial cancer is discovered early, removing the uterus surgically often eliminates all of the cancer.

Most cases of endometrial cancer develop in postmenopausal women, whose periods have stopped. The first clue that something is wrong may be abnormal vaginal bleeding.

Signs and symptoms of endometrial cancer may include:

• Any bleeding after menopause
• Prolonged periods or bleeding between periods
• An abnormal, nonbloody discharge from your vagina
• Pelvic pain
• Pain during intercourse
• Unintended weight loss

When to see a doctor
Because endometrial cancer is more likely to be cured the earlier it's detected, see your doctor if you experience any signs or symptoms of the disease — including vaginal bleeding or discharge not related to your periods, pelvic pain or pain during intercourse. Many of the same symptoms may be associated with noncancerous (benign) conditions, such as vaginal infections, uterine fibroids or uterine polyps. But it's very important to bring them to the attention of your doctor.

If you're at increased risk of endometrial cancer, talk with your doctor about what screening tests might be appropriate for you. If you have had endometrial cancer, your doctor should outline a regular follow-up program to watch for possible recurrence.

Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes cells become abnormal (mutate) and grow out of control. The cells continue dividing even when new cells aren't needed. These abnormal cells can invade and destroy nearby tissues and even have the ability to travel to other parts of the body and begin growing there.

In endometrial cancer, cancer cells develop in the lining of the uterus. Why these cancer cells develop isn't entirely known. However, scientists believe that estrogen levels play a role in the development of endometrial cancer. Factors that can increase the levels of this hormone and other risk factors for the disease have been identified and continue to emerge. In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium to become cancerous.

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Female reproductive system

The female reproductive system consists of two ovaries, two fallopian tubes, a uterus and a vagina. The ovaries produce two main female hormones — estrogen and progesterone. The balance between these two hormones changes each month, making the endometrium thicken during the early part of the monthly cycle. If no pregnancy occurs, the endometrium is then shed during the last phase of the menstrual cycle.

When the balance of these two hormones shifts toward more estrogen — which stimulates growth of the endometrium — a woman's risk of developing endometrial cancer increases. Factors that increase levels of estrogen in the body include:

• Many years of menstruation. If you started menstruating at an early age — before age 12 — or you began menopause later, you're at greater risk of endometrial cancer than is a woman who menstruated for fewer years. The more years you have had periods, the more exposure your endometrium has had to estrogen.
• Never having been pregnant. Pregnancy seems to decrease the risk of endometrial cancer, although experts aren't sure exactly why this might be. The body produces more estrogen during pregnancy, but it produces more progesterone, too. Increased progesterone production may offset the effects of the rise in estrogen levels. It's also possible that not having been pregnant may be the result of infertility caused by irregular ovulation, which may be the reason why women who've never been pregnant are at an increased risk of endometrial cancer.
• Irregular ovulation. Ovulation, the monthly release of an egg from an ovary in menstruating women, is regulated by estrogen. Irregular ovulation or failure to ovulate increases your lifetime exposure to estrogen. Ovulation irregularities have many causes, including obesity and a condition known as polycystic ovary syndrome (PCOS). This is a condition in which hormonal imbalances prevent ovulation and menstruation. Treating obesity and managing the symptoms of PCOS can help restore your monthly ovulation and menstruation cycle, decreasing your risk of endometrial cancer.
• Obesity. Ovaries aren't the only source of estrogen. Fat tissue can produce estrogen. Being obese can increase the level of estrogen in your body, putting you at a higher risk of endometrial cancer and other cancers. Obese women have three times the risk of endometrial cancer and overweight women have twice the risk, according to the American Cancer Society. However, thin women can also develop endometrial cancer.
• A high-fat diet. This type of diet may add to your risk of endometrial cancer by promoting obesity. Or, fatty foods may directly affect estrogen metabolism, further increasing a woman's risk of endometrial cancer.
• Diabetes. Endometrial cancer is more common in women with diabetes, possibly because obesity and type 2 diabetes often go hand in hand. However, even women with diabetes who aren't overweight have a greater risk of endometrial cancer.
• Estrogen-only replacement therapy (ERT). Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen — combination hormone replacement therapy — causes the lining of the uterus to shed and actually lowers your risk of endometrial cancer. However, this combination may cause other health risks, such as blood clots or breast cancer.
• Ovarian tumors. Some tumors of the ovaries may themselves be a source of estrogen, increasing estrogen levels.

Other factors that can increase your risk of endometrial cancer include:

• Age. The older you are, the greater your risk of endometrial cancer. The majority of endometrial cancer occurs in women older than 55.
• Personal history of breast cancer or ovarian cancer. If you've had breast or ovarian cancer, you may have an increased risk of endometrial cancer because all of these cancers share some of the same risk factors. However, the vast majority of women who have either breast or ovarian cancer never develop endometrial cancer.
• Tamoxifen treatment. One in every 500 women whose breast cancer was treated with tamoxifen will develop endometrial cancer. Although tamoxifen acts mostly as an estrogen blocker, it does have some estrogen-like effects and can cause the uterine lining to grow. If you're being treated with this hormone, see your doctor for an annual pelvic examination and be sure to report any unusual vaginal bleeding.
• Race. Black women have an increased risk of death from endometrial cancer, although white women are more likely to develop endometrial cancer.
• Hereditary nonpolyposis colorectal cancer (HNPCC). This inherited disease is caused by an abnormality in a gene important for DNA repair. Women with HNPCC have a significantly higher risk of endometrial cancer as well as colon and other cancers. The risk of endometrial cancer over a lifetime for women who have HNPCC mutations is between 40 and 60 percent, according to the American Cancer Society.

Having risk factors for endometrial cancer doesn't mean you'll get the disease. It means that you're at risk and should be alert to possible signs and symptoms of the disease. Conversely, some women who develop endometrial cancer appear to have no risk factors for the disease.

The most serious complication of any cancer, including endometrial cancer, is that it can spread to other parts of your body (metastasize). Fortunately, when discovered early, endometrial cancer is usually treatable. Five-year survival rates are 95 percent for early-stage endometrial cancer. If endometrial cancer has reached an advanced stage before diagnosis, it may have already spread to other parts of your body and be more difficult to treat successfully.

You're likely to start by first seeing your primary care doctor or a gynecologist. However, after your initial appointment, you may be referred immediately to a gynecologic oncologist.

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what you can expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking. Also note if you have used any type of hormonal therapy in the past, including birth control pills, tamoxifen or other hormonal treatments.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For endometrial cancer, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need to diagnose endometrial cancer?
• Are there other tests for staging the cancer?
• What types of treatments are available? What kinds of side effects can I expect from each treatment? How will these treatments affect my sexuality?
• What do you feel is the best course of action for me?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Has my cancer spread? What stage is it?
• What's my prognosis?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor will likely have a number of questions for you. If you're ready to answer them, it may help reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Have you experienced any usual vaginal bleeding or discharge? How often does that occur?
• Do you have any pelvic pain?
• Have you had any other symptoms?
• Have your symptoms been continuous, or occasional?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you taken estrogen-only hormone therapy for menopausal symptoms?
• Do you have any personal history of cancer?
• Have you ever been told you have HNPCC mutations?

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Pelvic examination

Your gynecologist or your primary care doctor will conduct a complete medical history and perform a physical and pelvic examination. During the pelvic examination, the doctor feels for any lumps or changes in the shape of the uterus that may indicate a problem.

Diagnosis may or may not involve these other tests:

• Transvaginal ultrasound. Your doctor may recommend a transvaginal ultrasound to look at the thickness and texture of the endometrium and help rule out other conditions. In this procedure, a wand-like device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining, and it may be done prior to an endometrial biopsy to locate suspicious-looking tissue.
• Endometrial biopsy. To get a sample of cells from inside your uterus, you'll likely undergo an endometrial biopsy. This involves removing tissue from your uterine lining for laboratory analysis. This may be done in your physician's office and usually doesn't require anesthesia. Because of the increased risk, women who have HNPCC mutations should talk with their doctors about yearly endometrial biopsies beginning around age 35.
• Dilation and curettage (D and C). If enough tissue can't be obtained during a biopsy or if the biopsy suggests cancer, you'll likely need to undergo a D and C. In this procedure, which requires you to be in an operating room under anesthesia, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells.
• Pap test. Your doctor takes a sample of cells from the cervix, the lower, narrower portion of the uterus that opens into your vagina. Doctors use the Pap test to detect another type of cancer — cervical cancer. Because endometrial cancer begins inside your uterus, it's rarely detectable by a Pap test.

If endometrial cancer is found, you'll likely be referred to a gynecologic oncologist — a doctor who specializes in treating cancers involving the female reproductive system. You'll need more tests (staging) to determine if the cancer has spread (metastasized) to other parts of your body. These tests may include a chest X-ray, a computerized tomography (CT) scan and some blood tests.   

In endometrial cancer, final staging is done through a surgical procedure and is done at the same time as any surgical treatment:

• Stage I cancer is found only in your uterus and hasn't spread.
• Stage II cancer is present in both the body of your uterus and in your cervix. In this stage, cancer is no longer confined to the uterus, but hasn't spread beyond the pelvic region.
• Stage III cancer has not involved the rectum and bladder, though pelvic area lymph nodes may be involved.
• Stage IV cancer is the most serious and means that the cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of your body.

Surgery is the most common treatment for endometrial cancer. Most doctors recommend either the surgical removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes in the area should also be removed during surgery along with other tissue samples.

A hysterectomy is a major operation, and because you can't get pregnant after your uterus has been removed, it can be a difficult decision for some women. However, surgery is usually the only way to eliminate the cancer or the need for further treatment.

If you have an aggressive form of endometrial cancer or the cancer has spread to other parts of your body, you may need additional treatments. These may include:

• Radiation. If your doctor believes you're at high risk of cancer recurrence, he or she may suggest that you have radiation therapy after a hysterectomy. Your doctor may also recommend radiation therapy if the cancerous tumor is fast growing, invades deeply into the muscle of the uterus or involves blood vessels. Radiation therapy involves the use of high-dose X-rays to kill cancer cells. When done from outside the body, it's called external beam radiation therapy. Brachytherapy is another form of radiation that involves the internal application of radiation, usually to the inner lining of the uterus. Brachytherapy has fewer side effects than conventional radiation therapy does. However, brachytherapy treats only a small area of the body.

• Hormone therapy. If the cancer has spread to other parts of your body, synthetic progestin, a form of the hormone progesterone, may stop it from growing. The progestin used in treating endometrial cancer is administered in higher doses than is used in hormone replacement therapy for menopausal women. Other medications may be used as well. Treatment with progestin may be an option for women with early endometrial cancer who want to have children and, therefore, don't want to have a hysterectomy. However, this approach is not without the risk that the cancer will return. Carefully discuss this treatment with an expert in this field.

  Another hormone therapy option is gonadotropin-releasing hormone agonists. These drugs can lower estrogen levels in premenopausal women.

• Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells. Often, chemotherapy drugs are used in combination to increase their efficacy. Generally, women with stage III or stage IV endometrial cancer will be offered chemotherapy as part of their treatment regimen. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells outside the uterus.

Each type of treatment for endometrial cancer can have side effects. Ask your doctor what side effects you can expect and what can be done to manage them.

If you have late-stage or recurrent endometrial cancer, you may benefit from participating in clinical trials that provide new experimental treatment options. For more information on clinical trials, contact the National Cancer Institute at 800-4-CANCER (800-422-6237) or visit its Web site.

After treatment for endometrial cancer, your doctor will likely recommend regular follow-up examinations to determine whether the cancer has returned. Checkups may include a physical exam, a pelvic exam, a Pap test, a chest X-ray and laboratory tests.

After you receive a diagnosis of endometrial cancer, you may have many questions, fears and concerns. How will the diagnosis affect you, your family, your work and your future? You may worry about tests, treatments, hospital stays and medical bills. Even if a full recovery is likely, you may worry about possible recurrence of your cancer.

Fortunately, many resources are available to you and your family to help answer questions and provide support. The key is to remember that you don't have to face your questions or fears alone. Here are some strategies and resources that may make dealing with endometrial cancer easier:

• Know what to expect. Find out everything you can about your cancer — the stage, your treatment options and their side effects. It's important for you to have honest, open discussions with your cancer care team. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. Staff of the National Cancer Institute will answer questions from the public. You can reach the cancer institute at 800-4-CANCER (800-422-6237). Or contact the American Cancer Society at 800-ACS-2345 (800-227-2345).
• Be proactive. Although you may feel tired and discouraged, don't ask others — including your family and your doctor — to make important decisions for you. Take an active role in your treatment. Before starting treatment, you might want a second opinion from a qualified specialist. Many insurance companies will pay for such consultations.
• Maintain a strong support system. Strong relationships may help you cope with treatment and survive your cancer. Although friends and family can be your best allies, they sometimes may have trouble dealing with your illness. If so, the concern and understanding of a formal support group or other cancer survivors can be especially helpful. Ask your doctor to help you get in touch with a support group in your area.

Although most cases of endometrial cancer aren't preventable, certain factors can lower your risk of developing the disease. These include:

• Taking hormone therapy (HT) with progestin. Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen causes the lining of the uterus to shed. This kind of combination hormone therapy lowers your risk. But not all effects of HT are positive. Taking HT as a combination therapy can result in serious side effects and health risks, such as a higher risk of breast cancer and blood clots. Work with your doctor to evaluate the options and decide what's best for you.
• A history of using birth control pills. Use of oral contraceptives can reduce endometrial cancer risk even as long as 10 years after you stop taking them. The risk is lowest in women who take oral contraceptives for many years.
• Maintaining a healthy weight. Obesity is one of the most significant risk factors for the development of endometrial cancer. You can help prevent endometrial cancer by maintaining a healthy weight. Excess fat tissue can increase levels of estrogen in your body, which increases your risk of endometrial cancer. Maintaining a healthy weight as you age lowers your risk of endometrial cancer as well as other diseases.
• Exercise. Regular exercise can have a dramatic effect on your risk of endometrial cancer. Women who engage in exercise every day have half the risk of endometrial cancer compared with women who don't exercise, according to the American Cancer Society.