Uterine (endometrial) cancer is the most common gynecologic cancer in the United States, yet many patients are unfamiliar with the terminology used to describe the disease and how it can vary from person to person. To help break down these concepts, we spoke with Dr. Katherine Fuh, a gynecologic oncologist at UCSF Health. In this conversation, she explains the basics of endometrial cancer, clarifies commonly used medical terms, and discusses how our understanding of the disease continues to evolve.
Q: Can you explain what uterine (endometrial) cancer is and how it differs from other gynecologic cancers?
Dr. Katherine Fuh: Endometrial cancer is also commonly referred to as uterine cancer. The endometrium is the inner lining of the uterus that sheds each month during menstruation, and most endometrial cancers begin in that lining.
There are also other types of uterine cancers that start in the muscle layer of the uterus, called the myometrium. For example, leiomyosarcoma is a cancer that develops in that muscle layer. So while people may use the terms “uterine cancer” and “endometrial cancer” interchangeably, there are actually different types of cancers that can arise in the uterus.
Endometrial cancer can also differ from other gynecologic cancers in a few ways, including whether it is associated with hereditary conditions like Lynch syndrome and the different molecular or histologic subtypes we identify within endometrial cancer itself.
Q: Patients often hear terms like grade, stage, histology, or “aggressive subtype” after diagnosis. Can you explain these terms?
Dr. Katherine Fuh: These terms can definitely feel confusing at first, and they’re questions we go through often with patients.
Grade refers to what the tumor cells look like under the microscope. This is determined by the pathologist using tissue from a biopsy or surgery. Grades typically range from 1 to 3.
- Grade 1 tumors look more similar to normal endometrial cells.
- Grade 3 tumors look much more abnormal or atypical.
In general, the higher the grade, the more aggressive the cancer may behave.
Stage describes where the cancer is located and whether it has spread.
- Stage I means the cancer is confined to the uterus.
- Stage II means it has spread outside the uterus to nearby areas.
- Stage III can involve the lymph nodes or nearby organs such as the ovaries.
- Stage IV means the cancer has spread farther away to organs like the lungs, liver, or bones.
Histology is another term based on what the cancer looks like under the microscope.
When we talk about aggressive subtypes, we’re often referring to certain histologies that tend to behave more aggressively. For example, serous endometrial cancer is considered one of the more aggressive subtypes.
Q: Historically, uterine (endometrial) cancer has been thought of as a cancer that’s usually caught early because of symptoms like postmenopausal bleeding. Is that still true today?
Dr. Katherine Fuh: In many cases, yes. Endometrial cancer is still often diagnosed at an early stage, and early-stage disease remains the most common presentation.
However, we are also seeing an increase in more aggressive types of endometrial cancer. These cancers may present at a more advanced stage and sometimes do not cause the classic symptom of postmenopausal bleeding.
That’s part of the challenge. We don’t always have clear early warning symptoms for these more aggressive subtypes, which can make them harder to detect early. While many patients are still diagnosed early, we are continuing to see more advanced-stage cases as well.
For more insights from Dr. Fuh, watch the full webinar recording here.
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