Endometrial Cancer

Endometrial cancer, sometimes called uterine cancer is cancer that originates from the inner lining of the uterus (endometrium).  The uterus or womb is a female reproductive organ in female.

There is a less common type of cancer of uterus called uterine sarcoma.

Endometrial cancer often leads to abnormal vaginal bleeding and hence can be detected at an early stage.

Early diagnosis and surgical removal of uterus often cures endometrial cancer.

Signs and symptoms of endometrial cancer include:

• Vaginal bleeding in postmenopausal women
• Bleeding between periods
• Vaginal Discharge often blood tinged
• Pelvic pain
• Painful intercourse

The exact cause of endometrial cancer is unknown. However, genetic mutation within cells in the endometrium is thought to turn healthy cells into abnormal cells.

A mutated gene drives a cell to divide more rapidly thereby ceasing normal cellular functions.

As a result, a large number of new cells carrying the mutated gene are produced. Unlike normal cells, cancer cells lack tumor suppressor genes that tell them when to stop growing.

Accumulation of abnormal cells forms a mass of tissues called tumor. Cancer cells invade nearby tissues and can spread elsewhere in the body (metastasis).

Making a diagnosis of endometrial cancer is done by performing several tests and procedures.

Talk to your primary care doctor or a gynecologist if you have any bothersome signs and symptoms.

Tests and procedures used to diagnose endometrial cancer include:

• Pelvic Examination: Pelvic examination involves inspection of the outer portion of the genitals (vulva).Then two fingers are inserted into the vagina with the other hand on the abdomen to feel uterus and ovaries. A vaginal speculum is inserted into the vagina to open it wide enough to view the vagina and cervix for abnormalities.
• Transvaginal ultrasound: This uses the sound waves to create the images of uterus with the thickness and texture of the endometrium. The transducer is used to create video image of the uterus to detect any abnormalities in the uterine lining.
• Hysteroscopy: A thin, flexible, lighted tube (hysteroscope) is inserted through your vagina and cervix into your uterus to examine the inside of your uterus and the endometrium.
• Endometrial biopsy: This is done to obtain the sample of cells from inside of the uterus. Endometrial biopsy usually doesn't require anesthesia.
• Dilation and curettage (D&C): This is a procedure performed when the tissues cannot be obtained by biopsy or when the biopsy results are not clear. It involves scraping the tissue from the lining of the uterus which is then examined under the microscope to rule out cancer cells.

If you are diagnosed with endometrial cancer, you may be referred to a gynecologic oncologist, a specialist in treating the cancers related to the female reproductive system.

Staging endometrial cancer

Once cancer is confirmed, you have to undergo further testing to determine the stage of the cancer. You doctor may recommend tests like a chest X-ray, a computerized tomography (CT) scan, positron emission tomography (PET) scan and blood tests to determine the stage of cancer.

Stages of endometrial cancer include:

• Stage I - cancer is limited only in the uterus.
• Stage II- cancer has spread uterus and cervix.
• Stage III- cancer has spread beyond the uterus often affecting pelvic area lymph nodes but rectum and bladder are still unaffected.
• Stage IV- cancer has spread past the pelvic region to affect bladder, rectum and more distant parts of the body.

The choice of treatment for endometrial cancer depends on factors such as stage of your cancer, general health and preferences.

• Surgery: Most women with endometrial cancer are recommended to get their uterus surgically removed through a process called hysterectomy. Fallopian tube and ovaries may also be removed by a procedure called salpingo-oophorectomy. It is impossible for a woman to have children after hysterectomy .A woman experiences menopause after the removal of the ovaries. During surgery, the areas around the uterus are inspected to look for signs of spread of cancer. The lymph nodes are also removed to determine the stage of cancer.
• Radiation therapy: Radiation therapy utilizes ionizing radiations such as X-rays to destroy cancer cells. Radiation therapy may also be recommended to prevent post-surgery cancer remission. Radiation therapy may be the only option for those who are not healthy enough to undergo surgery. Radiation therapy may help control cancer-related pain in women with advanced endometrial cancer. The radiation comes from an external source (external beam radiation), or it can be placed inside your body (brachytherapy)
• Hormone therapy: Hormone therapy acts as alternative therapy for advanced endometrial cancer that has spread beyond the uterus. Hormones are administered externally to alter the hormone levels in the body.

Medications to increase the amount of progesterone

Progesterone derivative, progestins, may help stop the growth of endometrial cancer cells.

Medications to reduce the amount of estrogen in your body

Some medications can reduce estrogen level or block their receptors. Estrogen dependent cancer may respond to these medications.

• Chemotherapy: It involves administering chemotherapeutic agent by oral or intravenous route. Chemotherapy is recommended in women with advanced or recurrent endometrial cancer.

Since Endometrial Cancer occurs in the uterus, it is best to speak with your OB/GYN to discuss preventative measures.

• Consult your doctor about the risks of hormone therapy after menopause. Replacing estrogen alone after menopause may increase the risk of endometrial cancer unless a woman has undergone hysterectomy. Such risk may be reduced by taking a combination of estrogen and progestin. Hormone therapy might increase risk for other cancers such as that of breast cancer.
• Intake of oral contraceptive for at least a year may reduce your endometrial cancer risk. The risk reduction is thought to last for several years even after discontinuing the pill.
• Obesity increases the risk of endometrial cancer. Keep your weight in check with exercise and low calorie intake. Exercise may reduce the risk of endometrial cancer.

Lifestyle modifications are necessary in order to cope with endometrial cancer.

Cancer diagnosis can be a devastating and life changing news for patients and their families.

We bring you some ideas to help you cope:

• Stay updated on endometrial cancer through internet or good and reliable sources of information such as National Cancer Institute and the American Cancer Society to make decisions about the care and treatment choices.
• Knowing about the stage, treatment options available and their side effects helps to better cope with the trauma and anxiety associated with cancer.
• Stay close to friends and family to get enough emotional support.
• Join a support group for cancer and connect with other cancer survivors.
• Continue with your life and usual activities, as far as possible.

There are several risks and complications associated with endometrial cancer.

Risks

• Hormonal imbalance- Estrogen and progesterone cause changes in the endometrium. Increases in the level of estrogen, but not that of progesterone in conditions like obesity and diabetes can increase the risk of endometrial cancer. Estrogen only hormone therapy in post-menopausal women increases the risk of endometrial cancer. An ovarian tumor of estrogen secreting cells also can increase the risk of endometrial cancer.
• More years of menstruation: Menstruation at early age (before age 12) or late menopause increases the risk of endometrial cancer.
• Women who have never been pregnant have a higher risk of endometrial cancer than do women who have had at least one pregnancy.
• The risk of endometrial cancer increases with age. Majority of endometrial cancer occurs in post-menopausal women.
• Obesity is another risk factor for endometrial cancer because excess body fat affects hormonal balance in the body.
• Hormone therapies for breast cancer such as taking drug tamoxifen have an increased risk of developing endometrial cancer.
• An inherited colon cancer syndrome, Hereditary Nonpolyposis Colorectal Cancer (HNPCC) increases the risk of colon cancer and endometrial cancer too.

Complications

Endometrial cancer can spread to other parts of the body, which makes the treatment more difficult. Endometrial cancer that spreads (metastasizes) most often travels to the lungs.