The OHSU Knight Cancer Institute offers advanced care for endometrial cancer and uterine sarcoma, including:

• The latest diagnostic imaging, with results often available within two days.
• Advanced genetic testing to guide treatment for every patient.
• Fellowship-trained doctors who focus on treating patients with gynecologic cancers.
• Team-based care, with a treatment plan tailored to your needs and wishes.
• A welcoming environment at the OHSU Center for Women’s Health.
• A wide range of support services, including options to protect your fertility.

Links

• Visit our Gynecologic Cancers page to:
  • Learn more about our care
  • Find anatomy illustrations

• Meet our team
• Learn about our sensitive care for your sexual health

What is it?

• Endometrial cancer arises in the endometrium, the inner lining of the uterus, the small, pear-shaped organ located inside the pelvic girdle. Sometimes cells in the endometrium start to divide and multiply out of control, forming tumors.
• Uterine sarcoma starts in the muscles of the uterus or in the tissues that support the uterus.

Who gets it?

• Endometrial cancer is the most common type of gynecologic cancer in the United States. An estimated 65,950 people are expected to be diagnosed in 2022. Anyone with a uterus, regardless of gender identity, is at risk.
• Uterine sarcoma is much rarer, making up no more than 5% of uterine cancer. It is twice as common in Black women as white or Asian women, though doctors don't know why.

What causes it?

Doctors don't yet know what causes these cancers, but they have identified risk factors.

For endometrial cancer, they include:

• Obesity
• Age
• Having something called 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. 

For uterine sarcoma, they include:

• Radiation therapy to the pelvic region
• Taking tamoxifen for breast cancer
• Being exposed to X-rays

Survival rates

Endometrial cancer can often be cured if it is diagnosed early. More than 81% of patients survive at least five years after being diagnosed 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.

Uterine sarcoma is an aggressive type of cancer. It is often found later, making it tougher to treat. Outcomes are discouraging but researchers are working on better ways to help patients with this condition.

Symptoms

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

Signs and symptoms of uterine sarcoma include:

• Unusual vaginal bleeding not related to menstruation
• Vaginal bleeding after menopause
• A mass in the vagina
• Pain or a feeling of fullness in the abdomen
• Frequent urination

Diagnosis

Doctors and specialists may conduct similar tests to look for endometrial cancer or uterine sarcoma. A Pap test, used to screen for cancer of the cervix, often fails to detect these cancers.

If you have symptoms of either cancer, your doctor will talk with you about your health history and conduct a physical exam. Your doctor will also most likely do a pelvic examination, which allows the doctor to feel and 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.

Types of cancer

Types of endometrial cancer include:

• Endometrioid cancer: This is the most common type. 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, requiring more aggressive treatment. They tend to grow quickly and have often spread outside the uterus when diagnosed.

Types of uterine sarcomas include:

• Endometrial stromal sarcomas: These rare cancers develop in the supporting connective tissue of the endometrium. They tend to grow slowly, making them easier to treat.
• Undifferentiated sarcomas: These are rare, making up less than 1% of uterine cancers. They are more aggressive.
• Uterine leiomyosarcomas: These rare cancers start in the muscle wall of the uterus known as the myometrium.

Stages of endometrial cancer

Staging determines whether and how much cancer has spread. This helps your care team plan the best treatment. Staging 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 to other tissue in 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 IV:

• Stage IVA: Cancer has spread to the bladder or rectum.
• Stage IVB: Cancer has spread to distant parts of the body.

Treatment

Your care team will work with you to develop a treatment plan for your unique condition. Recommendations may include:

Surgery

Surgery to remove the cancer is the most common treatment. Our doctors use minimally invasive and precise robotic surgical techniques. This allows for less pain, smaller incisions and quicker recovery.

Options include:

• 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

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. We use two types of therapy for these conditions:

• Externial beam radiation, which uses a machine outside the body to target the cancer.
• Brachytherapy, a form of internal radiation therapy, which allows for 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. Patients may receive several doses in a series of outpatient visits.

Chemotherapy

Medications are used to kill or stop the growth of cancer cells nearly anywhere in the body. The medications either kill the cells or stop them from dividing. Chemotherapy is usually given in a series of infusions — slow IV drips.

Hormone therapy

Hormone therapy removes, blocks or stimulates hormones to stop certain cancer cells from growing.

With endometrial cancer, medicine that increases the amount of progesterone in your body can help stop the growth of cancer cells.

Medicine that reduces the amount of estrogen in your body can help kill endometrial cancer cells that rely on estrogen to grow. These medications may be given as a pill, liquid or shot.

Targeted therapy

Medications given as pills or by IV can target specific molecules within cancer cells with little damage to normal cells. For endometrial cancer, targeted therapy may:

• Use antibodies from an immune system cell.
• Use antibodies that can carry toxins or radioactive material to the cancer cells.
• Use inhibitors that block a certain type of protein to keep cancer cells from growing.

Targeted therapy is used less often in uterine sarcoma.

Immunotherapy

These drugs harness the power of your immune system to knock out cancer cells. They prime immune cells to seek out and target cancer cells. Learn more about immunotherapy.

Support for you and your family

• Look for an OHSU clinical trial for uterine cancer. 
• Learn about options to protect your fertility. 
• We offer the area’s only program to support the sexual health of women affected by cancer.
• Learn about Woman to Woman, a program that pairs women who have a gynecologic cancer with a trained peer.
• Read about OHSU’s cancer registries, including one for sarcoma survivors.

Learn more

• Endometrial Cancer, National Cancer Institute
• Endometrial Cancer, American Cancer Society
• Uterine Sarcoma, National Cancer Institute
• Uterine Sarcoma, American Cancer Society
• Uterine Cancer, Society of Gynecologic Oncology