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Endometrial Cancer

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Definition

Endometrial cancer originates in the uterus. The uterus is the concave, pear-shaped pelvic organ in women where fetal growth happens.

Also known as Uterine cancer, endometrial cancer initiates in the sheets of cells that form the lining (endometrium) of the uterus. It is usually an adenocarcinoma .Other types of uterus cancer, including that of uterine sarcoma, are not as common as endometrial adenocarcinoma .

Endometrial cancer is more often detected in an initial stage because it recurrently produces anomalous vaginal bleeding, which prompts women to see their doctors and get the uterus removed surgically thereby curing the cancer.

 

Symptoms

Signs of endometrial cancer may consist of:

  • Vaginal bleeding past menopause
  • Unusual bleeding between periods
  • An unusual, dilute or blood-tinged discharge from vagina
  • Pain in the pelvic area
  • Pain during sex

Risk Factors

Factors that add to the risk of endometrial cancer include:

  • Changes in the Hormones Balance in Women: Ovaries produce two main hormones — estrogen and progesterone. Imbalance in levels of these hormones causes changes in the endometrium. A condition that increases the levels of estrogen, but not that of the progesterone, can increase the risk of endometrial cancer
  • More Years of Menstruation: Early menstruation or commencing menopause at an later age can increase the risk of endometrial cancer
  • Never Been Pregnant: Women who have never conceived fall under the higher risk category
  • Older Age: Older women who have undergone menopause are at a greater risk to develop endometrial cancer
  • Obesity: Obesity increases the risk of endometrial cancer as the excess body fat alters the body's hormonal balance
  • Hormone Therapy for Breast Cancer: Women with breast cancer who undertake hormone therapy have an augmented risk of developing endometrial cancer
  • An Inherited Colon Cancer Syndrome: HNPCC (Genetic nonpolyposis colorectal cancer) is a condition that boosts the risk of colon cancer and other cancers, together with the endometrial cancer

Diagnosis

Tests and procedures used to diagnose endometrial cancer include:

  • Pelvic examination
  • Ultrasound study
  • Using hysteroscope to examine the endometrium
  • Biopsy
  • Performing surgery to remove tissue for testing

Stages of Endometrial Cancer

Once the cancer has been detected, the doctor works to ascertain the stage of the cancer. Tests to detect the same may include a chest X-ray, a CT scan, PET scan and blood investigations. The concluding determination of the cancer's stage may not be made until or after the surgery.

Stages of endometrial cancer include:

  • Stage I - Cancer found only in the uterus
  • Stage II - Cancer is present both in the uterus and cervix
  • Stage III - Cancer has stretched beyond the uterus, but hasn't got to the rectum and bladder though the pelvic area lymph nodes may be affected
  • Stage IV - Cancer has spread beyond the pelvic region and can have an effect on the bladder, rectum and other parts of your body

Treatment

Treatment for endometrial cancer will depend on factors such as the stage, general health and preferences. Based on these factors, one or any of the below mentioned treatment methods will be advised.

Radiation

Radiation therapy uses strong energy beams to kill the cancer cells. In some instances, the doctor may propose radiation to reduce risk of a cancer recurrence post surgery. In certain conditions, radiation therapy may also be suggested ahead of surgery, to shrink a tumor making it easier to remove.

If the patient is not healthy enough to undergo surgery, doctors may suggest only radiation therapy. In women with advanced endometrial cancer, radiation therapy may support to control cancer-related pain.

Radiation therapy can involve:

  • External Beam Radiation: During this procedure the patient lies on a table while a machine directs radiation to specific points on to the body
  • Brachytherapy: Internal radiation or brachytherapy involves placing a radiation-filled tool, such as small seeds, wires or a cylinder, inside the vagina for a short duration

Hormone Therapy

Hormone therapy involves taking medications that influence hormone levels in the body. Hormone therapy may be an option if advanced endometrial cancer has been detected and options include:

  • Medications to augment the levels of progesterone in the body
  • Medications to decrease the levels of estrogen in the body

Chemotherapy

Chemotherapy uses chemicals to eradicate the cancer cells. Chemotherapy may be suggested for women with advanced or recurring endometrial cancer that has advanced beyond the uterus.

Surgery

Surgical procedure to remove the uterus is recommended for most women with endometrial cancer. Most women with endometrial cancer undergo hysterectomy, where the fallopian tubes and ovaries are also removed. (salpingo-oophorectomy).

During surgery, the surgeon will also inspect the areas around the uterus to look for signs that cancer has spread. The surgeon may also remove lymph nodes for testing as it helps in determining the stage of cancer.

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