Endometrial Cancer

HomeEndometrial Cancer
Overview

Endometrial cancer, also known as uterine cancer, is a type of cancer that originates in the lining of the uterus, called the endometrium. It is the most common type of cancer affecting the female reproductive system. Endometrial cancer typically occurs after menopause, but it can also develop in premenopausal women.

Types of Endometrial Cancer:

  1. Endometrioid carcinoma: This is the most common type, accounting for about 80% of all endometrial cancer cases. It usually develops due to excess estrogen exposure and is associated with obesity, diabetes, and hormonal imbalances.
  2. Serous carcinoma: This is a more aggressive type of endometrial cancer, accounting for around 10-20% of cases. It tends to be higher grade and has a higher risk of recurrence. Serous carcinoma is less related to estrogen exposure and is more common in older women.
  3. Clear cell carcinoma: This type of endometrial cancer is less common, accounting for about 5% of cases. It is often associated with a history of endometriosis and has a tendency for earlier spread to other organs.
  4. Mucinous carcinoma: This is a rare type of endometrial cancer, accounting for less than 5% of cases. It is characterized by the production of mucus by cancer cells.

Other rare types of endometrial cancer include squamous cell carcinoma, adenosquamous carcinoma, and carcinosarcoma.

Risk Factors for Endometrial Cancer:

  1. Hormonal factors: Increased exposure to estrogen without the balancing effect of progesterone is a significant risk factor. Factors that contribute to estrogen excess include early onset of menstruation, late menopause, never having been pregnant, infertility, polycystic ovary syndrome (PCOS), and estrogen-only hormone replacement therapy.
  2. Age: The risk of endometrial cancer increases with age, particularly after menopause.
  3. Obesity: Excess body weight, especially obesity, is associated with a higher risk of endometrial cancer due to increased estrogen production.
  4. Diabetes: Women with diabetes, especially type 2 diabetes, have an increased risk of developing endometrial cancer.
  5. Genetic factors: Certain genetic conditions, such as Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC) and Cowden syndrome, increase the risk of endometrial cancer.
  6. Family history: Having a close relative, such as a mother or sister, with endometrial or colorectal cancer can increase the risk.
  7. Polycystic ovary syndrome (PCOS): PCOS, a hormonal disorder characterized by irregular periods and excess androgens, is associated with a higher risk of endometrial cancer.
  8. Tamoxifen: Long-term use of the drug tamoxifen, commonly used for the treatment of breast cancer, increases the risk of developing endometrial cancer.

It’s important to note that having one or more risk factors does not necessarily mean that a person will develop endometrial cancer. However, individuals with these risk factors may benefit from regular screenings and discussions with their healthcare providers to manage their risk and detect any potential signs or symptoms of the disease.

The symptoms of endometrial cancer can vary from person to person, and some individuals may not experience any symptoms in the early stages of the disease. However, the following signs and symptoms may be associated with endometrial cancer:

  1. Abnormal vaginal bleeding: The most common symptom of endometrial cancer is abnormal vaginal bleeding, especially in postmenopausal women. This may include:

– Vaginal bleeding or spotting after menopause.

– Irregular menstrual bleeding in premenopausal women, such as heavier or prolonged periods or bleeding between periods.

– Bleeding or spotting after sexual intercourse.

  1. Pelvic pain: Some women with endometrial cancer may experience pelvic pain or discomfort. This pain can be persistent or intermittent.
  2. Painful urination: Endometrial cancer can cause pain or discomfort during urination.
  3. Pain during intercourse: Some women may experience pain or discomfort during sexual intercourse (dyspareunia).
  4. Unintended weight loss: In some cases, endometrial cancer can lead to unintended weight loss.

It’s important to note that these symptoms can be caused by conditions other than endometrial cancer, but if you experience any persistent or concerning symptoms, it is recommended to consult a healthcare professional for further evaluation and diagnosis. Early detection and treatment of endometrial cancer can improve outcomes and prognosis.

The diagnosis of endometrial cancer typically involves a combination of medical history evaluation, physical examination, imaging tests, and tissue sampling. The diagnostic process may include the following steps:

  1. Medical history and physical examination: Your healthcare provider will ask about your symptoms, medical history, and any risk factors you may have. They will also perform a physical examination, including a pelvic exam, to assess the uterus and surrounding structures.
  2. Transvaginal ultrasound: This imaging test uses sound waves to create images of the uterus. A transducer is inserted into the vagina to obtain detailed images of the endometrium and detect any abnormalities.
  3. Endometrial biopsy: This is a crucial step in diagnosing endometrial cancer. During an endometrial biopsy, a small sample of tissue from the lining of the uterus is collected and examined under a microscope. There are different methods for obtaining the tissue sample, including:

– Pipelle or suction curette: A thin tube is inserted into the uterus through the cervix, and a small sample of tissue is suctioned out.

– Dilatation and curettage (D&C): The cervix is dilated, and a spoon-shaped instrument called a curette is used to scrape tissue from the uterus.

  1. Hysteroscopy: In some cases, a hysteroscopy may be performed. This procedure involves the insertion of a thin, lighted tube (hysteroscope) through the cervix into the uterus. It allows the doctor to visualize the inside of the uterus and take a biopsy or remove abnormal tissue for further examination.
  2. Imaging tests: Additional imaging tests may be ordered to determine the extent and spread of the cancer. These can include:

– Magnetic resonance imaging (MRI)

– Computed tomography (CT) scan

– Positron emission tomography (PET) scan

  1. Staging: Once endometrial cancer is diagnosed, staging is done to determine the extent of the disease and guide treatment decisions. Staging may involve further imaging tests, such as CT scans or MRIs, as well as additional biopsies or surgical procedures.

It’s important to work closely with your healthcare team to undergo the necessary tests and procedures for an accurate diagnosis. A confirmed diagnosis of endometrial cancer will help determine the appropriate treatment plan based on the stage and characteristics of the cancer.

The treatment of endometrial cancer depends on several factors, including the stage of the cancer, the grade of the tumor, the presence of certain genetic mutations, the woman’s overall health, and her preferences. The primary treatment options for endometrial cancer may include:

  1. Surgery: Surgery is often the first-line treatment for endometrial cancer and involves the removal of the uterus (hysterectomy) along with the fallopian tubes and ovaries (salpingo-oophorectomy). Lymph node dissection may also be performed to determine if the cancer has spread to nearby lymph nodes. In some cases, minimally invasive techniques such as laparoscopic or robotic-assisted surgery may be used.
  2. Radiation therapy: Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or shrink tumors. It may be used before surgery to shrink the tumor (neoadjuvant therapy) or after surgery to destroy any remaining cancer cells (adjuvant therapy). In some cases, radiation therapy may be the primary treatment for women who are not suitable candidates for surgery.
  3. Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells or stop their growth. It may be recommended for women with advanced or high-grade endometrial cancer, or if there is evidence of cancer spread beyond the uterus. Chemotherapy can be given intravenously or orally.
  4. Hormone therapy: Certain types of endometrial cancer, such as those that are hormone receptor-positive, may be treated with hormone therapy. This involves the use of medications that block or reduce the effects of estrogen on cancer cells.
  5. Targeted therapy: Some endometrial cancers may have specific genetic mutations or alterations that can be targeted with specific medications. Examples include drugs that target the PI3K/AKT/mTOR pathway or immune checkpoint inhibitors.

The choice of treatment and the sequence of therapies will depend on individual factors and may involve a combination of approaches. It’s important to discuss treatment options with a gynecologic oncologist or a healthcare team experienced in managing endometrial cancer to determine the most appropriate treatment plan for each individual case. Additionally, supportive care and close monitoring for potential side effects and disease recurrence are important aspects of the overall treatment approach.

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