Endometrial cancer is a type of uterine cancer that begins in the layer of cells forming the lining, or endometrium, of the uterus. Endometrial cancer is often detected early because it causes abnormal bleeding.1
In the United States, endometrial cancer is the most common cancer of female reproductive organs. Uterine sarcomas account for up to 10% of uterine body cancers, including endometrial cancers and uterine sarcomas. Therefore, the numbers for endometrial cancer are slightly lower than these estimates.
According to the American Cancer Society, in the United States, in 20212:
Endometrial cancer is found mostly in postmenopausal women, usually 45 years and older. The average age at endometrial cancer diagnosis is 60 years.2
Survival rates are based on women who were diagnosed with endometrial cancer between 2010 and 2016.3
Risk factors do not always lead to endometrial cancer, and if a woman has endometrial cancer, it is not always possible to identify which, if any, risk factors, caused the cancer.
Risk factors include as follows4:
Conversely, birth control pills, nonhormonal intra-uterine devices, and pregnancy lower the risk.
Signs and Symptoms
Most women with endometrial cancer (over 90%) have abnormal vaginal bleeding. The bleeding may appear as watery, pink, or white discharge. Women who still menstruate may have heavy bleeding between periods. Other symptoms may include pain or difficulty urinating and pain during sexual intercourse. Pelvic pain and unexplained weight loss can be symptoms of later stages of endometrial cancer. Early detection significantly increases the chances of survival.5
The diagnosis of endometrial cancer involves a physical exam, including a pelvic exam and other imaging tests like computed tomography, magnetic resonance imaging, and positron emission tomography imaging.6
If it looks like endometrial cancer is present, an endometrial biopsy may be taken. A hysteroscopy may also be performed. Some patients also require dilation and curettage.6
Staging and Types of Endometrial Cancer
According to the International Federation of Gynecology and Obstetrics, endometrial cancer is classified into 4 stages7:
The most common type of endometrial cancer is endometrioid adenocarcinoma. This type accounts for up to 75% of all uterine cancers, is usually detected early, and has a high cure rate.8
About 10% of uterine cancers are serous adenocarcinomas, which are more likely to spread. Other, less common types include adenosquamous carcinoma and carcinomasarcoma.8
Endometrial cancer treatment options include surgery, radiation therapy, chemotherapy, and other drug therapies. A treatment plan is based on the stage and type of endometrial cancer, as well as age, overall health, and if the patient wants to bear children.9
Often, surgery is the main treatment for endometrial cancer.10 When detected early, surgery often cures the cancer.1 Surgery usually consists of the following10:
Other procedures may be necessary, depending on the cancer’s spread.10
Radiation is often used several weeks after surgery to kill any remaining cancer cells in the area. Sometimes, radiation is done before surgery to help shrink the tumor. There are different types of radiation that may be used separately or together.11
Chemotherapy is often used when the cancer has spread and surgery cannot be done, for cancers that are growing and spreading quickly, or cancers that have recurred. Chemotherapy is not used for stages I and II of endometrial cancer.
Usually, a combination of chemotherapy drugs is used in cycles. Common drugs include paclitaxel, carboplatin, doxorubicin, cisplatin, or docetaxel. The most common combinations are carboplatin and paclitaxel, or cisplatin and doxorubicin.12
Various types and stages of cancers are treated with different regimens, some involving radiation in between cycles or even chemotherapy and radiation together.12
Common adverse effects of chemotherapy include nausea, vomiting, appetite loss, mouth and vaginal sores, and hair loss. Low white blood cell counts increase the risk of infection, low platelet counts increase the risk of bleeding and bruising, and low red blood cell counts can cause fatigue and shortness of breath.12
Other adverse effects can occur with various chemotherapy drugs, such as the following12:
Hormone therapy uses hormones or hormone-blocking drugs to treat cancer. It is usually used for cancers in stages III or IV, or cancers that have recurred and usually used along with chemotherapy. The most common hormone therapy drugs are progestins (medroxyprogesterone or megestrol), but other drugs such as tamoxifen, LHRH agonists, or aromatase inhibitors may be used.13
Targeted therapy uses drugs that target changes in cancer cells and is still new in treating endometrial cancer. These drugs mostly treat high-risk cancers and cancers that have metastasized or recurred.14
Targeted therapy drugs include the following:
Immune checkpoint inhibitors are a newer class of drugs that work by turning the immune response on or off. Clinical trials are continuing to evaluate these drugs.15
One example is pembrolizumab, a PD-1 inhibitor that can be used to treat certain advanced endometrial cancers, usually after at least 1 other treatment has been attempted. Keytruda is given as an intravenous infusion every 3 weeks.15
The Pharmacist’s Role
Although there is no surefire way to prevent endometrial cancer, pharmacists can encourage patients to lower certain risk factors, for example, by maintaining a healthy weight and staying physically active. Pharmacists can remind patients to discuss hormonal factors with their obstetrician-gynecologist, and to follow up regularly, as endometrial cancer can develop over years and early detection leads to better outcomes.16
As trusted health care professionals, pharmacists can also help patients by providing education about medications and adverse effects, and referring them to their health care provider if they mention any symptoms that could indicate endometrial cancer, such as abnormal vaginal bleeding, or pain.
Karen Berger, PharmD, is a pharmacist at an independent pharmacy in northern New Jersey.