Endometrial cancer (patient information)

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 * Assistant Editor(s)-In-Chief: Katherine Ogando

Overview
Endometrial cancer is a cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a baby grows). It is the most common invasive cancer of the female reproductive system. Most endometrial carcinomas are cancers of the cells that form glands in the endometrium. These are called adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

The most common type of endometrial cancer is called endometrioid adenocarcinoma. Other rare types of endometrial carcinomas include squamous cell and undifferentiated. Your doctor may refer to endometrial cancers as "type 1" or "type 2", depending on the potential causes and the nature of the cancer. A cancer would be classified as:
 * Type 1 if the cause is exposure to too much estrogen. This type of cancer tends to spread more slowly than a "type 2" cancer.


 * Type 2 cancers are less common and their underlying causes remains unknown. They are believed to be caused by factors other than estrogen exposure. This type of cancer is more aggressive than "type 1" and are usually treated more assertively.

What are the symptoms of Endometrial cancer?
Possible signs of endometrial cancer include unusual vaginal discharge, pain in the pelvis, bleeding or discharge not related to menstruation (periods), difficult or painful urination and pain during sexual intercourse. Since other conditions may cause the same symptoms, you should always consult your doctor if you experience any of these symptoms.

Who is at highest risk?
Endometrial cancer usually occurs in women after menopause, and affects more white women than black women. Black women diagnosed with endometrial cancer are more likely to have more advanced disease at diagnosis, and are more likely to die from endometrial cancer than white women.

Some of the risk factors for endometrial cancer are:

Estrogen Exposure

Estrogen exposure through estrogen-only hormone replacement therapy. A combination estrogen-progestin replacement therapy in post menopausal women, however, has not been shown to increase the risk of endometrial cancer.

Beginning to have menstrual periods at an early age also increases the number of years the body is exposed to estrogen and increases a woman's risk of endometrial cancer. Similarly, women who reach menopause at an older age are exposed to estrogen for a longer time and have an increased risk of endometrial cancer.

Never being pregnant is also a risk factor for endometrial cancer. Because estrogen levels are lower during pregnancy, women who have never been pregnant are exposed to estrogen for a longer time than women who have been pregnant. This increases the risk of endometrial cancer.

Tamoxifen

Tamoxifen is one of a group of drugs called selective estrogen receptor modulators, or SERMs. Tamoxifen is used to prevent breast cancer in women who are at high risk for the disease, but it increases the risk of endometrial cancer. This risk is greater in postmenopausal women.

Another drug in the SERM group, raloxifene, is used to prevent bone weakness in postmenopausal women and has not been shown to increase the risk of endometrial cancer.

Inherited risk

Hereditary nonpolyposis colon cancer (HNPCC) syndrome is an inherited disorder caused by changes in certain genes. Women who have HNPCC syndrome have a much higher risk of developing endometrial cancer than women who do not have HNPCC syndrome.

Polycystic ovary syndrome

Women who have polycystic ovary syndrome (a disorder of the hormones made by the ovaries) have an increased risk of endometrial cancer.

Body fat

Obesity increases the risk of endometrial cancer. This may be because obesity is related to other risk factors such as estrogen levels, polycystic ovary syndrome, lack of physical activity, and a diet that is high in saturated fats.

It is not known if losing weight decreases the risk of endometrial cancer.

When to seek urgent medical care?
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 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

Diagnosis
Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. For this reason, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. One of the following procedures may be used:


 * Endometrial biopsy: The removal of tissue from the endometrium (inner lining of the uterus) by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. A pathologist views the tissue under a microscope to look for cancer cells.


 * Dilatation and curettage: Surgery to remove samples of tissue or the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped instrument) is inserted into the uterus to remove tissue. Tissue samples may be taken and checked under a microscope for signs of disease. This procedure is also called a D&C.

Treatment options
If you have been diagnosed with endometrial cancer, here are some of the treatment options for you:

Hysterectomy

A hysterectomy is an operation where the uterus and the cervix is removed. This is the primary treatment for endometrial cancer and, depending on how much the cancer has spread, may not require any further treatment.

Radiation Therapy

Your doctor may recommend radiation therapy to treat endometrial cancer. This is the medical use of ionizing radiation as part of cancer treatment to control malignant cells. Radiation therapy is commonly applied to the cancerous tumour.

Chemotherapy

Chemotherapy (often called "chemo") Chemotherapy, refers to treatment of disease by chemicals that kill cells, specifically of cancer. It is often referred to as "chemo". Since the drugs used in chemotherapy travel through the bloodstream, they are capable of acting on cancers that have spread to areas outside the endometrium.

Hormone Therapy

Hormone therapy involves the manipulation of certain hormones or hormone blocking drugs to target cancer in hormonally responsive tissues, such as the endometrium.

Diseases with similar symptoms

 * Cervical cancers
 * Uterine sarcomas

Where to find medical care for Endometrial cancer?
Directions to Hospitals Treating Endometrial cancer

What to expect (Outlook/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%.

Possible complications
Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy.

There can also be complications from hysterectomy, radiation, and chemotherapy.

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 smears beginning 3 years after becoming sexually active.

Women with any risk factors for endometrial cancer, including women who are taking estrogen replacement therapy, 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.

The following protective factors may also decrease the risk of endometrial cancer:


 * Combination oral contraceptives: Taking contraceptives that combine estrogen and progestin (combination oral contraceptives) decreases the risk of endometrial cancer. The protective effect of combination oral contraceptives increases with the length of time they are used, and can last for many years after oral contraceptive use has been stopped.


 * Physical activity: Physical activity may lower the risk of endometrial cancer.


 * Pregnancy and breast-feeding:Estrogen levels are lower during pregnancy and when breast-feeding. Being pregnant and/or breast-feeding may lower the risk of endometrial cancer.


 * Diet: A diet low in saturated fats and high in fruits and vegetables may lower the risk of endometrial cancer. The risk may also be lowered when soy -based foods are a regular part of the diet.