Endometrial Cancer – Symptoms, Causes, Stages & Treatment

Endometrial cancer

Endometrial cancer is a type of cancer that begins in the uterus. The uterus is the hollow, pear-shaped pelvic organ in women 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, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer.

Symptoms and causes

Symptoms

Signs and symptoms of endometrial cancer may include:

• Vaginal bleeding after menopause
• Bleeding between periods
• An abnormal, watery or blood-tinged discharge from your vagina
• Pelvic pain

When to see a doctor

Make an appointment with the gynaecologist if you experience any signs or symptoms that worry you, such as vaginal bleeding or discharge not related to your periods, pelvic pain, or pain during intercourse.

Causes

Doctors don’t know exactly what causes endometrial cancer. What’s known is that something occurs to create a genetic mutation within cells in the endometrium — the lining of the uterus.

The genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don’t die at a set time. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

Risk factors

Female reproductive system

Factors that increase the risk of endometrial cancer include:

• Changes in the balance of female hormones in the body. Your ovaries make two main female hormones — estrogen and progesterone. Fluctuations in the balance of these hormones cause changes in your endometrium.
• A disease or condition that increases the amount of estrogen, but not the level of progesterone, in your body can increase your risk of endometrial cancer. Examples include irregular ovulation patterns, such as those that can occur in women with polycystic ovary syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen but not progesterone increases the risk of endometrial cancer.
• A rare type of ovarian tumor that secretes estrogen also can increase the risk of endometrial cancer.
• More years of menstruation. Starting menstruation at an early age — before age 12 — or beginning menopause later increases the risk of endometrial cancer. The more periods you’ve had, the more exposure your endometrium has had to estrogen.
• Never having been pregnant. Women who have never been pregnant have a higher risk of endometrial cancer than do women who have had at least one pregnancy.
• Older age. As you get older, your risk of endometrial cancer increases. Endometrial cancer occurs most often in women who have undergone menopause.
• Obesity. Being obese increases your risk of endometrial cancer. This may occur because excess body fat alters your body’s balance of hormones.
• Hormone therapy for breast cancer. Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing endometrial cancer. If you’re taking tamoxifen, discuss this risk with your doctor. For most women, the benefits of tamoxifen outweigh the small risk of endometrial cancer.
• An inherited colon cancer syndrome. Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of colon cancer and other cancers, including endometrial cancer. HNPCC occurs because of a gene mutation passed from parents to children. If a family member has been diagnosed with HNPCC, discuss your risk of the genetic syndrome with your doctor. If you’ve been diagnosed with HNPCC, ask your doctor what cancer screening tests you should undergo

Diagnosing endometrial cancer

Tests and procedures used to diagnose endometrial cancer include:

• Pelvic examination. During a pelvic exam, your doctor carefully inspects the outer portion of your genitals (vulva), and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can view your vagina and cervix for abnormalities.
• Using sound waves to create a picture of your uterus. Your doctor may recommend a transvaginal ultrasound to look at the thickness and texture of the endometrium and help rule out other conditions. In this procedure, a wandlike device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining.
• Using a scope to examine your endometrium.During a hysteroscopy, your doctor inserts a thin, flexible, lighted tube (hysteroscope) through your vagina and cervix into your uterus. A lens on the hysteroscope allows your doctor to examine the inside of your uterus and the endometrium.
• Removing a sample of tissue for testing. To get a sample of cells from inside your uterus, you’ll likely undergo an endometrial biopsy. This involves removing tissue from your uterine lining for laboratory analysis. Endometrial biopsy may be done in your doctor’s office and usually doesn’t require anesthesia.
• Performing surgery to remove tissue for testing. If enough tissue can’t be obtained during a biopsy or if the biopsy results are unclear, you’ll likely need to undergo a procedure called dilation and curettage (D&C). During D&C, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells.

If endometrial cancer is found, you’ll likely be referred to a doctor who specializes in treating cancers involving the female reproductive system (gynecologic oncologist).

Also further testing on the endometrial biopsy is advised. Molecular testing for p53, MMR, POLE, ER/PR helps to classify the tumour for better prognostication and management

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.

• Stage I cancer is found only in your uterus.
• Stage II cancer is present in both the uterus and cervix.
• Stage III cancer has spread beyond the uterus, but hasn’t reached the rectum and bladder. The pelvic area lymph nodes may be involved.
• Stage IV cancer has spread past the pelvic region and can affect the bladder, rectum and more-distant parts of your body.

Treatment

Your options for treating your endometrial cancer will depend on the characteristics of your cancer, such as the stage, your general health and your preferences.

Surgery

Surgery to remove the uterus is recommended for most women with endometrial cancer. Most women with endometrial cancer undergo a procedure 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 have children 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

Radiation therapy uses powerful energy beams, such as X-rays and protons, 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. In women with advanced endometrial cancer, radiation therapy may help control cancer-related pain.

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.

Hormone therapy

Hormone therapy involves taking medications that affect hormone levels in the body. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.

• Medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop endometrial cancer cells from growing.
• Medications to reduce the amount of estrogen in your body. Hormone therapy drugs can help lower the levels of estrogen in your body or make it difficult for your body to use the available estrogen. Endometrial cancer cells that rely on estrogen to help them grow may die in response to these medications.

Chemotherapy

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). Chemotherapy may be recommended for women with advanced or recurrent endometrial cancer that has spread beyond the uterus. These drugs enter your bloodstream and then travel through your body, killing cancer cells.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Self-management

Coping and support

After you receive a diagnosis of endometrial cancer, you may have many questions, fears and concerns. Every person finds his or her own way to cope with an endometrial cancer diagnosis. In time, you’ll find what works for you. Until then, you might try to:

• Find out enough about endometrial cancer to make decisions about your care. Find out enough about your cancer so that you feel comfortable about making treatment choices. Ask your doctor about the stage, your treatment options and their side effects. In addition to talking with your doctor, look for information on the internet.
• Maintain a strong support system. Strong relationships may help you cope with treatment. Talk with close friends and family members about how you’re feeling. Connect with other cancer survivors in your community or online
• Stay involved in your usual activities when you can. When you’re feeling up to it, try to stay involved in your usual activities.

Prevention

To reduce your risk of endometrial cancer, you may wish to:

• Talk to your doctor about the risks of hormone therapy after menopause. If you’re considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you’ve undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, such as a possible increase in the risk of breast cancer, so weigh the benefits and risks with your doctor.
• Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor.
• Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day.
• Exercise most days of the week. Exercise may reduce your risk of endometrial cancer. Add physical activity into your daily routine. Try to exercise 30 minutes most days of the week. If you can exercise more, that’s even better.