Endometrial (Uterine) Cancer

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Endometrial (Uterine) Cancer

Topic Overview

Is this topic for you?

This topic provides information about cancer of the lining of the uterus (endometrium). It does not cover cancer in the muscle of the uterus, which is called uterine sarcoma. This topic focuses on type I endometrial cancer, which is the most common kind of uterine cancer.

If you are looking for information about cancer of the cervix, see the topic Cervical Cancer.

What is endometrial cancer?

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

What causes endometrial cancer?

The most common cause of type I endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:

  • Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
  • Takes estrogen without taking a progestin.
  • Is taking tamoxifen.
  • Has polycystic ovary syndrome, which causes hormone imbalance.
  • Starts her period before age 12 or starts menopause after age 55.
  • Has never been pregnant or had a full-term pregnancy.
  • Has never breast-fed.

What are the symptoms?

The most common symptoms of endometrial cancer include:

  • Bleeding or vaginal discharge not related to your period (menstruation).
  • Difficult or painful urination.
  • Pain during sexual intercourse.
  • Pelvic pain.

How is endometrial cancer diagnosed?

Endometrial cancer is usually diagnosed with a biopsy. In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

How is it treated?

Endometrial cancer in its early stages can be cured. The main treatment is surgery to remove the uterus plus the cervix, ovaries, and fallopian tubes. This is called a hysterectomy with bilateral salpingo-oophorectomy. The doctor may also remove pelvic and aortic lymph nodes to see if the cancer has spread.

A woman whose cancer has spread may also have:

It’s common to feel scared, sad, or angry after finding out that you have endometrial cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area.

Frequently Asked Questions

Learning about endometrial cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with endometrial cancer:

End-of-life decisions:

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The main cause of most type I endometrial cancer is too much of the hormone estrogen compared to the body's progesterone level.

Estrogen makes the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen—your progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what you know as menstrual bleeding.

When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. Over time, the endometrium cells can become cancerous.


The most common symptom of endometrial cancer is abnormal vaginal bleeding after menopause. "Abnormal" bleeding means unexpected bleeding. If you are taking hormone therapy after menopause, you can expect some bleeding. But if you have irregular bleeding, call your doctor.

Abnormal bleeding in women older than 35 who have not started menopause may also be a symptom of endometrial cancer, though this is less common. In rare cases, an unexplained abnormal vaginal discharge may be an early symptom.

Symptoms of more advanced endometrial cancer include:

  • Difficult or painful urination.
  • Pain in the pelvic area.
  • A pelvic lump.
  • Weight loss.

Other conditions with similar symptoms include cervical cancer and dysfunctional uterine bleeding.

What Happens

Normally, the lining of the uterus (endometrium) builds up and then sheds every month. You know this shedding as menstrual bleeding. In most cases of endometrial cancer, the endometrium has built up, or thickened, and has stayed that way. This is called endometrial hyperplasia. From this "precancer" stage, the cells can grow quickly and out of control. These fast-growing cells are cancer cells.

As the cancerous cells multiply, they form a mass of tissue. Some of this tissue mass passes out of the uterus through the cervix and vagina as part of abnormal bleeding. Abnormal bleeding occurs in 90% of post-menopausal women who have endometrial cancer.1

If endometrial cancer is not treated, it may spread from the uterus into deeper layers of the connective tissue around the uterus. As it progresses, it may spread to the pelvic lymph nodes and other pelvic organs. Advanced-stage cancer may spread to lymph nodes and on to the lungs, liver, bones, brain, and vagina.2

The stage and grade of your cancer is one of the most important factors in selecting the treatment option that is right for you. The long-term outcome (prognosis) depends on the stage of your cancer. The stage of you cancer will be determined by what your doctor finds at the time of surgery. The grade of your cancer is determined by how the cancer cells look under the microscope.

For more information, see the following topics:

What Increases Your Risk

The biggest risk factor for endometrial cancer is having too much estrogen and not enough progesterone. This is called "unopposed estrogen." (Your body makes progesterone. Man-made progesterone, as in birth control pills or hormone therapy, is called a progestin.)

Long-term exposure to unopposed estrogen may occur as a result of:

  • Being obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
  • Taking estrogen without taking a progestin.
  • Taking tamoxifen.
  • Polycystic ovary syndrome.
  • Beginning your menstrual cycle before age 12 or starting menopause after age 55.
  • Not ever being pregnant or not ever completing a full-term pregnancy (nulliparity).
  • Not ever breast-feeding.

Other things that increase your risk include:

If you are taking tamoxifen for breast cancer, keep taking it as directed by your doctor. But be sure to have a pelvic examination each year. The risk of endometrial cancer is less than the risk of getting breast cancer again. If you are worried about endometrial cancer risk, talk to your doctor. You might be able to use another medicine, instead of tamoxifen, for breast cancer.

Endometrial cancer has been linked to hereditary non-polyposis colon cancer (HNPCC). In women, this cancer often starts in the uterus and ovaries before it grows in the colon. The Canadian Cancer Society recommends that a woman with a family history of HNPCC talk to her doctor about screenings.4

Reducing your risk

There are some ways to help you lower your risk for endometrial cancer.

  • If you are on hormone therapy for menopausal symptoms, taking estrogen with progesterone will keep you from being at extra risk for endometrial cancer. (Women who have had a hysterectomy cannot get endometrial cancer, so taking estrogen without progesterone will not increase their risk for this cancer.)
  • Taking birth control pills that contain both estrogen and progestin for longer than 1 year.
  • Staying at a healthy body weight.
  • Being physically active.
  • Eating a diet that is low in animal fats and high in fruits and vegetables.

When To Call a Doctor

Schedule an appointment with your doctor if you have:

Symptoms of endometrial cancer can be mistaken for those of another condition, such as endometriosis.

Watchful Waiting

If you are concerned about your symptoms or think you may have an increased risk for endometrial cancer, call and make an appointment with your doctor.

Watchful waiting is not appropriate if you have symptoms that do not go away.

Who to See

Your family doctor or general practitioner can evaluate your symptoms and your risk for endometrial cancer.

You may be referred to doctors who can manage your cancer treatment, such as:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Most cases of endometrial cancer are diagnosed in an early stage. This is because women who have reached menopause usually see their doctors when they have vaginal bleeding. To check your symptoms, your doctor will perform a medical history and physical examination. The physical examination will include a pelvic examination and Pap test.

An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) for examination under a microscope.

Additional tests may include:

  • A transvaginal pelvic ultrasound, which uses sound waves to create images of the uterus. The images can show how thick the endometrium is. A thick endometrium can be a sign of cancer in post-menopausal women. Ultrasound also can help show whether cancer has grown into the uterine muscle (myometrium).
  • A hysteroscopy, which allows your doctor to view the inside of the uterus and obtain an endometrial tissue sample.
  • Dilation and curettage (D&C), which is done to obtain a sample of tissue from the inside of the uterus. A D&C is sometimes done at the same time as a hysteroscopy.

Testing for endometrial cancer may show that you have endometrial hyperplasia. This is not cancer but may develop into cancer. One type of hyperplasia, atypical adenomatous hyperplasia, progresses to cancer in about 1 out of 3 women.1

Tests to find out the extent (stage) of endometrial cancer include:

Your doctor will determine the stage of your cancer at the time of your surgery. Other tests done before surgery may include:

An imaging test may be done before surgery to look for spread (metastasis) of cancer in the abdomen and pelvis. This helps with planning for treatment. Imaging tests include the following:

After endometrial cancer is confirmed, surgery is usually done to remove the uterus, cervix, ovaries, and fallopian tubes. This is called a hysterectomy with bilateral salpingo-oophorectomy. Sometimes the pelvic lymph nodes are also removed. The removed tissue is examined to find out the stage and grade of cancer.

Early detection

There is no early detection test for endometrial cancer. If you have abnormal vaginal bleeding, schedule an appointment with your doctor for a medical evaluation. Unexpected bleeding, or more bleeding than normal, can be a symptom of endometrial cancer.

If you are nearing menopause, learn about the risks and symptoms of endometrial cancer.4

  • Women are advised to report to their doctors any unexpected bleeding or spotting or unusual vaginal discharge.
  • Women at risk for hereditary non-polyposis colon cancer (HNPCC) are advised to talk to their doctors about screening.4 These women also have a high risk of getting ovarian and uterine cancer. High-risk women who have no pregnancy plans can avoid these cancers by having the uterus, fallopian tubes, and ovaries removed (hysterectomy with bilateral salpingo-oophorectomy).5

Treatment Overview

Endometrial cancer detected in its early stages can be cured with surgery and close follow-up. Treatment choices depend on where the cancer is and how much it has grown. Treatment may include one or more of the following:

Initial treatment

After a diagnosis of endometrial cancer is confirmed, your doctor may recommend surgery to remove the uterus, ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). All tissues removed in surgery will be examined to find out the stage and grade of the cancer. Lymph nodes near the uterus may be examined to find out if cancer has spread outside of the uterus.6

Treatment for endometrial cancer depends on the size of the cancer, the extent of the cancer's growth, and how the cancer cells look under the microscope.

If you have recently been diagnosed with endometrial cancer, you may experience a wide variety of emotions in reaction to your diagnosis. There is no "normal" or "right" way to react to a diagnosis of cancer. But if your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment centre may offer counselling services.

You may also contact your local chapter of the Canadian Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

What to think about during initial treatment

Most treatments for endometrial cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

  • Your surgeon and oncologist will explain the possible side effects of your surgery. A hysterectomy means you will no longer be able to become pregnant.
  • Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
  • Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, anemia, or infections.

Your quality of life becomes a critical issue when you are considering your treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

Use home treatment measures to help manage the side effects of treatment. For more information, see the Home Treatment section of this topic. Your doctor also may prescribe medicines to control nausea and vomiting.

Click here to view an Actionset. Cancer: Controlling Nausea and Vomiting From Chemotherapy

Having cancer treatments such as radiation therapy or a hysterectomy may affect your ability to have or enjoy sexual intercourse. If you do have sexual problems, talk with your doctor.

If you are perimenopausal or have not yet reached menopause, your menstrual period will end immediately after most treatments for endometrial cancer. If your uterus and ovaries have been removed or have had radiation therapy, your body will have a decrease in estrogen. Estrogen normally prevents:

  • Menopausal symptoms, such as hot flashes, changes in mood, vaginal dryness, and atrophy (shrinking) of pelvic tissues. Talk with your doctor about how to manage your symptoms if they are bothersome. For more information, see the topic Menopause and Perimenopause.
  • An increased risk of heart disease and changes in your bones, such as osteoporosis.

Some women with endometrial cancer may be interested in taking part in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to be in clinical trials. These are ongoing in some parts of Canada, most parts of the United States, and in some other countries for all stages of endometrial cancer.

Ongoing treatment

After your initial treatment for endometrial cancer, it is important to receive follow-up care. Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.

Treatment if the condition gets worse

Endometrial cancer may come back (recur). But this is not likely when the first cancer is caught early and is low-risk. Of those cancers that do come back, nearly all do so within 3 years of the first diagnosis. This is why regular follow-up is extremely important after initial treatment.1

Cancer that comes back only in the pelvic area sometimes is treated with radiation therapy. This may stop the progress of cancer and may even cure it if it is only in the vagina. If cancer has spread to other parts of the body, radiation therapy often provides relief (palliation) from symptoms. Chemotherapy may also be used.

Progestin hormone therapy often is used to slow the growth of cancer that has recurred or spread. These hormone treatments can help 15 to 30 out of 100 women who have endometrial cancer that has spread to other organs (metastasized).2

Participation in clinical trials to test new treatments may be appropriate if cancer has spread to other parts of the body and hormonal therapy is ineffective in stopping the growth.

Hospice palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Hospice palliative care can improve your quality of life by helping you to manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice palliative care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:


Some risk factors for endometrial cancer are inherited, such as a family history of endometrial or colon cancer. But other risk factors are under your control. You can reduce your risk for endometrial cancer if you:

  • Use birth control pills that contain both estrogen and progestin, if you need birth control. Protection from combined hormonal pills lasts for 10 or more years after you stop taking the medicine if the medicine is taken for 1 year or longer.3
  • Use progestin along with estrogen if you decide to try hormone therapy for symptoms of menopause. Taking progestin with estrogen will not increase your risk for endometrial cancer, but it has other risks you may want to consider. For more information, see the topics Menopause and Perimenopause and Osteoporosis.
  • Stay at a healthy body weight. Overweight women are more likely to have high levels of estrogen in their bodies, because some estrogen is produced in the body's fat cells. For more information on controlling your weight, see the topic Weight Management.
  • Breast-feed if you are able. This decreases ovulation and estrogen activity.
  • Recognize and get treatment for abnormal or unexpected bleeding. (Endometrial hyperplasia, which may develop into endometrial cancer, is one cause of abnormal bleeding.) Heavy menstrual periods, bleeding between periods, and bleeding after menopause are symptoms of hyperplasia.
  • Exercise regularly. Physical activity may reduce unhealthy weight and may reduce estrogen levels.
  • Eat a diet that is low in animal fats and high in fruits and vegetables.

You have no risk for endometrial cancer if you have had your uterus removed (hysterectomy).

Home Treatment

During medical treatment for any stage of endometrial cancer, you can use home treatment to help manage the side effects that may accompany endometrial cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment includes the following:

Other issues that may arise include:

  • Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
  • Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.
  • Urinary problems, which can be caused by both endometrial cancer and its treatment. It may help to eliminate caffeine from your diet. Also, set up a schedule of urinating every 3 to 4 hours during your waking hours, even if you don't feel you need to go.
  • Hair loss. Hair loss may be unavoidable. But using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.

Many women with endometrial cancer face emotional issues as a result of their disease or its treatment.

  • Finding out that you have cancer and having treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Support groups and relaxation techniques, such as meditation, may be helpful.
  • Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly about your feelings with your partner and to discuss your concerns with your doctor. Your doctor may be able to refer you to groups that can offer support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a non-steroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to talk with your doctor about any home treatment you use for pain.


Medicines, such as chemotherapy, may be given after surgery for endometrial cancer, depending on the stage and grade of the cancer and the risk for the cancer to spread (metastasis) or recur. Progestin hormone therapy may be used if your cancer has recurred or spread or you are unable to have surgery or radiation therapy.

Medication Choices

Medicine treatment for endometrial cancer may include hormone therapy or chemotherapy.

Progestin hormone therapy. Examples include:

  • Megestrol (Megace).
  • Medroxyprogesterone (Provera).

Chemotherapy, used alone or in combination. Examples include:

Click here to view an Actionset. Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe medicines to help relieve nausea. These medicines include serotonin antagonists, phenothiazines, and aprepitant.


Surgery to remove the uterus (hysterectomy) is the most common treatment for endometrial cancer. The surgeon will also remove the fallopian tubes, ovaries, and often the pelvic lymph nodes, which are examined to find out the extent of the cancer and to help plan your treatment. If examination of tissue determines that more aggressive cancer still may be in the lymph system, a lymphadenectomy may be done to remove and examine additional lymph nodes. Surgery has the highest cure rate of all treatments for endometrial cancer.

Surgery Choices

Hysterectomy with removal of the fallopian tubes and ovaries (bilateral salpingo-oophorectomy)
Lymphadenectomy (removal of lymph nodes)

What To Think About

Laparoscopic surgery is an option for treating your endometrial cancer. This surgery is done with a tiny camera and special instruments. The surgeon puts these tools through several small incisions (cuts) in the belly. Some surgeons do this surgery by guiding robotic arms that hold the surgery tools. This is called robot-assisted laparoscopy.

Most women have their ovaries removed after a diagnosis of endometrial cancer to make sure the cancer has not spread to the ovaries, to reduce the production of estrogen, and to slow cancer growth. And some women who have had endometrial cancer may be at greater risk of developing ovarian cancer.

You will not be able to become pregnant or continue to menstruate after a hysterectomy. If you have not yet gone through menopause, it will begin as soon as your ovaries are removed. For more information, see the topic Menopause and Perimenopause.

Other Treatment

Radiation therapy

Radiation therapy may be used to treat endometrial cancer. Radiation may be given internally by placing radioactive substances in the vagina (vaginal radiation). Or it may be given externally by delivering radiation from an outside source (pelvic radiation).

If you need to have radiation, your doctor will plan the most effective treatment for you based on the stage and grade of your cancer.

Clinical trials

Studies called clinical trials are being conducted to find ways to prevent, detect, diagnose, and treat endometrial cancer. Talk with your doctor to see whether clinical trials are available and whether you are a good candidate.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Other Places To Get Help


Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.

Canadian Cancer Society
10 Alcorn Avenue
Suite 200
Toronto, ON  M4V 3B1
Phone: (416) 961-7223
Fax: (416) 961-4189
Email: ccs@cancer.ca
Web Address: http://cancer.ca

The Canadian Cancer Society (CCS) is a national, community-based organization that provides information about cancer prevention, care, and treatment. The CCS also provides funding for cancer research.



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  2. National Cancer Institute (2010). Endometrial Cancer Treatment (PDQ): Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/healthprofessional.
  3. Mutch DG (2003). Uterine Cancer. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., chap. 54, pp. 951–969. Philadelphia: Lippincott Williams and Wilkins.
  4. Canadian Cancer Society (2011). Uterine cancer overview. Canadian Cancer Encyclopedia. Available online: http://info.cancer.ca/cce-ecc/default.aspx?Lang=E&toc=53#Early_detection.
  5. Schmeler KM, et al. (2006). Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. New England Journal of Medicine, 354(3): 261–269.
  6. American Joint Committee on Cancer (2010). Corpus uteri. In AJCC Cancer Staging Manual, 7th ed., pp. 403–418. New York: Springer.

Other Works Consulted

  • American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.
  • American College of Obstetricians and Gynecologists (2005, reaffirmed 2009). Management of endometrial cancer. ACOG Practice Bulletin No. 65. Obstetrics and Gynecology, 106(2): 413–425.
  • Brand A, et al. (2000). Diagnosis of endometrial cancer in women with abnormal vaginal bleeding. SOGC Clinical Practice Guideline. Journal of Obstetrics and Gynaecology Canada, 22(1): 102–104.
  • McMeekin DS, et al. (2009). Corpus: Epithelial tumors. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., chap. 23, pp. 683–732. Philadelphia: Lippincott Williams and Wilkins.
  • National Comprehensive Cancer Network (2010). Uterine neoplasms. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site.


By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Brian D. O'Brien, MD - Internal Medicine
Specialist Medical Reviewer Ross Berkowitz, MD - Obstetrics and Gynecology
Last Revised February 1, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.