Endometrial cancer

Causes and Risks:
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 have a role. One of estrogen's normal physiological functions is to stimulate the build up of the epithelial wall of the uterus. Excess estrogen administered to laboratory animals produces endometrial hyperplasia and cancer . The incidence of endometrial cancer in women in the U.S. is 1 to 2%. The incidence peaks between the ages of 60 and 70 years, but 2 to 5% of cases may occur before the age of 40 years. Increased risk of developing endometrial cancer has been noted in women with increased levels of natural estrogen. Associated conditions include obesity , hypertension , and polycystic ovarian disease . Increased risk is also associated with nulliparity (never having carried a pregnancy ), infertility (inability to become pregnant ), early menarche (onset of menstruation) and late menopause (cessation of menstruation). Women who have a history of endometrial polyps or other benign growths of the uterine lining, postmenopausal women who use estrogen-replacement therapy (specifically if not given in conjunction with periodic progestin), and those with diabetes also fit into the higher risk category.

Prevention:
All women should have regular pelvic exams and Pap smears (beginning at the onset of sexual activity or at the age of 20 if not sexually active) to help detect signs of any abnormal development.

Since conditions associated with increased risk have been identified, it is important for women with such conditions to be followed more closely by their physicians. Frequent pelvic examinations and screening tests, including a pap smear and endometrial biopsy , should be done.

Women who are taking estrogen replacement therapy should also take these precautions. Any of the following symptoms should be reported immediately to the doctor:
  • bleeding or spotting after intercourse or douching
  • bleeding that lasts longer than 7 days
  • periods that recur every 21 days or less
  • reappearance of blood or staining after six months or more of no bleeding at all.



Symptoms:



Signs and Tests:
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or consistency of the uterus and/or its surrounding, supporting structures may exist when the disease is more advanced.

Stages of endometrial cancer:

  • 1. The cancer is confined to the uterine body.
  • 2. The cancer involves the uterine body and the cervix , but does not extend any further.
  • 3. The cancer extends outside of the uterus but not beyond the true pelvis (gynecological organs).
  • 4. The cancer has extended beyond the true pelvis and:
    • 4a. spread to adjacent organs.
    • 4b. spread to distant organs.



Treatment:
Women with the early stage 1 disease may be candidates for treatment with surgical hysterectomy , but removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended for two reasons. Tumor cells can spread to the ovaries very early in the disease, and any dormant cancer cells that may be present could possibly be stimulated by estrogen production by the ovaries. Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. For all other women with endometrial cancer, the preferred treatment is surgery in combination with radiation therapy . Chemotherapy may be considered in some cases.

Support Groups:
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group .

Prognosis:
Because endometrial cancer is usually diagnosed in the early stages (70 to 75% of cases are in stage 1 at diagnosis; 10 to 15% of cases are in stage 2; 10 to 15% of cases are in stage 3 or 4), there is a better prognosis (probable outcome) associated with it than with other types of gynecological cancers such as cervical or ovarian cancer .

The 5 year survival rate for endometrial cancer following appropriate treatment is:

  • 75 to 95% for stage 1
  • 50% for stage 2
  • 30% for stage 3
  • less than 5% for stage 4



Complications:

  • Anemia may result, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)
  • A perforation (hole) of the uterus may occur during a D & C or an endometrial biopsy .



Call Your Healthcare Provider:
Call for an appointment with your health care provider if any symptoms occur, particularly if you are a woman with associated risk factors or if you have not had women's health care examinations according to recommended schedules.


Pelvic laparoscopy is a surgical procedure used to view the interior of the lower abdomen without major surgery. Small optical instruments can be inserted through the abdominal wall to directly visualize the interior of the abdomen. Some surgeries can be done using laparoscopic techniques. Recovery from this type of surgery, unlike open surgery, often takes only a day and the patient usually returns home the next morning.



This is an illustration of the female reproductive syste