Endometrial cancer that metastasizes, or spreads to other parts of the body, is classified as stage 4 disease. Metastatic endometrial cancer tends to spread to certain locations, including the lungs. Overall, around one-fourth of endometrial cancer cases with metastasis involve the lungs. If the cancer spreads to the lungs, symptoms may include coughing and shortness of breath, in addition to common endometrial cancer symptoms.

This article explains how endometrial cancer spreads to the lungs and describes the symptoms you might notice. We’ll also cover how lung metastases are diagnosed and treated, as well as what they mean for your prognosis (outlook). Talk to your oncologist to learn more about your specific case.

How Does Endometrial Cancer Spread to the Lungs?

The medical term “metastasis” refers to cancer cells that have moved away from the primary tumor, where the cancer originally developed. Endometrial cancer cells can break away from the primary tumor and enter the bloodstream.

Tumors can also spread into nearby lymph nodes — immune system structures that filter certain harmful substances from your body, such as infections and cancer cells. Studies show that endometrial cancer usually spreads outside the uterus through the lymphatic system.

When endometrial cancer spreads beyond the pelvis and abdomen, it most commonly travels to the lungs.

Your lungs constantly filter blood to add oxygen and remove carbon dioxide. Blood flows throughout your entire body, delivering key nutrients to your organs. While this process is vital, it also raises the risk of cancer cells traveling through your bloodstream to your lungs.

Lung Metastasis and Recurrence of Endometrial Cancer

When endometrial cancer spreads beyond the pelvis and abdomen, it most often travels to the lungs. Lung metastasis happens in about 1.5 percent of cases, according to a 2022 study in the journal Frontiers in Oncology.

Sometimes, endometrial cancer returns after remission, which is a period without any signs of cancer. This return is called recurrence. In a study of 90 people with endometrial cancer recurrence, the lungs were the first site of recurrence in 31 cases (34.4 percent). Among those, 20 cases (64.5 percent) were isolated to the lungs, while 11 cases (35.5 percent) involved metastasis to other organs as well.

Symptoms of Lung Metastasis in Endometrial Cancer

When endometrial cancer spreads to the lungs, you may experience symptoms. The American Cancer Society states that common signs and symptoms of lung metastases include:

• Chest pain
• A cough, with or without blood
• Unexplained weight loss
• Buildup of fluid around the lungs
• Reduced appetite
• Shortness of breath

Many of these symptoms also occur with other health conditions. If you have endometrial cancer and develop respiratory issues that could indicate lung metastases, be sure to talk to your doctor. They may run tests to better understand what’s causing your symptoms.

Not everyone experiences symptoms if endometrial cancer has spread to the lungs, but you may have chest pain, coughing, and shortness of breath.

Some people with lung metastases don’t experience any symptoms. Many people with lung cancer don’t notice any problems until their disease has progressed. Doctors sometimes find the cancer during a chest X-ray performed for another condition.

How Are Lung Metastases Diagnosed?

If your doctor thinks you may have lung metastases, they’ll run some tests. Diagnosis usually starts with a physical exam and medical history. Your doctor will ask about your symptoms and any recent changes in your condition. They’ll also listen to your lungs to check for abnormalities.

Imaging Tests

Imaging tests help doctors see what’s happening inside your lungs. Your doctor will likely start with a chest X-ray, which can show tumors and other causes of shortness of breath or coughing.

If the chest X-ray reveals a lung tumor, the next step may be a computed tomography (CT) scan. This imaging test takes detailed images using X-rays from multiple angles, providing more information than chest X-rays. CT scans help doctors determine the size and location of any lung tumors.

Another imaging test, called a positron emission tomography (PET) scan, checks the entire body for cancer. This test uses a small amount of radioactive sugar that cancer cells absorb quickly, causing tumors to show up as bright spots on the scan. PET scans help doctors look for other distant metastases.

Bronchoscopy

If you’re coughing up blood, your doctor may order a bronchoscopy. This test uses a long, thin tube known as an endoscope. A camera on the end allows doctors to look inside the lungs. Depending on the type of bronchoscopy, you may be numbed or under general anesthesia (asleep).

The endoscope is inserted through your mouth or nose and down into your windpipe. Your doctor will look at your lungs for any signs of cancer growth. They may also take tissue samples to look at more closely.

Biopsy

When cancer spreads to other parts of the body, the cells may still look like those from the primary tumor. Doctors perform biopsies to look at tumor cells under a microscope. They can tell whether the cells originally came from an endometrial cancer tumor or another type of cancer.

If you need a biopsy, your doctor will use your imaging test results to find the tumor. They’ll take a small tissue sample in one of three ways:

• Using a long, thin needle inserted through your chest wall
• During a bronchoscopy, through a procedure called bronchoalveolar washing (flushing part of the lungs with saltwater and collecting the fluid)
• During surgery

How Are Lung Metastases From Endometrial Cancer Treated?

Metastatic endometrial cancer treatment usually involves a combination of approaches. Your treatment options may depend on your previous therapies. Be sure to sit down and talk with your cancer care team about your plan. Your options may include surgery, radiation therapy, and medications.

Depending on the details of your endometrial cancer and lung involvement, your cancer care team may recommend a combination of chemotherapy, immunotherapy, hormone therapy, or radiotherapy.

People with advanced and metastatic endometrial cancer can participate in clinical trials. These large studies help researchers find out how well new drugs work. Ask your doctor whether you might be eligible for clinical trials. Joining a study may give you access to medication you couldn’t take otherwise.

Like all medications, cancer treatments may come with side effects. Talk to your doctor about what side effects to expect and how to manage them if they occur. Be sure to let them know if you begin experiencing any side effects that make it difficult to stick with your treatment.

Surgery and Radiation Therapy

The American Cancer Society explains that metastatic endometrial cancer has spread too far to treat with surgery. Your doctor may recommend a hysterectomy (surgery to remove your uterus). They may also remove your ovaries and both fallopian tubes. This helps prevent unnecessary bleeding.

Radiation therapy (radiotherapy) uses intense beams of X-ray energy to destroy cancer cells. This approach also prevents excessive bleeding from endometrial cancer. Radiation therapy isn’t typically used to treat the lung metastases directly, but may be used to shrink tumors to help you breathe better.

Chemotherapy, Immunotherapy, and Hormone Therapy

Medications also help treat metastatic endometrial cancer for some time. Chemotherapy uses toxic chemicals that kill fast-growing cancer cells. Doctors usually combine different chemotherapies in the same cancer treatment. Examples of these drugs include:

• Carboplatin
• Cisplatin
• Doxorubicin
• Paclitaxel

Some endometrial cancers use hormones, such as estrogen and progesterone, to grow. Hormone therapy stops cancer cells from using these molecules to shrink tumors. However, not everyone responds to hormone therapy.

Immunotherapy boosts your immune system to fight endometrial cancer. Doctors give immunotherapy to people with advanced endometrial cancer. You may be eligible for treatment if you tried chemotherapy but it didn’t work for you or if surgery isn’t an option.

Prognosis for Endometrial Cancer Spread to the Lungs

Unfortunately, the prognosis (outlook) for endometrial cancer spread to the lungs is fairly poor. These cancers are harder to treat than early-stage disease. Researchers have looked at overall survival in people with endometrial cancer that spread to the lungs. Overall survival is the length of time that people with cancer are still alive after treatment starts.

One study looked at median overall survival — the length of time when at least half of people with cancer are alive from either the date of diagnosis or the start of treatment. The study followed 1,542 people with lung metastases from endometrial cancer. The results showed that:

• The median overall survival was eight months.
• The one-year survival rate was 38.06 percent.
• The three-year survival rate was 9.86 percent.

This means that three years after diagnosis with lung metastasis, 9.86 percent of the participants were still alive.

Fortunately, new treatments like immunotherapy and chemotherapy are helping people live longer with advanced endometrial cancer. It’s also important to remember that studies can’t predict your individual outlook. Ask your oncology team about the details of your endometrial cancer and risk factors that affect your prognosis.

Talk With Others Who Understand

On MyEndometrialCancerTeam, the site for people with endometrial cancer and their loved ones, members come together to gain a new understanding of endometrial cancer and connect with others who understand life with this condition.

Has your endometrial cancer spread to your lungs? What symptoms have you experienced? What treatment plan do you follow? Share your story in the comments below, or start a conversation on your Activities page.