Table of Contents
Definition of Endometrial Cancer
A malignant (cancerous) tumor, sometimes called uterine cancer, that arises from the tissues of the endometrium, the lining of the uterus. Often endometrial cancer is hormone driven, which means it requires estrogens to grow.
Doctors in the United States diagnose endometrial cancer in about 40,000 women each year; it is the fourth most common cancer among women.
With early detection and treatment, is highly treatable. Endometrial cancer tends to develop slowly, typically over years, and most commonly occurs in women over age 60 – develops when the cells that form the endometrium become disordered, often as a consequence of chronic endometrial hyperplasia (overgrowth of the endometrium).
Endometrial hyperplasia occurs when there is an imbalance between estrogens and progesterone in the woman’s blood circulation. Researchers do not know what sets the stage for this imbalance. Elevated estrogens cause the endometrium to thicken and engorge with blood, and diminished progesterone fails to initiate adequate sloughing of the endometrial tissue (such as during menstruation). The tissue continues to accumulate, and over time its cells become abnormal.
|BASIC STAGING OF ENDOMETRIAL CANCER|
|stage 0/carcinoma in situ||cancer remains confined to the cells of its origin||total hysterectomy with optional bilateral salpingo oophorectomy|
|stage 1||cancer remains confined to the body of the uterus||total hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node dissection|
adjuvant radiation therapy
|stage 2||cancer involves the uterus and the cervix||preoperative radiation therapy|
total hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node dissection
|stage 3||cancer has spread beyond the uterus though remains confined to the pelvic area|
cancer may involve the vagina and lymph nodes adjacent to the uterus
|preoperative radiation therapy|
adjuvant hormonal therapy
|stage 4||cancer has spread to other organs in the abdomen such as the rectum or bladder|
cancer has spread to distant sites
|stage 4 recurrent||cancer has returned after treatment||radiation therapy|
four to six cycles of two-drug (doxorubicin and cisplatin) or three-drug (doxorubicin, cisplatin, and paclitaxel) combination chemotherapy
Symptoms and Diagnostic Path
Because endometrial cancer usually develops later in life, its symptoms sometimes blend with those of menopause. Because of this a doctor should evaluate symptoms that persist, even when the symptoms do not seem especially serious. Early symptoms of endometrial cancer include
- Unusually long or severe menstrual periods
- Spotting or bleeding between menstrual periods
- Watery, blood-tinged vaginal discharge
- Pain during sexual intercourse
- Pelvic or lower abdominal pain
The diagnostic path includes a comprehensive medical examination with pelvic examination, during which the doctor often can palpate (feel) a growth within the uterus or detect abnormalities in the uterus’s size or shape. Diagnostic imaging procedures such as computed tomography (ct) scan or ultrasound may provide further information. However, only endometrial biopsy can provide a certain diagnosis.
The doctor may obtain a tissue sample for biopsy by inserting a narrow catheter through the vagina and cervix into the uterus and aspirating (suctioning) cells from the endometrium. Hysteroscopy or the surgical operation dilation and curettage (d&c) may also provide endometrial cells for pathology analysis.
When confirming the diagnosis, the pathologist assigns a grade and stage to the cancer that characterize its aggressiveness and the extent to which it has grown or metastasized (spread to other locations in the body). Additional pathology tests determine whether the cancer cells have estrogen receptors (are estrogen positive). Cancer staging and grading and estrogen reception provide guidance for cancer treatment options and decisions.
Treatment Options and Outlook
Total hysterectomy, a surgical operation to remove the uterus and cervix, is nearly always the first treatment of choice for stage 0, 1, and 2 endometrial cancers. Women who have stage 1 or stage 2 endometrial cancer subsequently undergo adjuvant (follow-up) treatment such as hormone therapy or radiation therapy. Very early endometrial cancer (stage 0, also called carcinoma in situ, and stage 1) is nearly always curable.
For stage 3 and 4 endometrial cancer, the first treatment of choice is radiation therapy to shrink the cancer, with follow-up surgery and hormonal therapy (stage 3) or hormonal therapy alone. Surgery may be total hysterectomy with salpingooophorectomy (removal of the uterus, cervix, fallopian tubes, and ovaries) or radical hysterectomy (removal of all the organs of reproduction, the fatty layer covering them called the omentum, and nearby lymph nodes).
Radiation therapy may be external beam (targeted at the pelvis from a machine outside the body) or brachytherapy (implanted radioactive pellets). Though other treatment options are more effective for stage 0, 1, and 2 endometrial cancers, combination chemotherapy becomes a treatment option for metastasized endometrial cancer (stage 3 and stage 4).
Most endometrial cancers are hormone sensitive. Hormonal therapy, such as progestins or estrogen antagonists, effectively shrinks cancer tumors in women by depriving their cells of the hormones they need to thrive. Progestin causes endometrial atrophy (shrinkage of the endometrium) and is an option for younger women with stage 0 or stage 1 endometrial cancer who wish to preserve their fertility.
Among the estrogen antagonists currently available are aromatase inhibitors and tamoxifen; these therapies require the cessation of ovarian function. Most women who have stage 2 and more advanced endometrial cancer undergo oophorectomy (surgical removal of the ovaries). Aromatase inhibitors block the conversion of testosterone to estrogen in adipose (fat) cells throughout the body, the primary means of estrogen production in a woman’s body after menopause.
Risk Factors and Preventive Measures
Endometrial cancer is most common in women over age 60. Unopposed estrogen therapy (estrogen without progestin, except in women who have had hysterectomies) and long-term tamoxifen use are additional risk factors.
Obesity, insulin resistance, and type 2 diabetes also increase the risk for endometrial cancer because these conditions result in higher levels of estrogens in the blood circulation. Endometrial cancer follows a predictable path of evolution from endometrial hyperplasia to full-blown cancer, a path that generally takes years or even decades to manifest. This characteristic makes endometrial cancer fairly easy to detect in women who have regular routine medical examinations with pelvic examination.
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