Endometrial cancer is a form of cancer that occurs in the lining of the uterus, which is known as endometrium. Endometrial cancer arises from abnormal growth of cells along the lining, and is commonly also referred to as uterine cancer.
Although the exact cause for endometrial cancer is unknown, it is understood that some factor results in healthy cells in the endometrium turning into abnormal cells, and growing and multiplying out of control. The abnormal cells do not die as they should like other healthy, normal cells do. This accrual results in a mass or tumor being formed.
While the cause for endometrial cancer is not known, certain conditions or factorshave been identified that may increase the likelihood of developing such cancer. A primary risk factor for endometrial cancer is high level of the hormone estrogen. Estrogen is one of the two main female hormones made in the ovaries. An increase in estrogen levels, without being kept in balance with the other hormone progesterone, increases risks of endometrial cancer. This may result from a conditionthat causes irregular ovulation like polycystic ovarian syndrome. Women who start menstruating early and begin menopause later have a high exposure to estrogen which could be a risk factor.
Using the drug tamoxifenas part of hormone therapy to reduce the risk of or to treat breast cancer may also slightly increasethe risk of developing endometrial cancer.However, in most cases, the benefits of the drug outweigh the small risk associated with endometrial cancer.
Certain other risk factors that have been identified include increasing age, never having been pregnant, obesity,and genetic factors (for instance, hereditary non-polyposis colorectal cancer or Lynch syndrome).
Abnormal vaginal bleeding is a common symptom of endometrial cancer. In post-menopausal women, any bleeding is considered abnormal. For women who are yet to reach menopause, abnormal cycles, heavy bleeding and frequent instances of bleeding may be signs of endometrial cancer.
Less common symptoms include vaginal discharge in post-menopausal women, pelvic pain, swelling or a mass in the pelvic region, and weight loss. The last three are usually found in advanced stages of cancer.
Abnormal bleeding, which is the most common symptom of endometrial cancer, may be caused by several other conditions. The diagnosis of endometrial cancer would involve a thorough medical history, including details regarding menstrual cycles, pregnancies, and lifestyle. This would typically be followed by a physical examination including a pelvic examination.
A trans-vaginal ultrasound, which is a technique that uses sound waves to get an image of the uterus, may be performed. This would help determine the thickness of the endometrium. A thick wall is indicative of cancer in post-menopausal women. In case a tumor is detected through an ultrasound, further imaging tests,suchas a CT scan or an MRI of the pelvic area, may be carried out.
A procedure called hysteroscopy may be performed which involves inserting a thin, light tube through the vagina to view the endometrium and the inside of the uterus.
A biopsy is required to confirm the diagnosis of endometrial cancer. Tissue from the uterine wall is removed and sent for laboratory testing. Another test known as D&C or dilation and curettage could also be performed to get a sample of the tissue.
If confirmed, the next step is to determine the stage of the cancer. In early stages, the cancer is confined to the uterus. In very advanced stages, the cancer metastasizes or spreads beyond the pelvic area and mayaffect other parts of the body.
The stage of cancer would determine the treatment options available to the patient. Endometrial cancer is primarily treated through surgery. The most common surgery involves removal of the uterus, cervix, ovaries and fallopian tubes (known as a total hysterectomywith bilateral salpingo-oophorectomy). Surgery may also involve removal of the lymph nodes in the pelvic region if it is believed that the cancer may have spread to other parts. Examining the lymph nodes near the uterus would help in determining whether the cancer has spread beyond the uterus.
In cases where such surgery cannot be performed, other forms of treatment may be recommended. In some cases, in addition to the surgery, additional treatment may be required to contain the cancer (depending on its stage).
Such alternative/ additional treatments include:
Radiation: High energy beams are used to attack the cancer cells in the body. This may be recommended for eliminating remaining cancer cells or in some cases, as a substitute to surgery for women unable to undergo surgery. Radiation may be given from an external source or from a source placed inside the body.
Progestin hormone therapy: This therapy seeks to block the growth of cancer cells and to lower estrogen levels in the body.
Chemotherapy: Chemotherapy may be used in advanced cases where the cancer has spread beyond the uterus. The drugs may be administered orally or intravenously.