Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ where fetal development occurs.
Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is sometimes called uterine cancer. Other types of cancer can form in the uterus, including uterine sarcoma, but they are much less common than endometrial cancer.
Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer.
Factors that increase the risk of endometrial cancer include:
- Changes in the balance of female hormones in the body.
- More years of menstruation
- Never having been pregnant
- Older age
- Hormone therapy for breast cancer
- An inherited colon cancer syndrome
In India, the rates are as low as 4.3 per 100,000. Ninety-seven percent of all cancers of the uterus arise from the glands of the endometrium and are known as endometrial carcinomas. Its annual incidence is estimated at 10–20 per 100,000 women and it is increasing
Signs and symptoms of endometrial cancer may include:
- Vaginal bleeding after menopause
- Bleeding between periods
- Pelvic pain
Tests and procedures used to diagnose endometrial cancer include:
- Examining the pelvis
- Using sound waves to create a picture of your uterus
- Using a scope to examine your endometrium
- Removing a sample of tissue for testing
- Performing surgery to remove tissue for testing
If endometrial cancer is found, you'll likely be referred to a doctor who specializes in treating cancers involving the female reproductive system (gynec oncologist).
Staging endometrial cancer
Once your cancer has been diagnosed, your doctor works to determine the extent (stage) of your cancer. Tests used to determine your cancer's stage may include a chest X-ray, a computerized tomography (CT) scan, positron emission tomography (PET) scan and blood tests. The final determination of your cancer's stage may not be made until after you undergo surgery to treat your cancer.
Treatment for endometrial cancer is usually with surgery to remove the uterus, fallopian tubes and ovaries. Another option is radiation therapy with powerful energy. Drug treatments for endometrial cancer include chemotherapy with powerful drugs and hormone therapy to block hormones that cancer cells rely on. Other options might be targeted therapy with drugs that attack specific weaknesses in the cancer cells and immunotherapy to help your immune system fight cancer.
Treatment for endometrial cancer usually involves an operation to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to become pregnant in the future. Also, once your ovaries are removed, you'll experience menopause, if you haven't already.
During surgery, your surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer's stage.
Radiation therapy uses powerful energy beams, such as X-rays to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.
If you aren't healthy enough to undergo surgery, you may opt for radiation therapy only.
Radiation therapy can involve:
• Radiation from a machine outside your body. During external beam radiation, you lie on a table while a machine directs radiation to specific points on your body.
• Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.
Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells.
Chemotherapy is sometimes recommended after surgery if there's an increased risk that the cancer might return. It can also be used before surgery to shrink the cancer so that it's more likely to be removed completely during surgery.
Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread beyond the uterus.
Hormone therapy involves taking medications to lower the hormone levels in the body. In response, cancer cells that rely on hormones to help them grow might die. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.
Targeted drug therapy
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced endometrial cancer.
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments haven't helped.
Overall the prognosis of Endometrial Cancer is good. Those women who are diagnosed early have a far better prognosis. Most recurrences will occur within the first three years after treatment. The majority of women will be diagnosed with early-stage disease and are cured with surgery.The overall 20-year survival rate for all forms of endometrial cancer is about 80%. This in comparison to 62% for clear cell and 53% for papillary carcinomas. Prognosis depends on the type and stage of tumour. Five-year overall survival ranges from 74% to 91% in patients without metastatic disease.
Tests are used to screen for different types of cancer when a person does not have symptoms. Endometrial cancer is usually found early. Endometrial cancer is diagnosed most often in postmenopausal women at an average age of 60 years. There is no standard or routine screening test for endometrial cancer.
Tests that may detect (find) endometrial cancer are being studied:
- Pap test
- Transvaginal ultrasound
- Endometrial sampling