What is Endometrial Cancer? Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus. Uterine sarcomas can begin in the uterine wall (leiomyosarcoma), the supportive tissue of the endometrium (endometrial stromal sarcoma), or in the endometrium itself (uterine malignant mixed mesodermal tumor)
What Causes Endometrial Cancer? Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen without accompanying progesterone appear to have a role. Estrogen helps stimulate the buildup of the epithelial lining of the uterus. Studies have shown that high levels of estrogen in animals results in endometrial hyperplasia and cancer. Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40. The younger cases have been associated with obesity and familial cancer syndromes. The following increase your risk of endometrial cancer:
- Obesity (with increasing obesity there is an increasing risk)
- History of endometrial polyps or other benign growths of the uterine lining
- Estrogen without a progesterone
- Tamoxifen, a drug for breast cancer treatment
- Diabetes mellitus
- Polycystic ovarian disease
- Never being pregnant (nulliparity)
- Starting menstruation at an early age (before age 12)
- Infertility (inability to become pregnant)
- Starting menopause after age 50
- Abnormal uterine bleeding, abnormal menstrual periods
- Bleeding between normal periods before menopause
- Vaginal bleeding or spotting after menopause (or brown discharge)
- Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
- Lower abdominal pain or pelvic cramping
- Thin white or clear vaginal discharge after menopause
Endometrial Cancer Exams and Tests Available: A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or consistency of the uterus or its surrounding, supporting structures may be seen when the disease is more advanced.
Tests used to diagnose endometrial cancer include:
- Endometrial aspiration or biopsy
- Dilation and curettage (D and C)
If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging. Stages of endometrial cancer:
- The cancer is only in the uterus.
- The cancer is in the uterus and cervix.
- The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
- The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.
Endometrial Cancer Treatment Options: The primary treatment option for these cancers involves surgery. Extra treatment with radiation therapy and/or chemotherapy is occasionally indicated for patients with endometrial cancer or uterine sarcoma.
A hysterectomy (removal of uterus and cervix) with removal of the tubes and ovaries and removal of pelvic and para-aortic lymph modes will most commonly be performed in women with endometrial cancer. Abdominal hysterectomy is recommended over vaginal hysterectomy unless the patient has many other medical problems. An abdominal hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for pathology. Depending on patient factors, and surgeon preference, the surgical treatment may be done through an open procedure (laparotomy) or minimally invasive (laparoscopic) approach. In the past, surgery combined with radiation therapy was often used to treat women with stage I disease that could return and stage II disease. Currently, if a complete surgical procedure is performed, radiation does not increase patient survival for a patient with stage I disease. Also, if a more extensive surgical procedure (radical hysterectomy) is performed, radiation is not necessary for stage II disease. Radiation is currently used when lymph nodes were not adequately removed in high risk stage I disease. Chemotherapy may be considered in some cases, especially for those with stage III and IV disease. Endometrial Cancer Prognosis: Endometrial cancer is usually diagnosed at an early stage. The 10-year survival rate is over 90% for patients with early stage disease that is properly treated. The 5-year survival rate for endometrial cancer that has not spread is 96%. If the cancer has spread to distant organs, the 5-year survival rate drops to 50%.
Possible complications with endometrial cancer: Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy. Patients may develop swelling in both legs after therapy (lymphedema) especially if radiation is used after a thorough lymph node dissection. Other risks will be discussed by the gynecologic oncologist prior to your surgery.
When to contact a medical professional: Call for an appointment with your health care provider if you have abnormal vaginal bleeding or any other symptoms of endometrial cancer. This is particularly important if you have any associated risk factors or if you have not had routine pelvic exams. If you have been diagnosed with endometrial cancer asked to be referred to a gynecologic oncologist for treatment and evaluation. Any of the following symptoms should be reported immediately to the doctor:
- Bleeding or spotting after intercourse or douching
- Bleeding lasting longer than 7 days
- Periods that occur every 21 days or less
- Bleeding or spotting after 6 months or more of no bleeding at all
- Bleeding or spotting after the menopause
Endometrial Cancer Prevention: All women should have regular pelvic exams and Pap smears beginning at the onset of sexual activity (or at the age of 20 if not sexually active) to help detect signs of any abnormal development. Women with any risk factors for endometrial cancer should be followed more closely by their doctors. This includes women with family history of endometrial cancer or colon cancer.
Endometrial Cancer Support: