The OHSU Knight Cancer Institute offers advanced care for endometrial cancer, including:
- The latest diagnostic imaging, with results often available within two days.
- Advanced genetic testing to guide your treatment.
- Fellowship-trained doctors who focus on gynecologic cancers.
- Team-based care, with a treatment plan tailored to your needs and wishes.
- A wide range of support services, including options to protect your fertility.
- Visit our Gynecologic Cancers page to:
- Learn more about our care
- Find more anatomy illustrations
- Meet our expert gynecologic cancer team
- Learn about our sensitive care for your sexual health
Understanding endometrial cancer
What is endometrial cancer?
Endometrial cancer is a type of uterine cancer. It arises in the endometrium, the lining of the uterus, the small, pear-shaped organ inside the pelvis. Sometimes cells in the endometrium start to divide and multiply out of control, forming tumors.
Who gets endometrial cancer?
Endometrial cancer is the most common type of gynecologic cancer in the United States. An estimated 65,950 people were expected to be diagnosed in 2022. Anyone with a uterus, regardless of gender identity, is at risk.
What causes it?
Doctors don't yet know what causes endometrial cancer, but they have identified risk factors:
- Metabolic syndrome, a cluster of conditions that include high blood pressure, high blood sugar and excess fat around the waist
- Never having given birth
- Beginning menstruation at an early age
- Reaching menopause at a later age
- Taking tamoxifen for breast cancer
- Taking estrogen without progesterone
- Family history: You have a higher chance of getting it if your mother, sister or daughter had it. OHSU offers genetic counseling, risk assessment and testing to see if you have inherited a gene linked to a higher risk.
Endometrial cancer can often be cured if it is diagnosed early. More than 81% of patients survive at least five years after diagnosis compared with the general population. This is only an average, though, and can't predict the outcome for any one patient. The rate also does not include the risk of dying from other causes.
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Symptoms of endometrial cancer
Signs and symptoms of endometrial cancer include:
- Unusual vaginal bleeding not related to menstruation
- Vaginal bleeding after menopause
- Painful urination
- Pain during intercourse
- Pain in the pelvic region
- Losing weight without trying
If you have symptoms of endometrial cancer, your doctor will talk with you about your health history and do a physical exam. Your doctor will also most likely do a pelvic exam to look for anything abnormal in your uterus, ovaries or cervix.
These are other tests your care team may recommend:
- Transvaginal ultrasound: A small wandlike device is inserted into your vagina. The device produces sound waves that allow a computer to create a video image of your uterus. This can show something unusual in the lining.
- Hysteroscopy: Your doctor inserts a thin, flexible tube through your vagina and cervix into your uterus. The device has a light and small camera so the doctor can see the uterus lining on a video screen.
- Endometrial biopsy: A thin, flexible tube is inserted into the uterus through the vagina and cervix. Suction is used to extract a tiny bit of the endometrium. A type of doctor called a pathologist examines the tissue under a microscope to look for cancer cells.
- Dilation and curettage: This procedure, also called D&C, is sometimes needed if a biopsy sample doesn’t provide clear results. The opening of the cervix is enlarged and an instrument is used to scrape tissue from inside the uterus.
- Genetic testing: Your doctor may recommend a blood test for gene mutations linked to some uterine cancers to help guide your care plan.
Unfortunately, Pap tests are not a reliable way to detect endometrial cancer.
Types of endometrial cancer
- Endometrioid cancer: This is the most common type. It is an adenocarcinoma, meaning it grows in gland tissue. This cancer is made up of cells in glands that look like the normal uterine lining. Endometrioid cancer is linked to excess estrogen and is generally slower-growing. It is commonly detected early and has a high survival rate.
- Clear cell carcinoma and papillary serous adenocarcinoma: These types are more likely to spread to lymph nodes and other parts of the body. They tend to grow quickly and have often spread outside the uterus when diagnosed. They often require more aggressive treatment.
Stages of endometrial cancer
The stage of your cancer measures its size and how far it has spread. This helps your care team plan the best treatment. The stage also takes the grade of your cancer (how normal or abnormal the cancer cells look under a microscope) and other factors into account.
This is the system for adenocarcinomas, the vast majority of endometrial cancers:
Stage I: Cancer is only in the uterus.
- Stage IA: Cancer is only in the endometrium or endocervix (an opening in the cervix, linking the vagina and uterus).
- Stage IB: The tumor has spread to less than half of the myometrium (the uterus’s muscle layer).
- Stage IC: The tumor has spread to more than half of the myometrium.
Stage II: The tumor has spread outside the uterus but remains inside the pelvis.
- Stage IIA: Cancer has spread to tissue attached to the uterus, such as the ovaries or ligaments.
- Stage IIB: Cancer has spread to other pelvic tissues.
Stage III: The tumor has spread beyond the pelvis to the abdomen.
- Stage IIIA: Cancer has spread to one site.
- Stage IIIB: Cancer has spread to more than one site.
- Stage IIIC: Cancer has spread to nearby lymph nodes. The tumor ranges from being only in the uterus to having spread to abdominal sites.
- Stage IVA: Cancer has spread to the bladder or rectum.
- Stage IVB: Cancer has spread to distant parts of the body.
Everyone’s cancer is unique. Your care team will work with you to develop a treatment plan for your condition. Recommendations may include:
Surgery is the most common treatment for endometrial cancer. Our doctors use minimally invasive and precise robotic surgical techniques. This allows for less pain, smaller incisions and quicker recovery.
- Total hysterectomy, which removes the uterus and cervix.
- Bilateral salpingo-oophorectomy, which removes ovaries and fallopian tubes on both sides.
- Radical hysterectomy, which removes the uterus, cervix, part of the vagina and possibly the ovaries, fallopian tubes and nearby lymph nodes.
- A lymph node dissection, which removes lymph nodes so they can be checked for cancer cells.
Radiation therapy uses beams of energy to kill cancer cells or stop them from growing. We may recommend two types of therapy:
- External beam radiation, which uses a machine outside the body to target the cancer.
- Brachytherapy, which produces a higher dose in a smaller area. A radiation source is placed in a tube that’s inserted into the vagina for a short time. You may get several doses in a series of outpatient visits.
Chemotherapy drugs are used to kill or stop the growth of cancer cells. The drugs are usually given in a series of infusions — slow IV drips.
Hormone therapy blocks or stimulates hormones to stop cancer cells from growing.
In some cases, reducing estrogen levels in your body can help kill endometrial cancer cells, because they need estrogen to grow.
In some cases, boosting progesterone levels can also slow or stop endometrial cancer from growing.
These medications may be given as a pill, liquid or shot.
Targeted therapy drugs lock onto cancer cells and shut them down, leaving healthy cells mostly unharmed.
Targeted therapy drugs are usually given as pills or by IV.
These drugs harness your immune system to knock out cancer. They prime immune cells to seek out and kill cancer cells.