The endometrium is the inner lining of the uterus, a hollow, muscular organ in a woman’s pelvis. Endometrial cancer begins when cells in the endometrium starts to grow in an unregulated and uncontrolled way. In later stages, endometrial cancer can spread to the vagina, fallopian tubes, ovaries, bladder or rectum. It can also be spread to more distant organs. It is the second most common gynecological malignancy with an incidence of 5.9 per 100,000 women in most developing countries.
There are different types of endometrial cancer based on type of cells under the microscope.
• Adenocarcinoma (most endometrial cancers are a type of adenocarcinoma called endometrioid cancer)
• Uterine carcinosarcoma or CS
• Squamous cell carcinoma
• Small cell carcinoma
• Transitional carcinoma
• Serous carcinoma
In more than 95% of cases, endometrial cancer happens in women over 40 years of age. Postmenopausal women are at high risk of getting endometrial cancer if they:
• Have a family history of endometrial, colorectal, or breast cancer
• Got their first period early
• Went through menopause late
• Are Overweight
• Have diabetes or hypertension
• Have few or no children
• Women taking drugs such as tamoxifen or estrogen-only hormone replacement therapy.
• Women have a history of infertility, irregular periods, or abnormal cells in the endometrium.
• Women are using intrauterine device (IUD)
• Women have received radiation therapy to the pelvis to treat another cancer
- Abnormal vaginal bleeding or discharge
- Vaginal discharge that may range from pink and watery to thick, brown, and foul smelling.
- Painful urination.
- An enlarged uterus, detectable during a pelvic examination.
- Pain during intercourse.
- Unexpected weight loss.
- Weakness and pain in the lower abdomen, back, or legs.
If women have any of the above-mentioned symptoms, their healthcare professional will examine them and possibly order blood and urine tests.
Other important tests include
- Pelvic examination and Pap smears, look for cervical cancer and can also find a small number of endometrial cancers before symptoms develop.
- Transvaginal ultrasound: The device aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates an image of the uterus. Saline can be putdown into the uterus through the cervix before the ultrasound test to give a clearer image. This is called a sonohystogram. If the endometrium seems to be too thick or irregular, your doctor can do an endometrial biopsy or a dilation and curettage (D&C) in the operating room.
- The confirmatory test is a biopsy (taking and analyzing a tissue sample from the uterus). If a biopsy confirms the diagnosis, your healthcare professional will order imaging tests such as a CT/PET scan or MRI; blood tests for CA-125, a marker seen both with ovarian and endometrial cancer; and a colonoscopy. The doctor may also order exploratory surgery (opening the abdomen) to determine the spread of the disease.
Surgery is often the main treatment for endometrial cancer that has not spread. It is also an effective prevention for women at high risk of developing the cancer. The most successful treatment for early cancer is total hysterectomy with bilateral salpingo-oophorectomy, in which the uterus, cervix, ovaries, and fallopian tubes are removed. This surgery is most likely to prevent the cancer from coming back.
If the cancer has spread outside the uterus, then after surgery the patient is given radiotherapy, often in combination with chemotherapy, to kill tumor is large but has not spread outside the uterus.
Patients with extensive endometrial cancer usually receive hormone therapy, usually progesterone, to delay the growth of cancer. Chemotherapy or radiotherapy might also be given to reduce the size and number of tumors – all of which can increase the survival rate and relieve symptoms.
Patients in remission need examination every few months for several years. If cancer comes back, it usually happens within three years. Caught early, cancer that comes back may be cured with aggressive radiation, chemotherapy, or more surgery.