Types of endometrial tumours

An endometrial tumour is a growth that develops in the endometrium, the inner lining of the womb (uterus). Endometrial tumours can be benign (not cancerous) or malignant (cancerous). Malignant endometrial tumours are usually called endometrial cancer, the most common type of womb cancer. It mainly affects women after the menopause, although it can also occur in younger women. In this post I explain the main types of endometrial tumours, who is most at risk, and how they are diagnosed and treated.

Benign endometrial tumours

• Endometrial polyps: small growths attached to the inner wall of the womb. They are usually benign, but occasionally they can become precancerous, so they are often removed and checked, usually during a hysteroscopy.
• Leiomyomas (fibroids): non-cancerous growths in the muscle wall of the womb. They do not start in the endometrium itself, but they can affect how it works, for example by causing heavy periods. Fibroids are extremely common and, on their own, are not a sign of cancer.

Malignant endometrial tumours

• Endometrial adenocarcinoma: the most common form of endometrial cancer, starting in the gland cells of the womb lining.
• Uterine sarcoma: a rarer cancer that develops in the muscle or supporting tissues of the womb, rather than the lining.

Our post on uterine cancers explains the difference between these two cancers in more detail.

Who is at risk of endometrial tumours?

Several factors are linked with a higher risk of endometrial cancer:

• Hormonal imbalance: high levels of oestrogen without enough progesterone to balance it can overstimulate the womb lining.
• Excess weight: fat tissue produces extra oestrogen.
• Age: the risk rises with age, especially after the menopause.
• Family history: a family history of womb or bowel cancer can increase the risk.
• Reproductive history: starting periods early, a late menopause or never having children may raise the risk.

Symptoms of endometrial tumours

The most important symptom is abnormal vaginal bleeding or discharge, particularly bleeding after the menopause. Other symptoms include pelvic pain or discomfort and pain during sex. Any bleeding after the menopause should be checked promptly, even if it is light or only happens once.

How are endometrial tumours diagnosed and treated?

Diagnosis usually involves a pelvic examination, an ultrasound scan to measure the thickness of the womb lining (see gynaecological ultrasounds), and an endometrial biopsy to examine a small sample of tissue. Benign polyps can often be removed during a hysteroscopy.

If cancer is confirmed, treatment depends on the stage and may include:

• Surgery: usually a hysterectomy, often with removal of the ovaries and fallopian tubes, and frequently by keyhole (see total laparoscopic hysterectomy).
• Radiotherapy: to destroy cancer cells or reduce the risk of the cancer returning.
• Chemotherapy: for advanced cancer or cancer that has spread.
• Hormone therapy: for some cancers that are sensitive to hormones.

Outlook for endometrial cancer

The outlook for endometrial cancer is generally good, especially when it is found early. Early-stage endometrial cancer has a high survival rate, and many women are cured with treatment. Acting promptly on symptoms makes a real difference.

After treatment, you will have regular follow-up appointments, so that any change can be picked up early. Between appointments, tell your team straight away about any new bleeding, discharge or pain. Keeping active, eating well and keeping to a healthy weight can also support your recovery and your general health.

Cancer Research UK explains the different types of womb cancer, and NICE sets out when symptoms should be referred urgently. If you are concerned about endometrial cancer, you can book a consultation with Mr Jafaru Abu at The Park Hospital, Nottingham.