Endometrial cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 23, 2016
StartDiseasesEndometrial cancer

Endometrial cancer is cancer of the endometrium which is the inner lining of the uterus. It is the most common kind of uterine cancer and primarily afflicts postmenopausal women. In 2012, more than 76,000 deaths resulted from endometrial cancer.

Contents

Definition & Facts

A woman's uterus is located in the pelvic region and is about the size of a small pear. The endometrium is the tissue that lines the inside of the uterus, and is a spongy material that is sloughed off every month during menstrual cycle when fertilization does not take place.

It is believed that an imbalance between the hormones estrogen and progesterone can cause the endometrium to build up and not be sloughed off normally. This may enable cancer cells to grow in the lining. If not detected, the cells may attack other tissues.

Symptoms & Complaints

Several symptoms are associated with this disease. Any vaginal bleeding between menstrual periods is cause for concern. Any bleeding after menopause should not be ignored. Many women suffer from excessive pain or menstrual cramps and experience a heavy flow with large clots.

Pelvic pain may be present in between periods. The pain may extend the full length of the abdomen and may be present in the lower back. A watery, smelly bloody vaginal discharge is a common complaint. Many women experience extremely painful intercourse that prevents them from enjoying normal sexual relationships.

Causes

The exact causes of endometrial cancer remain a mystery, but there are some well-known risk factors that could contribute to its onset. Obesity can play a major role in the development of this disease. Excess fat increases the risk of cancer because body fat contains an enzyme known to increase the level of the hormone estrogen in the body. It is believed that the risk for endometrial cancer increases when higher estrogen levels are present.

Some medical conditions such as polycystic ovary syndrome (PCOS) tend to increase estrogen levels and increase the risk for cancers. Experiencing puberty early in life adds to the risk. Beginning periods before 12 years of age is believed to be a significant factor. The early onset of periods makes estrogen available to the endometrium for a longer period.

Never being pregnant increases the risk as does going through a late life menopause. Even though family history is not a cause of this cancer, it does present more of a risk. If a mother, aunt, or sister had the disease, the chances of developing it increase. Having had cancer in another part of the body such as having had breast cancer or ovarian cancer increases the risk.

Diagnosis & Tests

It is important for women who suffer symptoms of endometrial cancer to visit their doctor immediately. Ignoring pain or unusual bleeding may lead to more problems. The doctor reviews the patient’s medical and family history and then performs an examination that includes a pelvic exam. Based on the results of the exam, the doctor will probably refer the patient to a specialist who is more qualified to make a cancer diagnosis.

An endometrial biopsy is performed in order for the doctor to remove endometrial tissue for examination under a microscope. Other tests such as dilation and curettage (D&C) may be performed if the biopsy is inconclusive. An X-ray procedure known as a CT scan gives the doctor better images to aid in diagnosis. Another common test is the MRI that uses radio waves instead of X-rays to determine if other parts of the body might be involved. Blood tests that detect the difference between red blood cells and white blood cells as well as a specific test for checking the levels of CA-125, a cancer antigen which could indicate the presence of cancer, may be used along with a regular blood test.

Treatment & Therapy

When a cancer diagnosis is confirmed, the usual first step is surgery to remove the uterus, ovaries and Fallopian tubes. This surgery is known as a total hysterectomy. Lymph nodes and surrounding pelvic tissue is examined to determine if the cancer has spread.

Further treatment for endometrial cancer is determined by stages of the disease. Whereas stage I cancer may not need more treatment if it has not spread to other parts of the body, stage II usually requires radiation therapy. Stage III indicates that the cancer is no longer contained in the uterus but has spread. Radiation therapy is recommended. Treatment for stage IV may require extensive radiation therapy, possible hormone therapy, and some form of chemotherapy. The oncologist will decide on the proper course of treatment.

Prevention & Prophylaxis

Eliminating known risk factors is a good start for preventing all cancers. Maintaining a healthy weight is one positive step. Eating a diet rich in vegetables, fruits, whole grains and meats helps to lower the risk of consuming too many calories that can lead to weight gain. Regular exercise plays a major role in reducing the risk of development endometrial cancer. Smoking contributes to cancer development and should be avoided.

Getting regular check-ups, follow-up screenings, and reporting any unusual symptoms are prevention techniques that should not be ignored. Because genetics can play a role in the development of endometrial cancer, those with a family history should be especially vigilant in scheduling regular exams.