When endometrial cancer metastasizes (spreads), it often moves to nearby areas such as the ovaries, fallopian tubes, or cervix. Like other cancers, it can also spread to other parts of the body. Although less common, endometrial cancer may reach the liver, bladder, lungs, or brain.

This article discusses the eight most common sites for endometrial cancer to spread. We’ll also cover what symptoms you may experience if your cancer has metastasized. Be sure to talk with your oncologist (cancer doctor) if you notice any new symptoms. They’ll run additional tests to check if the cancer has spread.

How Does Endometrial Cancer Spread?

In early-stage endometrial cancer, the tumor starts as a growth or lesion on the inner lining of the uterus. This lining is known as the endometrium.

The tumor keeps growing deeper into the lining and eventually meets vessels from your lymphatic system. This is a key part of your immune system that carries immune cells throughout your body and filters your blood.

Once cancer cells spread into your lymphatic system, they can travel to nearby lymph nodes. These bean-shaped tissues contain immune cells and carry lymph fluid. Endometrial cancer typically spreads into the pelvic lymph nodes first.

Endometrial cancer that has spread to the lymph nodes can keep moving out to distant organs. The lymphatic system and circulatory system connect — meaning that cancer cells can move into your bloodstream. The cells travel around the body until they land in another organ and begin growing another tumor.

Where Does Endometrial Cancer Spread?

Depending on how severe your endometrial cancer is, it may spread to nearby or distant organs. Here are eight places it may travel to.

1. Pelvic Lymph Nodes

When endometrial cancer starts spreading, it first moves into the nearby pelvic lymph nodes. These nodes run along the blood vessels that are inside the pelvis — the large cavity that holds your reproductive organs.

For anyone diagnosed with stage 3 (stage III) endometrial cancer, the cancer may have spread to the pelvic lymph nodes. A study published in the journal Cancer found that around half of metastases found outside the uterus were in the pelvic lymph nodes.

2. Ovaries, Fallopian Tubes, and Cervix

Once endometrial cancer moves to the lymph nodes, it can travel to other reproductive organs. The ovaries and fallopian tubes sit next to the uterus. Together, these organs are known as the adnexa. In stage 3 endometrial cancer, tumors may have spread outside the uterus to these structures.

A study of 788 people with endometrial cancer looked at adnexal metastases. The authors noted that 4.4 percent of cases had cancer spread to the ovaries and fallopian tubes.

Endometrial cancer can also spread to the cervix — the lowermost part of the uterus. In stage 2 endometrial cancer, the cancer has grown and spread to the cervix.

3. Lungs

Endometrial cancer rarely spreads outside the pelvis and abdomen. When it does, it spreads to the lungs most often. In one study of nearly 3,900 people with metastatic endometrial cancer, researchers found that 29.4 percent of distant metastases occurred in the lungs.

Symptoms of endometrial cancer that has spread into the lungs include:

• Chest pain
• Shortness of breath
• Coughing, which may bring up blood
• Loss of appetite and weight loss

4. Liver

The next most common place for endometrial cancer to spread farther from the uterus is the liver. The same study of nearly 3,900 people found that 14.9 percent of distant metastases occur in the liver.

Another report found that cancer spread to the liver has a worse median overall survival rate compared to other sites. The median overall survival refers to the length of time in which half of people with a disease are still alive. Liver metastases from endometrial cancer have a median overall survival of eight months. This means that after eight months, half of people with liver metastases are still alive.

Signs of cancer spread to the liver can include:

• Jaundice (yellowing of skin and the whites of the eyes)
• Itchy skin
• Lack of appetite
• Swollen legs
• Abdominal pain, especially in the upper right part
• Fatigue and weakness

5. Bones

Another 10.5 percent of metastatic endometrial cancers form in the bones. The most common sites include the hips and spine. It’s also possible for the cancer to spread to the arms, legs, and skull.

According to the American Cancer Society, symptoms of bone metastases include:

• Bone pain that gets better with movement or worsens at night
• Broken bones or fractures
• High calcium levels in blood
• Spinal cord issues that cause back pain, along with weakness or numbness in the legs

6. Brain

Endometrial cancer spread to the brain is less common, occurring in only 3.1 percent of metastatic cases. Most people with brain metastases have high-grade tumors and other sites where the cancer has spread. Symptoms of cancer spread to the brain include headaches, seizures, and aphasia (difficulty speaking) or stroke.

7. Rectum

Endometrial cancer rarely spreads to the rectum. This is the final part of the colon that collects stool (poop). Most rectal tumors form in the rectum first. However, some small case reports show that endometrial cancer can spread here as well.

Most people with cancer spread to the rectum also have endometriosis. This condition occurs when uterine tissues start growing outside the uterus. They can cover the fallopian tubes, ovaries, and area around the pelvis. Symptoms of endometrial cancer spread to the rectum include constipation, diarrhea, and blood in your stool.

8. Bladder

Bladder cancer metastases are also rare but possible with endometrial cancer. One report noted that only four studies documented these metastases. Endometrial cancers can also spread from the uterus to the outside of the bladder.

If your endometrial cancer has spread to your bladder, you might experience symptoms such as:

• Blood in your urine
• Pain or burning sensation when urinating
• An urge to pee, even when your bladder is empty
• Frequent nighttime urination

How Do Doctors Diagnose Endometrial Cancer Spread?

After you’ve been diagnosed with endometrial cancer, your oncologist will continue monitoring your tumor. Whole-body imaging tests look for cancer spread to different organs.

Computed tomography (CT) scans use X-rays taken at many angles to create “slices” of images of your body. Doctors take a close look at these images for any signs of metastasis. CT scans are also useful for checking whether your cancer has returned after treatment.

Magnetic resonance imaging (MRI) uses strong magnets and radio waves to take pictures of your body in slices. These scans give extremely detailed pictures for finding cancer spread. Doctors usually use MRI to look for tumors in the brain and spinal cord. They can also use this test to check for cancer growth deep in the uterus.

Positron emission tomography (PET) scans use radioactive glucose (sugar) to look for cancer spread throughout the body. Cancer cells use more sugar than healthy cells. This means the radioactive sugar collects in small tumors, which light up on a screen.

If your doctor finds a suspicious area, they may perform a biopsy. This involves taking a small tissue sample to look at under a microscope. A pathologist (tissue specialist) can confirm endometrial cancer spread.

Once your doctor confirms that your cancer has spread, they’ll create a new treatment plan. Stage 4 endometrial cancer is usually treated with systemic, or body-wide, therapies. Examples include chemotherapy, immunotherapy, and hormone therapy. Radiation therapy can help shrink large tumors in some cases.

Find Your Team

On MyEndometrialCancerTeam, the social network for people with endometrial cancer and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with endometrial cancer.

Do you have advanced endometrial cancer? Has it spread to other parts of your body? Share your experience in the comments below, or start a conversation by posting on your Activities page.