Endometrial cancer starts when cells in the inner lining of the uterus (endometrium) begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Endometrial cancer is most often diagnosed after a woman goes to her doctor because she has symptoms.

If there’s a possibility you could have endometrial cancer, you should be examined by a gynecologist, a doctor qualified to diagnose and treat diseases of the female reproductive system. Gynecologists can diagnose endometrial cancer, as well as treat some early cases. Specialists in treating cancers of the endometrium and other female reproductive organs are called gynecologic oncologists. These doctors treat both early and advanced cases of endometrial cancer.

Medical history and physical exam

If you have any of the symptoms of endometrial cancer (see Signs and Symptoms of Endometrial Cancer), you should see your doctor. The doctor will ask about your symptoms, risk factors, and medical history. The doctor will also give you a physical exam and a pelvic exam.

Ultrasound

Ultrasound is often one of the first tests used to look at the uterus, ovaries, and fallopian tubes in women with a possible gynecologic problem. Ultrasound tests use sound waves to take pictures of parts of the body. A small instrument called a transducer or probe gives off sound waves and picks up the echoes as they bounce off the organs. A computer translates the echoes into pictures.

For a pelvic ultrasound, the transducer is placed on the skin of the lower part of the abdomen. Often, to get good pictures of the uterus, ovaries, and fallopian tubes, the bladder needs be full. That is why women getting a pelvic ultrasound are asked to drink lots of water before the exam.

A transvaginal ultrasound (TVUS) is often preferred for looking at the uterus. For this test, the TVUS probe (that works the same way as the ultrasound transducer) is put into the vagina. Images from the TVUS can be used to see if the uterus contains a mass (tumor), or if the endometrium is thicker than usual, which can be a sign of endometrial cancer. It may also help see if a cancer is growing into the muscle layer of the uterus (myometrium).

Salt water (saline) may be put through a small tube into the uterus before the ultrasound so the doctor can see the uterine lining more clearly. This procedure is called a saline infusion sonogram or hysterosonogram. (sonogram is another term for ultrasound.) Sonography may help doctors pinpoint the area they want to biopsy if other procedures didn't detect a tumor.

Endometrial tissue sampling

To find out whether endometrial hyperplasia or endometrial cancer is present, the doctor must remove some tissue so that it can be looked at with a microscope. Endometrial tissue can be obtained by endometrial biopsy or by dilation and curettage (D&C) with or without a hysteroscopy. A specialist such as a gynecologist usually does these procedures, which are described below.

Endometrial biopsy

An endometrial biopsy is the most commonly performed test for endometrial cancer and is very accurate in postmenopausal women. It can be done in the doctor's office. In this procedure a very thin flexible tube is inserted into the uterus through the cervix. Then, using suction, a small amount of endometrium is removed through the tube. The suctioning takes about a minute or less. The discomfort is similar to menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug such as ibuprofen before the procedure. Sometimes numbing medicine (local anesthetic) is injected into the cervix just before the procedure to help reduce the pain.

Hysteroscopy

For this technique doctors insert a tiny telescope (about ¹/₆ inch in diameter) into the uterus through the cervix. To get a better view of the inside of the uterus, the uterus is filled with salt water (saline). This lets the doctor see and biopsy anything abnormal, such as a cancer or a polyp. This is usually done using a local anesthesia (numbing medicine) with the patient awake.

Dilation and curettage (D&C)

If the endometrial biopsy sample doesn't provide enough tissue, or if the biopsy suggests cancer but the results are uncertain, a D&C must be done. In this outpatient procedure, the opening of the cervix is enlarged (dilated) and a special instrument is used to scrape tissue from inside the uterus. This may be done with or without a hysteroscopy.

This procedure takes about an hour and may require general anesthesia (where you are asleep) or conscious sedation (given medicine into a vein to make you drowsy) either with local anesthesia injected into the cervix or a spinal (or epidural). A D&C is usually done in an outpatient surgery area of a clinic or hospital. Most women have little discomfort after this procedure.

Testing endometrial tissue samples

Endometrial tissue samples removed by biopsy or D&C are looked at with a microscope to see whether cancer is present. If cancer is found, the lab report will state what type of endometrial cancer it is (like endometrioid or clear cell) and what grade it is.

Endometrial cancer is graded on a scale of 1 to 3 based on how much it looks like normal endometrium. (This was detailed in What Is Endometrial Cancer?) Women with lower grade cancers are less likely to have advanced disease or recurrences.

If the doctor suspects hereditary non-polyposis colon cancer (HNPCC) as an underlying cause of the endometrial cancer, the tumor tissue can be tested for protein changes (such as having fewer mismatch repair proteins) or DNA changes (called microsatellite instability, or MSI) that can happen when one of the genes that causes HNPCC is faulty. If these protein or DNA changes are present, the doctor may recommend that you consider genetic testing for the genes that cause HNPCC. Testing for low mismatch repair protein levels or for MSI is most often ordered in women diagnosed with endometrial cancer at a younger than usual age or who have a family history of endometrial or colon cancer.

Tests to look for cancer spread

If the doctor suspects that your cancer is advanced, you will probably have to have other tests to look for cancer spread. For more information about these tests see the Exams and Tests for Cancer section on our website.

Chest x-ray

A plain x-ray of your chest may be done to see if cancer has spread to your lungs.

Computed tomography (CT)

The CT scan is an x-ray procedure that creates detailed, cross-sectional images of your body. For a CT scan, you lie on a table while an X-ray takes pictures. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as the camera rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of many slices of the part of your body that is being studied.

CT scans are not used to diagnose endometrial cancer. However, they may be helpful to see whether the cancer has spread to other organs and to see if the cancer has come back after treatment.

Magnetic resonance imaging (MRI)

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. This creates cross sectional slices of the body like a CT scanner and it also produces slices that are parallel with the length of your body.

MRI scans are particularly helpful in looking at the brain and spinal cord. Some doctors also think MRI is a good way to tell whether, and how far, the endometrial cancer has grown into the body of the uterus. MRI scans may also help find enlarged lymph nodes with a special technique that uses very tiny particles of iron oxide. These are given into a vein and settle into lymph nodes where they can be spotted by MRI.

Positron emission tomography (PET)

In this test radioactive glucose (sugar) is given to look for cancer cells. Because cancers use glucose (sugar) at a higher rate than normal tissues, the radioactivity will tend to concentrate in the cancer. A scanner can spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells. Special scanners combine a PET scan with a CT to more precisely locate areas of cancer spread. PET scans are not a routine part of the work-up of early endometrial cancer, but may be used for more advanced cases.

Cystoscopy and proctoscopy

If a woman has problems that suggest the cancer has spread to the bladder or rectum, the inside of these organs will probably be looked at through a lighted tube. In cystoscopy the tube is placed into the bladder through the urethra. In proctoscopy the tube is placed in the rectum. These exams allow the doctor to look for possible cancers. Small tissue samples can also be removed during these procedures for pathologic (microscopic) testing. They can be done using a local anesthetic but some patients may require general anesthesia. Your doctor will let you know what to expect before and after the procedure. These procedures were used more often in the past, but now are rarely part of the work up for endometrial cancer.

Blood tests

Complete blood count

The complete blood count (CBC) is a test that measures the different cells in the blood, such as the red blood cells, the white blood cells, and the platelets. Endometrial cancer can cause bleeding, which can lead to low red blood cell counts ( anemia).

CA-125 blood test

CA-125 is a substance released into the bloodstream by many, but not all, endometrial and ovarian cancers. If a woman has endometrial cancer, a very high blood CA-125 level suggests that the cancer has probably spread beyond the uterus. Some doctors check CA-125 levels before surgery or other treatment. If they are elevated, they can be checked again to find out how well the treatment is working (for example, levels will drop after surgery if all the cancer is removed).

CA-125 levels are not needed to diagnose endometrial cancer, and so this test isn’t ordered on all patients.

There are a few symptoms that may point to endometrial cancer, but some are more common as this cancer becomes advanced.

Unusual vaginal bleeding, spotting, or other discharge

About 90% of women diagnosed with endometrial cancer have abnormal vaginal bleeding, such as a change in their periods or bleeding between periods or after menopause. This symptom can also occur with some non-cancerous conditions, but it is important to have a doctor look into any irregular bleeding right away. If you have gone through menopause already, it’s especially important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor.

Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you cannot see blood in the discharge, it does not mean there is no cancer. In about 10% of cases, the discharge associated with endometrial cancer is not bloody. Any abnormal discharge should be checked out by your doctor.

Pelvic pain, a mass, and weight loss

Pain in the pelvis, feeling a mass (tumor), and losing weight without trying can also be symptoms of endometrial cancer. These symptoms are more common in later stages of the disease. Still, any delay in seeking medical help may allow the disease to progress even further. This lowers the odds of treatment being successful.

Although any of these symptoms can be caused by things other than cancer, it’s important to have them checked out by a doctor.

How common is endometrial cancer?

In the United States, cancer of the endometrium is the most common cancer of the female reproductive organs. The American Cancer Society estimates for cancer of the uterus in the United States for 2018 are:

• About 63,230 new cases of cancer of the body of the uterus (uterine body or corpus) will be diagnosed.
• About 11,350 women will die from cancers of the uterine body.

These estimates include both endometrial cancers and uterine sarcomas. Up to 8% of uterine body cancers are sarcomas, so the actual numbers for endometrial cancer cases and deaths are slightly lower than these estimates.

Lifetime chance of getting endometrial cancer

Endometrial cancer affects mainly postmenopausal women. The average age of women diagnosed with endometrial cancer is 60. It is uncommon in women under the age of 45.

This cancer is slightly more common in white women, but black women are more likely to die from it. There are more than 600,000 survivors of endometrial cancer.

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.

As you cope with cancer, you need to have honest, open talks with your doctor. You should feel free to ask any question, no matter how small it might seem. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions. Here are some questions you might want to ask:

When you’re told you have endometrial cancer

• What type and grade of endometrial cancer do I have?
• Has my cancer spread outside the uterus?
• What is the stage of my cancer and what does that mean?

When deciding on a treatment plan

• What treatments might be right for me? What do you recommend? Why?
• Am I eligible for a clinical trial?
• What is the goal of this treatment?
• How will you monitor my response to treatment?
• What should I do to be ready for treatment?
• What risks or side effects should I expect?
• What are the chances my cancer will come back with the treatments we have discussed?

During treatment

Once treatment begins, you’ll need to know what to expect and what to look for. Not all of these questions may apply to you, but asking the ones that do may be helpful.

• How will we know if the treatment is working?
• Is there anything I can do to help manage side effects?
• What symptoms or side effects should I tell you about right away?
• How can I reach you on nights, holidays, or weekends?
• Do I need to change what I eat during treatment?
• Are there any limits on what I can do?
• What kind of exercise should I do, and how often?
• Will I be able to have children after my treatment?
• Can I still consider estrogen replacement therapy?
• How will I feel during treatment?

After treatment

• Are there any limits on what I can do?
• What symptoms should I watch for?
• What kind of exercise should I do now?
• What type of follow-up will I need after treatment?
• How often will I need to have follow-up exams and imaging tests?
• Will I need any blood tests?
• How will we know if the cancer has come back? What should I watch for?
• What will my options be if the cancer comes back?
• When can I resume my usual activities at work and/or around the house?

Along with these sample questions, be sure to write down some of your own. For instance, you might want to ask about getting a second opinion, or you may need specific information about how long it might take you to recover so you can plan your work schedule.

Doctors aren’t the only ones who can give you information. Other health care professionals, such as nurses and social workers, can answer some of your questions. To find out more about speaking with your health care team, see The Doctor-Patient Relationship.

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

Although certain factors increase a woman's risk for developing endometrial cancer, they do not always cause the disease. Many women with one or more risk factors never develop endometrial cancer.

Some women with endometrial cancer do not have any known risk factors. Even if a woman with endometrial cancer has one or more risk factors, there is no way to know which, if any, of these factors was responsible for her cancer.

Several factors influence the risk of developing endometrial cancer, including:

• Things that affect hormone levels, like taking estrogen after menopause, birth control pills, or tamoxifen; the number of menstrual cycles (over a lifetime), pregnancy, obesity, certain ovarian tumors, and polycystic ovarian syndrome
• Use of an intrauterine device
• Age
• Diet and exercise
• Diabetes
• Family history (having close relatives with endometrial or colorectal cancer)
• Having been diagnosed with breast or ovarian cancer in the past
• Having been diagnosed with endometrial hyperplasia in the past
• Treatment with radiation therapy to the pelvis to treat another cancer

Some of these, like pregnancy, birth control pills, and the use of an intrauterine device are linked to a lower risk of endometrial cancer, while many are linked to a higher risk. These factors and how they affect endometrial cancer risk are discussed in more detail below.

Hormone factors

A woman's hormone balance plays a part in the development of most endometrial cancers. Many of the risk factors for endometrial cancer affect estrogen levels. Before menopause, the ovaries are the major source of the 2 main types of female hormones -- estrogen and progesterone.

The balance between these hormones changes during a woman's menstrual cycle each month. This produces a woman's monthly periods and keeps the endometrium healthy. A shift in the balance of these hormones toward more estrogen increases a woman's risk for developing endometrial cancer.

After menopause, the ovaries stop making these hormones, but a small amount of estrogen is still made naturally in fat tissue. Estrogen from fat tissue has a bigger impact after menopause than it does before menopause.

Estrogen therapy

Treating the symptoms of menopause with hormones is known as menopausal hormone therapy (or sometimes hormone replacement therapy). Estrogen is the major part of this treatment. Estrogen treatment can reduce hot flashes, improve vaginal dryness, and help prevent the weakening of the bones (osteoporosis) that can occur with menopause.

Doctors have found, however, that using estrogen alone (without progesterone) can lead to type I endometrial cancer in women who still have a uterus. To lower that risk , a progestin (progesterone or a drug like it) must be given along with estrogen. This approach is called combination hormone therapy.

Women who take progesterone along with estrogen to treat menopausal symptoms do not have an increased risk of endometrial cancer. Still, taking this combination increases a woman's chance of developing breast cancer and also increases the risk of serious blood clots.

If you are taking (or plan to take) hormones after menopause, it is important to discuss the possible risks (including cancer, blood clots, heart attacks, and stroke) with your doctor.

Like any other medicine, hormones should be used only at the lowest dose that is needed and for the shortest possible time to control symptoms. As with any other medicine you take for a long time, you’ll need to see your doctor regularly. Experts recommend yearly follow-up pelvic exams. If you have any abnormal bleeding or discharge from the vagina you should see your doctor or other health care provider right away (and not wait for a check-up).

For more information about the cancer risks from taking hormones after menopause, see Menopausal Hormone Therapy and Cancer Risk.

Birth control pills

Using birth control pills (oral contraceptives) lowers the risk of endometrial cancer. The risk is lowest in women who take the pill for a long time, and this protection continues for at least 10 years after a woman stops taking this form of birth control. However, it is important to look at all of the risks and benefits when choosing a contraceptive method; endometrial cancer risk is only one factor to be considered. It's a good idea to discuss the pros and cons of different types of birth control with your doctor.

Total number of menstrual cycles

Having more menstrual cycles during a woman's lifetime raises her risk of endometrial cancer. Starting menstrual periods (menarche) before age 12 and/or going through menopause later in life raises the risk. Starting periods early is less a risk factor for women with early menopause. Likewise, late menopause may not lead to a higher risk in women whose periods began later in their teens.

Pregnancy

The hormonal balance shifts toward more progesterone during pregnancy. So having many pregnancies protects against endometrial cancer. Women who have never been pregnant have a higher risk, especially if they were also infertile (unable to become pregnant).

Obesity

A woman's ovaries produce most of her estrogen, but fat tissue can change some other hormones (called androgens) into estrogens. Having more fat tissue can increase a woman's estrogen levels, which increases her endometrial cancer risk. In comparison with women who maintain a healthy weight, endometrial cancer is twice as common in overweight women, and more than three times as common in obese women.

Tamoxifen

Tamoxifen is a drug that is used to prevent and treat breast cancer. Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause the uterine lining to grow, which increases the risk of endometrial cancer.

The risk of developing endometrial cancer from tamoxifen is low (less than 1% per year). Women taking tamoxifen must balance this risk against the benefits of this drug in treating and preventing breast cancer. This is an issue women should discuss with their doctors. If you are taking tamoxifen, you should have yearly gynecologic exams and should be sure to report any abnormal bleeding, as this could be a sign of endometrial cancer.

Ovarian tumors

A certain type of ovarian tumor, the granulosa cell tumor, often makes estrogen. Estrogen release by one of these tumors is not controlled the way hormone release from the ovaries is, and can sometimes lead to high estrogen levels. The resulting hormone imbalance can stimulate the endometrium and even lead to endometrial cancer. In fact, sometimes vaginal bleeding from endometrial cancer is the first symptom of one of these tumors.

Polycystic ovarian syndrome

Women with a condition called polycystic ovarian syndrome (PCOS) have abnormal hormone levels, such as higher androgen (male hormones) and estrogen levels and lower levels of progesterone. The increase in estrogen relative to progesterone can increase a woman's chance of getting endometrial cancer. PCOS is also a leading cause of infertility in women.

Using an intrauterine device

Women who used an intrauterine device (IUD) for birth control seem to have a lower risk of getting endometrial cancer. Information about this protective effect is limited to IUDs that do not contain hormones. Researchers have not yet studied whether newer types of IUDs that release progesterone have any effect on endometrial cancer risk. However, these IUDs are sometimes used to treat pre-cancers and early endometrial cancers in women who wish to preserve child-bearing ability.

Age

The risk of endometrial cancer increases as a woman gets older.

Diet and exercise

A high-fat diet can increase the risk of several cancers, including endometrial cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity, which is a well-known endometrial cancer risk factor. Many scientists think this is the main way in which a high-fat diet raises endometrial cancer risk. Some scientists think that fatty foods may also have a direct effect on estrogen metabolism, which increases endometrial cancer risk.

Physical activity lowers the risk of endometrial cancer. Several studies found that women who exercised more had a lower risk of endometrial cancer, while in one study women who spent more time sitting had a higher risk. To learn more, you can read the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.

Diabetes

Endometrial cancer may be as much as 4 times more common in women with diabetes. Diabetes is more common in people who are overweight, but even people with diabetes who are not overweight have a higher risk of endometrial cancer.

Family history

Endometrial cancer tends to run in some families. Some of these families also have an inherited tendency to develop colon cancer. This disorder is called hereditary nonpolyposis colon cancer (HNPCC). Another name for HNPCC is Lynch syndrome. In most cases, this disorder is caused by a defect in either the mismatch repair gene MLH1 or the gene MSH2. But at least 5 other genes can cause HNPCC: MLH3, MSH6, TGBR2, PMS1, and PMS2. An abnormal copy of any one of these genes reduces the body's ability to repair damage to its DNA or regulate cell growth. This results in a very high risk of colon cancer, as well as a high risk of endometrial cancer. Women with this syndrome have a 40% to 60% risk of developing endometrial cancer at some point. The risk of ovarian cancer is also increased. General information about inherited cancer syndromes can be found in Family Cancer Syndromes.

Some families have a high rate of only endometrial cancer. These families may have a different genetic disorder that hasn't been discovered yet.

Breast or ovarian cancer

Women who have had breast cancer or ovarian cancer may have an increased risk of developing endometrial cancer, too. Some of the dietary, hormonal, and reproductive risk factors for breast and ovarian cancer also increase endometrial cancer risk.

Endometrial hyperplasia

Endometrial hyperplasia is an increased growth of the endometrium. Mild or simple hyperplasia, the most common type, has a very small risk of becoming cancerous. It may go away on its own or after treatment with hormone therapy. If the hyperplasia is called “atypical,” it has a higher chance of becoming a cancer. Simple atypical hyperplasia turns into cancer in about 8% of cases if it’s not treated. If it’s not treated, complex atypical hyperplasia (CAH) has a risk of becoming cancerous in up to 29% of cases, and the risk of having an undetected endometrial cancer is even higher. For this reason, CAH is usually treated. (Treatment is discussed in the section  Can endometrial cancer be prevented?)

Prior pelvic radiation therapy

Radiation used to treat some other cancers can damage the DNA of cells, sometimes increasing the risk of a second type of cancer such as endometrial cancer.

We do not yet know exactly what causes most cases of endometrial cancer, but we do know certain risk factors, particularly hormone imbalance, for this type of cancer. A great deal of research is going on to learn more about the disease.

We know that most endometrial cancer cells contain estrogen and/or progesterone receptors on their surfaces. Somehow, interaction of these receptors with their hormones leads to increased growth of the endometrium. This can mark the beginning of cancer. The increased growth can become more and more abnormal until it develops into a cancer.

As noted in the risk factors section, many of the known endometrial cancer risk factors affect the balance between estrogen and progesterone in the body.

Scientists are learning more about changes in the DNA of certain genes that occur when normal endometrial cells become cancerous. Some of these are discussed in What's New in Endometrial Cancer Research and Treatment?

Most cases of endometrial cancer cannot be prevented, but there are some things that may lower your risk of developing this disease.

Get to and stay at a healthy weight

One way to lower endometrial cancer risk is to do what you can to change your risk factors whenever possible. For example, women who are overweight or obese have up to 3½ times the risk of getting endometrial cancer compared with women at a healthy weight. Getting to and maintaining a healthy weight is one way to lower the risk of this cancer.

Be physically active

Studies have also linked higher levels of physical activity to lower risks of endometrial cancer, so engaging in regular physical activity (exercise) may also be a way to help lower endometrial cancer risk. An active lifestyle can help you stay at a healthy weight, as well as lower the risk of high blood pressure and diabetes (other risk factors for endometrial cancer.

Discuss pros and cons of hormone therapy with your doctor

Estrogen to treat the symptoms of menopause is available in many different forms like pills, skin patches, shots, creams, and vaginal rings. If you are thinking about using estrogen for menopausal symptoms, ask your doctor about how it will affect your risk of endometrial cancer. Progestins (progesterone-like drugs) can reduce the risk of endometrial cancer in women taking estrogen therapy, but this combination increases the risk of breast cancer. If you still have your uterus and are taking estrogen therapy, discuss this issue with your doctor.

Get treated for endometrial problems

Getting proper treatment of pre-cancerous disorders of the endometrium is another way to lower the risk of endometrial cancer. Most endometrial cancers develop over a period of years. Many are known to follow and possibly start from less serious abnormalities of the endometrium called endometrial hyperplasia (see  Endometrial Cancer Risk Factors). Some cases of hyperplasia will go away without treatment, but it sometimes needs to be treated with hormones or even surgery. Treatment with progestins (see Hormone Therapy for Endometrial Cancer) and a dilation and curettage (D&C) or hysterectomy can prevent hyperplasia from becoming cancerous. (D&C is described in Tests for Endometrial Cancer) Abnormal vaginal bleeding is the most common symptom of endometrial pre-cancers and cancers, and it needs to be reported and evaluated right away.

Talk to your doctor if you have HNPCC

Women with hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome) have a very high risk of endometrial cancer. A woman with HNPCC may choose to have her uterus removed (a hysterectomy) after she has finished having children to prevent endometrial cancer. One study found that none of 61 women with HNPCC who had prophylactic (preventive) hysterectomies was later found to have endometrial cancer, while 1/3 of the women who didn't have the surgery were diagnosed with endometrial cancer over the next 7 years.

In most cases, noticing any signs and symptoms of endometrial cancer, such as abnormal vaginal bleeding or discharge (that is increasing in amount, occurring between periods, or occurring after menopause), and reporting them right away to your doctor allows the disease to be diagnosed at an early stage. Early detection improves the chances that your cancer will be treated successfully. But some endometrial cancers may reach an advanced stage before signs and symptoms can be noticed. More information can be found in  Signs and Symptoms of Endometrial Cancer.

Early detection tests

Early detection (also called screening) refers to the use of tests to find a disease such as cancer in people who do not have symptoms of that disease.

Women at average endometrial cancer risk

At this time, there are no screening tests or exams to find endometrial cancer early in women who are at average endometrial cancer risk and have no symptoms.

The American Cancer Society recommends that, at menopause, all women should be told about the risks and symptoms of endometrial cancer and strongly encouraged to report any vaginal bleeding, discharge, or spotting to their doctor.

Women should talk to their doctors about getting regular pelvic exams. A pelvic exam can find some cancers, including some advanced uterine cancers, but it is not very effective in finding early endometrial cancers.

The Pap test, which screens women for cervical cancer, can occasionally find some early endometrial cancers, but it’s not a good test for this type of cancer. For information on screening tests for cervical cancer, see Cervical Cancer Prevention and Early Detection.

Women at increased endometrial cancer risk

The American Cancer Society recommends that most women at increased risk should be informed of their risk and be advised to see their doctor whenever they have any abnormal vaginal bleeding. This includes women whose risk of endometrial cancer is increased due to increasing age, late menopause, never giving birth, infertility, obesity, diabetes, high blood pressure, estrogen treatment, or tamoxifen therapy.

Women who have (or may have) hereditary non-polyposis colon cancer (HNPCC, sometimes called Lynch syndrome) have a very high risk of endometrial cancer. If several family members have had colon or endometrial cancer, you might want to think about having genetic counseling to learn about your family’s risk of having HNPCC.

If you (or a close relative) have genetic testing and are found to have a mutation in one of the genes for HNPCC, you are at high risk of getting endometrial cancer. See Understanding Genetic Testing for more on this topic.

The American Cancer Society recommends that women who have (or may have) HNPCC be offered yearly testing for endometrial cancer with endometrial biopsy beginning at age 35. Their doctors should discuss this test with them, including its risks, benefits, and limitations. This applies to women known to carry HNPCC-linked gene mutations, women who are likely to carry such a mutation (those with a mutation known to be present in the family), and women from families with a tendency to get colon cancer where genetic testing has not been done.

Another option for a woman who has (or may have) HNPCC would be to have a hysterectomy once she is done having children. This was discussed in Can Endometrial Cancer Be Prevented?

For many women with endometrial cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

For other women, this cancer may never go away completely. They may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful.

Follow-up care

When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.

Doctor visits and tests

Endometrial cancer is most likely to come back within the first few years after treatment, so an important part of your treatment plan is a specific schedule of follow-up visits after treatment is finished. How often you need to be seen depends mostly on what stage your cancer was.

• Women who had stage IA low-grade endometrioid cancers (grades 1 and 2) may be seen every 6 months for the first year after treatment, and then yearly after that.
• If the cancer was stage IB or II low-grade endometrioid cancers (grades 1 and 2), follow-up visits are every 3 months for the first year, then every 6 months for the next 4 years, and then once a year.
• For women with higher stage or grade cancers (stages III or IV, or cancers that were grade III, including papillary serous, clear cell, or carcinosarcomas), experts recommend visits every 3 months for the first 2 years, every 6 months for the next 3 years, and then yearly after that.

During each follow-up visit, the doctor will do a pelvic exam (using a speculum) and check for any enlarged lymph nodes in the groin area. A Pap test may also be done to look for cancer cells in the upper part of the vagina, near the area where the uterus used to be, but it is no longer recommended as a matter of routine due to the low chance of detecting a recurrence. Sometimes a CA 125 blood test is done as a part of follow-up, but this is also not needed in all patients. The doctor will also ask about any symptoms that might point to cancer recurrence or side effects of treatment. Most endometrial cancer recurrences are found because of symptoms, so it’s very important that you tell your doctor exactly how you are feeling.

If your symptoms or the physical exam results suggest the cancer may have come back, imaging tests (such as CT scans or ultrasound studies), a CA 125 blood test, and/or biopsies may be done. Studies of many women with endometrial cancer show that if no symptoms or physical exam abnormalities are present, routine blood tests and imaging tests are not needed.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include:

• A suggested schedule for follow-up exams and tests
• A list of potential late or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• A schedule for other tests you might need, such as tests to look for long-term health effects from your cancer or its treatment
• Suggestions for things you can do that might improve your health, including possibly lowering your chances of the cancer coming back

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower the risk of my cancer progressing or coming back?

After completing treatment for endometrial cancer, you should see your doctor regularly to look for signs the cancer has come back. Experts do not recommend additional testing to look for second cancers in patients without symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors of endometrial cancer should follow the American Cancer Society guidelines for the early detection of cancer and should also stay away from tobacco products. Smoking increases the risk of many cancers, as well as other health problems.

To help maintain good health, survivors should also:

• Get to and stay at a healthy weight
• Adopt a physically active lifestyle
• Eat a healthy diet, with an emphasis on plant foods
• Limit alcohol to no more than 1 drink per day

Taking these steps may also lower the risk of some other cancers.

If the cancer comes back

If cancer does come back at some point, your treatment options will depend on where the cancer is, what treatments you’ve had before, and your health. Surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or some combination of these might be options. Other types of treatment might also be used to help relieve any symptoms from the cancer. For more on how recurrent cancer is treated, see Treatment Choices by Stage of Endometrial Cancer. For more general information on dealing with a recurrence, you may also want to read When Your Cancer Comes Back: Cancer Recurrence.

Could I get a second cancer after endometrial cancer?

People who’ve had endometrial cancer can still get other cancers, although most don’t get cancer again. Endometrial cancer survivors are at risk for getting some other types of cancer. Learn more in Second Cancers After Endometrial Cancer.