Endometrial Cancer

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Overview

Endometrial cancer, which is also sometimes known as uterine cancer, happens when the cells present in the endometrial wall of the uterus begin to divide and grow abnormally.

Endometrial cancer is one of the few cancers that can be detected in the early stages as it causes abnormal vaginal bleeding that will demand immediate medical attention.

Obesity is found to be one of the biggest risk factors for endometrial cancer.

Symptoms

One of the first symptoms of endometrial cancer is abnormal vaginal bleeding that is not associated with the menstrual cycle. Other symptoms associated with endometrial cancer include:

Bleeding after menopause
Unusual vaginal discharge
Pain in the pelvic region
Presence of an abnormal mass in the pelvic region
Painful urination
Painful sexual intercourse
Extreme tiredness
Anaemia
Weight loss

Courses

Although there are no known causes that are associated with endometrial cancer, researchers have identified a few risk factors that increase the risk of endometrial cancer. The key risk factors for endometrial cancers include:

Obesity: Excess fatty tissue contributes to increased estrogen levels, and this translates to an increased risk of endometrial cancer.
Age: The risk of developing endometrial cancer is found to be high among women aged 50 and above.
Family History of Endometrial Cancer: Those who have a family history of endometrial cancer are at a higher risk of getting diagnosed with this disease.
History of Breast Cancer and Ovarian Cancer: Women who have been treated for breast cancer and ovarian cancer also have a higher risk of getting endometrial cancer.
Hormone Factors: An increase in the levels of estrogen levels is associated with endometrial cancer risk. Excess levels of estrogen hormone may be caused due to hormone replacement therapy (taken after menopause), conditions like obesity, PCOS, endometriosis, insulin resistance, etc.
Type 2 Diabetes: Women diagnosed with type 2 diabetes are also found to have an increased risk of endometrial cancer.
High Animal Fat Diet: Women who consume foods rich in animal fat also have a higher risk of getting endometrial cancer.
Early Menstruation: Women who have started menstruating before age 12; having late menopause is also a risk factor for endometrial cancer.
No Pregnancy: Women who have never got pregnant are also at increased risk of getting endometrial cancer.
Radiation Therapy to Pelvic Region: Those women who have received radiation therapy for cancers in the pelvic region also have a higher risk of getting diagnosed with endometrial cancer.

Diagnosis

There are multiple diagnostic tests available for the detection and diagnosis of endometrial cancer.

a. Physical Examination and Medical History Assessment: When a patient comes with symptoms of endometrial cancer, the doctor will physically examine the patient’s pelvic region for the signs of the disease, such as lumps and other abnormalities. The doctor may also try to understand the patient’s medical history during which the family history, symptoms experienced by the patient, past/underlying medical conditions, etc., will be discussed in detail.

b. Endometrial Biopsy: During an endometrial biopsy, a small amount of endometrial tissue is collected by inserting a slender and flexible tube into the uterus. Later, this tissue sample is examined under a microscope for the presence of abnormal cells.

c. Dilation and Curettage (D&C): Dilation and Curettage involves collecting the tissue from the uterine lining and examining it under a microscope for cancer cells. During this procedure, the cervix is opened (dilated), and a curette, which is a spoon-shaped special instrument, is used to scrape enough samples of the uterine lining, which is further sent for examination.

This procedure can cause discomfort, and general anaesthesia or sedative is used during the procedure.

d. Imaging Tests: Transvaginal ultrasound is a commonly recommended imaging test for endometrial cancer diagnosis. This procedure helps the doctor in finding if there is a tumour growing or if there are any abnormalities in the endometrial lining.

Along with this, the doctor may also recommend additional imaging tests, such as PET CT scan, MRI scan, chest X-ray, etc., to check if cancer has spread to other organs.

These tests may also be used for staging, treatment planning, therapy monitoring and checking if the disease has relapsed.

Treatment

Treatment planning for endometrial cancer is devised upon considering multiple factors, such as the stage of the disease, exact location of the tumour, its size, the patient’s age and her overall health condition along with the patient’s preferences.

The main treatment options available for endometrial cancer include surgery, chemotherapy and radiation therapy. For a few cases, the doctor may recommend targeted therapy, immunotherapy and hormone therapy.

a. Surgery: Surgery is the main line of treatment for endometrial cancer. Before surgery, chemotherapy or radiation therapy may be given in order to shrink the tumour. These treatments could be recommended after the surgery as well – this helps in getting rid of residual cancer cells and bringing down the risk of a relapse.

The surgery for endometrial cancer could either be open or minimally invasive. Advanced laparoscopic and robotic surgical approaches are available for endometrial cancer – they come with fewer treatment complications and support faster recovery. Following are the main surgical options available for endometrial cancer and the doctor may recommend one of these depending on the severity of the condition:

Hysterectomy: Since the tumour forms in the uterine lining, the removal of the uterus is recommended. This procedure is performed if the cancer growth is confined to the uterine lining only.
Salpingo-oophorectomy: This procedure involves the removal of the fallopian tubes and the ovaries. It could be unilateral (removal of fallopian tube and ovary on one side) or bilateral (removal of fallopian tube and ovary on both sides).
Pelvic Lymph Node Dissection: Pelvic lymph node dissection involves the removal of lymph nodes in the pelvic region if the cancer is suspected to have spread to them. They may be further examined for the presence of cancer cells.
Pelvic Exenteration: This procedure may be recommended for women with advanced endometrial cancer, where the disease has spread to the bladder, lower colon, rectum, etc.During this procedure, the ovaries, fallopian tube, uterus, cervix, vagina, bladder and rectum, along with lower colon (in a few cases) may be removed. After this procedure, an artificial opening (stoma) may be created for urine and stools to pass.

b. Radiation Therapy: During radiation therapy, powerful radiation beams are used to destroy cancer cells. For endometrial cancer, radiation therapy may be administered using an external radiation source (external radiation therapy) or by placing the radiation source inside the body (brachytherapy), very close to the tumour.

c. Chemotherapy: Chemotherapy uses strong anticancer drugs to kill cancer cells. Usually, more than one chemo drug is used in the treatment. Chemotherapy may be administered orally or intravenously. Chemotherapy is also administered before and after the surgery to enhance the overall effectiveness of the treatment.

d. Hormone Therapy: Hormone therapy is often administered with chemotherapy. This treatment approach works by blocking the growth of endometrial cancer cells that have specific hormone receptors. Hormone therapy is largely recommended for advanced-stage endometrial cancers.

e. Targeted Drug Therapy: Targeted therapy identifies the specific vulnerabilities present on the cancer cells and attacks them to kill the cancer cells or stop them from growing. Targeted therapy is largely recommended for advanced-stage endometrial cancers.

f. Immunotherapy: This is a unique treatment approach that stimulates the body’s own immune system to attack cancer cells present in the body. Usually, cancer cells synthesise special proteins that block the immune cells from attacking cancer cells, and immunotherapy works by blocking those special proteins. Immunotherapy may be administered in cases where other treatments have not worked.

Frequently Asked Questions

1. Is endometrial cancer treatable?

Yes, endometrial cancer is treatable. We have a multitude of treatment options available today that can help us in treating even aggressive endometrial cancers.

Just like every other cancer, early detection goes a long way in the case of endometrial cancers. Keeping an eye on the symptoms that last more than two weeks and reporting them to your doctor can help you with early detection and timely treatment.

2. Can endometrial cancer come back?

Yes, in a few cases, endometrial cancer can come back. Nevertheless, it can be treated successfully, if caught early.

In order to detect endometrial cancer relapses in their early stages, patients must be mindful to keep up their follow-up appointments without fail after the completion of their treatment.

3. Can being overweight cause endometrial cancer?

Being overweight or obese is one of the important risk factors for endometrial cancer. This is because having excess fat tissue contributes to high estrogen levels, which in turn increases one’s risk of endometrial cancer.

Losing weight, on the other hand, is clinically proven to reduce the endometrial cancer risk among women who are overweight or obese.

4. Is endometrial cancer hereditary?

Yes, endometrial cancers can run in families. In such cases, women must take extra care with a healthier lifestyle and talk to their doctor for the best practices that will help them reduce their endometrial cancer risk.

5. Can I prevent endometrial cancer?

There is no known way to prevent endometrial cancer completely. However, there are a few measures that you can take to reduce your risk of developing this disease:

Maintain Healthy Weight: Healthy weight management plays a significant role in reducing the risk of endometrial cancers, along with many other health disorders.
Have a Balanced Diet: Having a balanced diet that includes vegetables, fruits and fibres helps in improving the health of the endometrium and brings down the risk of endometrial cancers.
Cultivate an Active Lifestyle: Having a sedentary lifestyle is also a risk factor for endometrial cancer. Regular exercising can help you reduce your endometrial cancer risk.
Quit Smoking: The harmful chemicals present in tobacco lead to an increased risk of endometrial cancer. Therefore, if you smoke, you should quit immediately, not just to reduce your risk of endometrial cancer but various other cancer types.