ConditionCancer
Uterine Cancer
Uterine cancer is cancer that starts in the uterus (womb). More than 90% of cases are endometrial cancer, which begins in the inner lining; the rest are uterine sarcomas, which start in the muscle wall. It is the most common gynecologic cancer in the US and usually affects women after menopause. The key early warning sign is abnormal vaginal bleeding, especially any bleeding after menopause. Because this sign appears early, most cases are found at stage 1, when surgery cures the large majority.
Also called: Cancer of the uterus, womb cancer, endometrial cancer (most common type), uterine corpus cancer, uterine sarcoma (rare type)
At a glance
- What it is
- Cancer of the uterus, mostly endometrial cancer (lining), rarely uterine sarcoma (muscle).
- Who
- Mainly women over 50; risk rises with obesity, diabetes, unopposed estrogen and Lynch syndrome.
- Main warning sign
- Any bleeding after menopause, or heavier, longer or between-period bleeding in your 40s and beyond.
- Diagnosis
- Transvaginal ultrasound and an endometrial biopsy, sometimes hysteroscopy.
- Treatment
- Hysterectomy with removal of tubes and ovaries; plus radiation, chemotherapy, hormone or immunotherapy depending on stage and type.
When to get help
Call 911 or go to the ER
- Very heavy vaginal bleeding, soaking a pad an hour for 2 hours, or bleeding with dizziness or fainting
See a doctor within a day or two
- Any vaginal bleeding or spotting after menopause, even once and even if light: see a doctor within 2 weeks
- A rapidly enlarging uterus or pelvic mass, especially after menopause
Book a routine appointment
- Periods that become much heavier, longer or more frequent, or bleeding between periods, after age 40
- Abnormal, watery or blood-tinged vaginal discharge after menopause
- Pelvic pain or pressure lasting more than a few weeks
- A family history of uterine, colon or ovarian cancer at young ages (ask about Lynch syndrome testing)
Types of uterine cancer
| Endometrial cancer | Uterine sarcoma | |
|---|---|---|
| Where it starts | Endometrium (inner lining) | Myometrium (muscle) or supporting tissue |
| Share of uterine cancers | More than 90% | About 3% to 5% |
| Main subtypes | Endometrioid (most common), serous, clear cell, carcinosarcoma | Leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma |
| Typical sign | Abnormal bleeding | Bleeding, a fast-growing mass, pelvic pain |
| Outlook | Usually good when found early | Generally worse; often found later |
Endometrial cancers are further described by grade and by molecular class: POLE-mutated (excellent outlook), mismatch repair deficient (MMRd), p53-abnormal (more aggressive) and no specific molecular profile. This classification increasingly guides treatment. For more detail on the most common type, see endometrial cancer.
Uterine fibroids are benign muscle tumors and do not turn into sarcoma, though rarely a sarcoma is mistaken for a fibroid before surgery.
Symptoms and warning signs
- Bleeding after menopause: the most important sign. About 90% of people with endometrial cancer have abnormal bleeding, and about 1 in 10 people with postmenopausal bleeding have endometrial cancer.
- Heavier, longer or more frequent periods, or bleeding between periods, around or before menopause
- Watery, pink or foul-smelling vaginal discharge
- Pelvic pain, pressure or a feeling of fullness
- Pain during sex
- In advanced disease: a pelvic mass, bloating, weight loss, and changes in bladder or bowel habits
Bleeding after menopause is often caused by benign conditions such as vaginal atrophy or endometrial polyps, but it always needs to be checked.
Causes and risk factors
Most endometrial cancers are driven by long-term exposure to estrogen without enough progesterone to balance it, which overstimulates the lining.
- Obesity: the strongest modifiable risk factor; fat tissue makes estrogen after menopause
- Age: most cases occur after 50
- Diabetes and insulin resistance
- Estrogen-only hormone therapy in a person with a uterus
- Never having been pregnant, early first period and late menopause
- Polycystic ovary syndrome, with irregular ovulation
- Tamoxifen for breast cancer
- Endometrial hyperplasia, especially atypical hyperplasia
- Lynch syndrome: an inherited condition with a lifetime endometrial cancer risk of up to about 40% to 60%, depending on the gene
- Pelvic radiation in the past, a risk for sarcoma
Combined birth control pills, hormonal IUDs, pregnancy and physical activity lower the risk.
How uterine cancer is diagnosed
- Pelvic exam and history.
- Transvaginal ultrasound: measures the thickness of the lining. After menopause, a lining of 4 mm or less makes cancer unlikely.
- Endometrial biopsy: a thin tube takes a sample of the lining in the office. This is the key test.
- Hysteroscopy with dilation and curettage (D&C): if the biopsy is not possible or inconclusive.
- Staging tests: MRI of the pelvis, CT of the chest, abdomen and pelvis, or PET-CT for higher-risk types.
- Tumor testing: mismatch repair or MSI testing on all endometrial cancers, which screens for Lynch syndrome and guides immunotherapy.
Stages of uterine cancer
| Stage | Meaning |
|---|---|
| Stage 1 | Cancer only in the uterus |
| Stage 2 | Spread to the cervix's supporting tissue (stroma) |
| Stage 3 | Spread outside the uterus to nearby tissues, ovaries, vagina or pelvic and para-aortic lymph nodes |
| Stage 4 | Spread to the bladder or bowel lining, or distant organs such as the lungs, liver or bones |
The 2023 FIGO system also incorporates the cancer's type and molecular class.
Treatment
Surgery
The standard first treatment is total hysterectomy (removal of the uterus and cervix) with removal of both fallopian tubes and ovaries. It is usually done by minimally invasive (laparoscopic or robotic) surgery. Sentinel lymph node mapping checks whether cancer has reached the nodes.
After surgery
Further treatment depends on stage, grade and type:
- Vaginal brachytherapy: internal radiation to the top of the vagina, to reduce local recurrence
- External beam radiation to the pelvis
- Chemotherapy, usually carboplatin and paclitaxel, for higher-risk or advanced disease
- Immunotherapy (checkpoint inhibitors such as dostarlimab or pembrolizumab), especially effective in mismatch repair deficient cancers and now combined with chemotherapy for advanced disease
- Targeted therapy: trastuzumab for HER2-positive serous cancers, and lenvatinib with pembrolizumab for some recurrent cancers
- Hormone therapy (progestins and others) for low-grade or recurrent hormone-sensitive cancers
Fertility-sparing treatment
For selected younger people with early, low-grade endometrial cancer who want children, high-dose progestin therapy (often a hormonal IUD) with close biopsy monitoring may be offered. Hysterectomy is usually recommended once childbearing is complete.
Uterine sarcoma
Surgery is the main treatment. Chemotherapy or hormone therapy may follow depending on subtype.
Survival and outlook
Most endometrial cancers are found early. Approximate 5-year relative survival from US data:
- Localized (confined to the uterus): about 95%
- Regional spread: about 70%
- Distant spread: about 20%
Outcomes are worse for serous, clear cell and carcinosarcoma types and for uterine sarcomas. Follow-up visits every 3 to 6 months for the first 2 to 3 years focus on symptoms and examination; report any new bleeding, pain or weight loss.
Reducing your risk
- Keep a healthy weight and stay physically active.
- If you take hormone therapy after menopause and have a uterus, use estrogen combined with a progestogen.
- Discuss irregular periods with your doctor; PCOS can be treated to protect the lining.
- If you have Lynch syndrome, discuss yearly checks and risk-reducing hysterectomy after childbearing, often around age 40 to 45.
- Never ignore bleeding after menopause.
Frequently asked questions
What is the first sign of uterine cancer?
Abnormal vaginal bleeding is the first sign in about 9 out of 10 cases. After menopause, that means any bleeding or spotting at all. Before menopause, it means heavier or longer periods or bleeding between periods. A watery or blood-tinged discharge can also be an early sign.
Is uterine cancer the same as endometrial cancer?
Mostly. Endometrial cancer, which starts in the uterine lining, makes up more than 90% of uterine cancers, so the terms are often used interchangeably. Uterine cancer also includes uterine sarcomas, rare cancers of the uterine muscle or supporting tissue that behave differently.
Does a Pap smear detect uterine cancer?
No. A Pap test screens for cervical cancer and rarely detects endometrial cancer. There is no routine screening test for uterine cancer in people at average risk. Reporting abnormal bleeding promptly is the most effective way to find it early.
What is the survival rate for uterine cancer?
When the cancer is confined to the uterus, about 95% of people are alive 5 years later. Survival is about 70% when it has spread to nearby areas and about 20% when it has spread to distant organs. Type, grade and molecular features also matter.
Is uterine cancer hereditary?
Most cases are not. About 3% to 5% are linked to Lynch syndrome, an inherited condition that also raises the risk of colon and ovarian cancer. All endometrial cancers are now tested for features of Lynch syndrome so families can be offered genetic counseling.
Sources
This guide was written from current patient and clinical guidance, including:
- National Cancer Institute (NCI): Endometrial cancer treatment (PDQ); Uterine sarcoma treatment (PDQ)
- American Cancer Society: Key statistics for endometrial cancer
- American College of Obstetricians and Gynecologists (ACOG): The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding
- NCCN Guidelines for Patients: Uterine cancer
- CDC: Uterine cancer