Uterine Cancer - Endometrial Cancer

Introduction

Endometrial cancer is the most common type of uterine cancer.  It is the most common cancer of the female reproductive system.  The primary symptom of endometrial cancer is abnormal vaginal bleeding.  Treatment usually involves surgery followed by radiation, chemotherapy, hormone therapy, or a combination of treatments.  Because the majority of endometrial cancers are detected and treated early, it is associated with better outcomes than other forms of gynecological cancers. 

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina.  The ovaries are two small organs that produce eggs (ova) and hormones.  An ovary typically releases one mature egg each month.  Two fallopian tubes extend from near the ovaries to the uterus.  The fallopian tubes transport the mature eggs to the uterus (womb).

The uterus is a pear-shaped organ.  The inner lining of the uterus is called the endometrium.  The outer layer of the uterus, the myometrium, is composed of muscle tissue.  Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg.  An egg that is fertilized by a sperm cell may implant itself in the nourishing lining and develop into a baby.  An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system.  During menstruation the uterine lining sheds and the blood leaves the body through the vagina.

The vagina is a muscular passageway that extends from the cervix to the external female genitalia.  The cervix is located at the bottom of the uterus.  The cervix joins the uterus to the vagina and opens during childbirth.

Causes

Cancer can develop in the inner or outer lining of the uterus.  Cancer of the endometrium lining is the most common type of uterine cancer.  The exact cause of endometrial cancer is unknown.  Cancer occurs when the cells in the endometrium grow abnormally and out of control, instead of dividing in an orderly manner.  The abnormal cancer cells form a tissue mass or a growth called a tumor.  Increased levels of estrogen hormone appear to contribute to endometrial cancer development.

Symptoms

Abnormal vaginal bleeding is the most common symptom of endometrial cancer.  Unusual vaginal bleeding or spotting may occur between your periods or after you have completed menopause.  Extremely long, heavy, or frequent bleeding episodes can be indications of precancerous changes in women over the age of 40.  Postmenopausal women may experience a thin white or clear vaginal discharge.

You may experience lower abdominal or pelvic pain.  You may feel a lump or a mass in your lower abdomen.  It may be difficult or painful to urinate.  You may experience pain during sexual intercourse.  You may also lose weight.

Diagnosis

The symptoms of endometrial cancer may be similar to the symptoms of other less serious conditions.  It is important to have general symptoms and signs of uterine endometrial cancer evaluated by a doctor.  Cancer that is detected early improves the likelihood of successful treatment.

Your doctor will review your medical history and family history of cancer.  Your doctor will examine your abdomen for any abnormal masses or lumps.  Your doctor will perform a pelvic examination and a Pap smear test.  A transvaginal ultrasound may be used to produce images of the uterus and reproductive organs.  A uterine tissue sample may be taken for biopsy, an examination for cancer or abnormal cells.  In some cases, a dilation and curettage (D&C) surgery is necessary to remove the uterine lining to check for cancer or abnormal cells.

If you have endometrial cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the cancer and how it has metastasized.  Cancer that has spread from its original site is termed metastasized cancer.  Staging is helpful for treatment planning and recovery prediction.

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.  Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer.  The stages may be subdivided into grades or classifications that use letters and numbers.

Treatment

Your doctor may refer you to a gynecologist oncologist who specializes in reproductive cancer treatments.  Treatment for endometrial cancer depends on many factors, including the stage of the cancer, tumor size, and the aggressiveness of the cancer cell type.  You may opt to receive a second opinion about the best kind of cancer treatment for you.  Treatment for endometrial cancer usually includes surgery and radiation, chemotherapy, hormone therapy, or a combination of treatments.

Most women with uterine cancer receive a hysterectomy.  This procedure removes the uterus.  The fallopian tubes and both ovaries are also usually removed in a salpingo-oophorectomy procedure.  In some cases, nearby lymph nodes are removed.  Following a hysterectomy, a woman will not be able to be pregnant.  Removal of both ovaries causes menopause to take place, regardless of a woman’s age.

Radiation, chemotherapy, hormone therapy, or a combination of treatments frequently follows surgery.  Chemotherapy uses cancer-fighting drugs to destroy cancer cells.  Radiation uses high-energy rays to kill cancer cells.  Hormone therapy is used to prevent cancer cells from using the hormones that they need to grow.

The experience of endometrial cancer, cancer treatments, and infertility can be an emotional process for people with cancer and their loved ones.  It is important that you receive support from a positive source.  Some people find comfort in their family, friends, counselors, co-workers, and faith.  Cancer support groups are another good option.  They can be a good source of information and support from people who understand what you are experiencing.  Ask your doctor for cancer support group locations in your area.

Prevention

You should contact your doctor if you experience symptoms.  Early diagnosis and treatment of endometrial cancer is associated with the best outcomes.  Annual pelvic examinations and Pap smear tests are recommended for women over the age of 20 or younger females that are sexually active. 

You may prevent uterine cancer by reducing the risk factors that you can control. It is helpful to lose excess weight and maintain a healthy weight. Talk to your doctor about your risk for uterine cancer before taking estrogen supplements.

Am I at Risk

Risk factors may increase your likelihood of developing endometrial cancer.  Women with all of the risk factors may never develop the disease; however, the chance of developing endometrial cancer increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for endometrial cancer:

_____ Endometrial cancer occurs more frequently in women who are over the age of 50; but it can certainly occur in younger women.
_____ The risk is higher for women with endometrial hyperplasia, an abnormally high number of cells in the uterine lining. In some cases, endometrial hyperplasia can turn into cancer.
_____ Hormone replacement therapy (HRT) is associated with an increased risk of uterine cancer development. The risk is higher for women who receive estrogen alone versus a combination of estrogen and progesterone.
_____ Greater cumulative estrogen exposure is associated with an increased risk for uterine cancer. Women who have never given birth, never were pregnant, began menstruation at an early age, or began menopause later in life are exposed to estrogen longer and have a higher risk of developing uterine cancer.
_____ Obesity is associated with an increased risk of uterine cancer. Estrogen is stored in the fatty tissues in the body. Women with high body fat percentages are more likely to have high estrogen levels.
_____ High blood pressure and diabetes is linked to an increased risk for uterine cancer.
_____ Polycystic ovarian disease is associated with an increased risk for uterine cancer. Polycystic ovarian disease causes an increase in estrogen.
_____ A history of benign (noncancerous) endometrial polyps or growths contributes to an increased risk for uterine cancer.
_____ Tamoxifen, a medication used to treat breast cancer, may increase the risk of endometrial cancer.
_____ Caucasian women have the highest incidence of uterine cancer.
_____ Women who have had colon, breast, or ovarian cancer have a higher risk of developing uterine cancer.
_____ A family history of uterine cancer increases a woman’s risk for uterine cancer.

Complications

Endometrial cancer can have several complications.  Surgical treatment that removes both ovaries or the uterus ends the chance of pregnancy, which may be a concern for women desiring to give birth to their children.  Removing both ovaries induces early menopause.

Tumor cells tend to spread to the ovaries in early stages of the disease.  Advanced endometrial cancer can spread to the nearby pelvic organs, lymph nodes, bladder, liver, rectum, bones, lungs, and kidneys.  Advanced endometrial cancer can cause death.

Advancements

Researchers continue to study methods to detect, treat, and prevent endometrial cancer.  Researchers are studying less invasive surgery methods and hope to find new treatments with fewer side effects to improve the quality of life.