Endometrial Cancer Metastatic

Metastatic endometrial cancer occurs when cancer that begins in the lining of the uterus spreads to other parts of the body. While this advanced stage presents serious challenges, newer treatments are helping to slow cancer growth, manage symptoms, and improve quality of life for many patients.

Table of contents

• What Is Metastatic Endometrial Cancer?
• Medical Identification Codes
• Other Names for This Disease
• How Endometrial Cancer Spreads
• Where Cancer Most Commonly Spreads
• Signs and Symptoms
• Diagnosis and Testing
• Who Treats This Cancer
• Treatment Options
• Outlook and Life Expectancy
• Getting Support

What Is Metastatic Endometrial Cancer?

Metastatic endometrial cancer is cancer that starts in the endometrium (the inner lining of the uterus) and spreads to other parts of the body^[1]. Doctors also call this stage IV endometrial cancer or advanced metastatic uterine cancer^[1].

When doctors talk about stage IV endometrial cancer, they divide it into two subtypes based on where the cancer has spread. Stage IVA means cancer has reached the bladder or colon. Stage IVB means cancer has traveled to distant organs like the lungs, liver, or lymph nodes outside the pelvis^[1].

Around 10% to 15% of people with endometrial cancer are diagnosed after it has already spread to distant body parts^[1]. While metastatic endometrial cancer is not considered curable, newer treatments can slow its growth, ease symptoms, and help patients live longer^[1].

Medical Identification Codes

C54.1

Other Names for This Disease

Metastatic Endometrioid Adenocarcinoma, Metastatic Endometrioid Cancer, Metastatic Endometrioid Carcinoma, Metastatic Uterine Adenocarcinoma, Metastatic Uterine Cancer, Metastatic Uterine Carcinoma

How Endometrial Cancer Spreads

A muscle layer called the myometrium surrounds the lining of the uterus. It acts like a gate that holds cancer in, but sometimes cancer cells find a way out^[1]. Endometrial cancer spreads in three main ways.

Direct invasion happens when cancer cells detach from the original tumor and invade nearby tissues. In endometrial cancer, cells are most likely to spread from the uterus directly to the cervix, bladder, vagina, ovaries, fallopian tubes, or rectum^[1].

Lymphatic spread occurs when cancer cells travel through your lymphatic system, a network that helps move germ-fighting fluid through the body. These tubes act like highways for immune cells, which is normally helpful. But when cancer cells hitch a ride, they can reach other organs^[1]. Studies show that endometrial cancer usually spreads outside the uterus through the lymphatic system^[6].

Hematogenous spread (through the bloodstream) happens when cancer cells travel to faraway organs like the lungs or liver by entering the bloodstream. This is more common with aggressive types of endometrial cancers like serous and clear cell adenocarcinomas^[1]. Your lungs constantly filter blood to add oxygen and remove carbon dioxide. While this process is vital, it also raises the risk of cancer cells traveling through your bloodstream to your lungs^[6].

Where Cancer Most Commonly Spreads

When endometrial cancer spreads, it often moves into the cervix, bladder, vagina, ovaries, fallopian tubes, rectum, or nearby lymph nodes first. But given the chance, it can show up in distant organs^[1].

A study of nearly 4,000 people with metastatic endometrial cancer found that the lungs are the most common distant site where the cancer spreads. Lung metastasis occurred in 29.4% of cases. The liver was the second most common site at 14.9%, followed by bones at 10.5%, and the brain at 3.1%^[1][2].

Other studies report lower rates of brain involvement. One study reported brain metastasis in about 0.3% to 1.4% of people with endometrial cancer, most often in those with advanced, high-grade tumors^[1].

Stage 4 endometrial cancer includes cancer that has spread to the bladder, bowel, lymph nodes outside the pelvic area, the omentum (which is part of the lining around the abdomen), or to organs like the lungs, liver, or other distant locations^[2].

Signs and Symptoms

Abnormal vaginal bleeding is the most common sign of endometrial cancer at any stage. This includes bleeding between periods or after menopause (going a full year without a period). Even light spotting after menopause is cause for concern and should be checked by a doctor^[1].

Some symptoms of endometrial cancer can be more common as the cancer progresses. People may notice^[2]:

• Atypical vaginal bleeding, such as spotting
• Atypical discharge
• Pelvic pain
• Feeling a mass in the pelvic area
• Unexplained weight loss

If cancer has spread to another part of the body, people may also experience symptoms relating to that part of the body. These can include shortness of breath for lung metastasis, swollen abdomen or yellowing of the skin and eyes for liver metastasis, bone pain and fractures for bone metastasis, and headache, dizziness, or seizures for brain metastasis^[2].

These symptoms can also occur with other health conditions, but it is always best to speak with a doctor as soon as possible if you notice any new or worsening symptoms^[2].

Diagnosis and Testing

The diagnosis and staging of endometrial adenocarcinoma is made through several tests and procedures^[5]:

• Chest x-ray
• Computed tomography (CT) scan
• Dilation and curettage (D&C)
• Endometrial biopsy
• Hysteroscopy
• Lymph node dissection
• Magnetic resonance imaging (MRI)
• Pelvic exam
• Positron emission tomography (PET) scan
• Physical exam and health history
• Transvaginal ultrasound exam

A pelvic exam is often done during a regular checkup, but it might be needed if you have symptoms of endometrial cancer. During the exam, a health care professional carefully inspects the outer genitals. Two fingers of one hand are inserted into the vagina and the other hand presses on the abdomen to feel the uterus and ovaries^[9].

One imaging test might be a transvaginal ultrasound. In this procedure, a wandlike device called a transducer is inserted into the vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs^[9].

Who Treats This Cancer

Your regular doctor or obstetrician/gynecologist (OB/GYN) may be the first to suspect cancer, but a gynecologic oncologist should confirm the diagnosis and create a treatment plan. These are specialists who focus on cancers of the female reproductive system and know about the latest treatment options^[1].

As one gynecologic oncologist explains, “Patients should seek out the highest level of care available to them because it’s hard to go back and redo things. There’s no replacement for expertise in getting it right the first time”^[1].

Your care team for endometrial cancer may include several specialists^[15]:

• Gynecologic oncologists are doctors who specialize in both cancer diagnosis and treatment and have special training in operating on cancers of the uterus, cervix, ovaries, fallopian tubes, vulva, and vagina.
• Medical oncologists are experts in treating cancer using different medical approaches, like chemotherapy or pharmaceutical drugs.
• Oncology nurses specialize in cancer care, and may work with you throughout diagnosis and treatment, help with medical information, assist in managing symptoms and side effects, and answer questions.
• Radiation oncologists are experts in using radiation to treat cancer (if this is part of your treatment plan).
• Social workers have training in counseling and practical support with things like transportation to and from appointments, support programs, and more. They can be advocates for you and help you find emotional support.
• Patient navigators can help educate you about cancer and facilitate conversations with providers. They can also guide you through diagnosis and treatment, coordinate treatment and care, and help you find financial, logistical, and educational resources.
• Registered dietitians can help you cope with some side effects of treatment you may experience and help you maintain healthy eating habits to aid in recovery.

Treatment Options

Surgery is typically the first-line treatment for endometrial cancer. This includes a hysterectomy to remove the uterus, as well as removal of the fallopian tubes and ovaries. People may also have surgery to remove lymph nodes in the pelvic area^[2].

During surgery, the cervix and uterus are removed (total hysterectomy), as well as both ovaries and fallopian tubes (salpingo-oophorectomy). Lymph nodes and other tissue may be removed and tested to find out if they contain cancer. Staging of the cancer occurs after surgery^[5].

The other treatment modalities are^[5]:

• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy

Standard treatments for localized endometrial cancer include hysterectomy with bilateral salpingo-oophorectomy and postoperative adjuvant radiation therapy in patients who meet certain criteria. Radiation therapy is directed at sites of known or suspected tumor involvement and may include external beam radiation therapy, brachytherapy, or both^[10].

For metastatic endometrial cancer specifically, there is no general agreement as to what constitutes the best chemotherapy choice, as very few phase III studies have been done comparing different regimens. Salvage agents such as paclitaxel may be an option for second-line therapy in patients who have disease recurrence even after first-line chemotherapy. Biomarker-directed systemic therapy may be used for second-line therapy^[10].

While several treatment modalities are now available to treat women who present with metastatic endometrial cancer, overall prognosis remains poor^[5].

Outlook and Life Expectancy

Endometrial cancer is the most common gynecologic malignancy in the United States and accounts for 7% of all cancers in women. Most cases are diagnosed at an early stage and are amenable to treatment with surgery alone. However, patients with pathological features predictive of a high rate of relapse and patients with extrauterine spread at diagnosis have a high rate of relapse despite adjuvant therapy^[12].

The most common cause of death in patients with endometrial cancer is cardiovascular disease because of related metabolic risk factors^[12].

The majority of women will survive their diagnosis of endometrial cancer, so they remain at risk for breast and colorectal cancer. Women with endometrial cancer should be counseled about screening for these cancers^[19].

A small proportion of women with endometrial cancer have Lynch syndrome, a genetic condition that increases cancer risk. Improving the detection rate of Lynch syndrome among these women increases the probability of reducing their subsequent colorectal cancer risk and prolonging their life expectancy^[19].

Getting Support

Being diagnosed with cancer often comes with a range of emotions and a sense of urgency to start treatment right away. However, it is important to understand your diagnosis and treatment options, and get answers to questions such as: Has the cancer spread? What stage is the cancer? What are the most common treatment options? Is there a clinical trial that may be a good fit?^[15]

After your initial diagnosis, talk to the doctor and let them know you are going to seek a second opinion. It is normal to feel uncomfortable talking about seeing another physician, but most providers welcome a second opinion because it can provide confirmation of diagnosis and treatment, or even more information. Remember that it is not uncommon to get a second opinion—and your doctor may even refer you to another provider^[15].

Maintaining a healthy diet is crucial for people living with advanced endometrial cancer, as proper nutrition helps manage treatment side effects and supports healing. Researchers and doctors recommend sticking with plant-based foods, which are high in vitamins and minerals. You will also want to limit inflammatory, processed foods and alcohol when possible^[13].

For more guidance on healthy eating with cancer, talk to your doctor or a registered dietitian. Your doctor may recommend meeting with a registered dietitian or a nutritionist to draft a healthy eating plan. These members of your care team can also offer suggestions if you are dealing with the side effects of treatment, like nausea, vomiting, or diarrhea^[13].