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Endometrial cancer is cancer that starts in the lining of the uterus (called endometrium). Endometrial cancer is the growth of abnormal cells in the lining of the uterus. Endometrial cancer is also called cancer of the uterus, or uterine cancer.
Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.
ENDOMETRIAL CANCER causes and risk factors
Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to play a dramatic role. The main cause of most endometrial cancer is too much of the hormone estrogen compared to the hormone progesterone in the body.
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In general estrogens are responsible for the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen - progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what we know as menstrual bleeding.
When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow. Over time, the endometrium cells can become cancerous.
Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.
The biggest risk factor for endometrial cancer is having too much estrogen and not enough progesterone. Women who have mentioned hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:
- Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
- Takes estrogen without taking a progestin - Estrogen only hormone replacement therapy (HRT).
- Has polycystic ovary syndrome (PCOS) and chronic anovulation, which causes hormone imbalance.
- Starts her period before age 12 or starts menopause after age 55.
- Has never been pregnant or had a full-term pregnancy.
- Has never breast-fed.
The following factors can increase the risk of endometrial cancer:
- Diabetes,
- Estrogen replacement therapy without the use of progesterone,
- History of endometrial polyps or other benign growths of the uterine lining,
- Infertility (inability to become pregnant),
- Infrequent irregular periods,
- High blood pressure (hypertension),
- Tamoxifen, a drug for breast cancer treatment,
- Colon or breast cancer,
- Gallbladder disease,
- Pprevious radiation therapy to the pelvis.
ENDOMETRIAL CANCER symptoms
In most cases the early stages of endometrial cancer can cause symptoms. The most common symptom of endometrial cancer is unexpected (abnormal) bleeding from the vagina after menopause. When a post-menopausal woman has vaginal bleeding, the first thing that needs to be looked into is the possibility of endometrial cancer. However, some of the other symptoms are occasionally non-specific, and don't always point toward a diagnosis of endometrial cancer. As a tumor grows in size, it can produce a variety of problems including:
- vaginal bleeding (in a post-menopausal woman)
- abnormal bleeding after age 40 (including bleeding in between periods, or heavier/longer lasting menstrual bleeding)
- abnormal vaginal discharge (thin white or clear or may be foul smelling),
- vaginal spotting after menopause,
- losing weight without trying.
- pelvic or back pain
- pain on urination
- pain on sexual intercourse
- blood in the stool or urine
All of these symptoms are non-specific, and could represent a variety of different conditions; however, your doctor needs to see you if you develop any of these problems.
ENDOMETRIAL CANCER diagnosis
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or feel of the uterus or surrounding structures may be seen when the disease is more advanced.
Tests that may be done include:
 Endometrial aspiration or biopsy
Dilation and curettage (D&C)
Pap smear (may raise a suspicion for endometrial cancer, but does not diagnose it)
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:
| 1 |
The cancer is only in the uterus. |
| 2 |
The cancer is in the uterus and cervix. |
| 3 |
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). |
| 4 |
The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs. |
ENDOMETRIAL CANCER treatment
Endometrial cancer treatment options involve surgery, radiation therapy, and chemotherapy.
The main treatment for endometrial cancer at its early stages is surgery - to remove the uterus plus the cervix, ovaries, and fallopian tubes. The doctor will also remove pelvic and aortic lymph nodes to see if the cancer has spread.
A woman whose cancer has spread may also have:
- Chemotherapy to kill cancer cells.
- Hormone therapy (progestin hormone) to block cancer growth.
- Radiation therapy to kill cancer cells.
Surgery combined with radiation therapy is often used to treat women with stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3. It is also used to treat women with stage 2 disease.
Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.
ENDOMETRIAL CANCER prognosis
Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 92%.
The 5-year survival rate for endometrial cancer that has not spread is 95%. If the cancer has spread to distant organs, the 5-year survival rate drops to 23%.
Endometrial cancer complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D&C or endometrial biopsy.
There can also be complications from hysterectomy, radiation, and chemotherapy.
ENDOMETRIAL CANCER - 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 (see above) or if you have not had routine pelvic exams.
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 more
- Bleeding or spotting after 6 months or more of no bleeding at all
ENDOMETRIAL CANCER prevention
All women should have regular pelvic exams beginning at the onset of sexual activity (or at the age of 21 if not sexually active) to help detect signs of infection of abnormal development.
Women should have Pap tests beginning 3 years after becoming sexually active.
Women with any risk factors for endometrial cancer should be followed more closely by their doctors. Frequent pelvic examinations and screening tests such as a Pap smear and endometrial biopsy should be considered.
Women who are taking estrogen replacement therapy should have regular pelvic examinations and Pap smears.
ENDOMETRIAL CANCER risk reduction
There are some measures that can lower your risk for developing endometrial cancer.
- Taking birth control pills that contain both estrogen and progestin for longer than 1 year. Similarly, taking estrogen with progestin for menopausal symptoms lowers your endometrial cancer risk. (You have no risk for endometrial cancer if you have had your uterus removed, or hysterectomy.)
- Staying at a healthy body weight.
- Being physically active.
- Eating a diet rich in fruits, vegetables, and fiber.
- Lowering the amount of animal fats you eat.
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