Endometrial Cancer

Endometrial cancer at a glance

• Endometrial cancer is the uncontrolled growth of cells that form cancerous tumors in the uterus’ lining, called the endometrium.
• This is the most common gynecologic cancer in the United States, and is particularly prevalent in postmenopausal women.
• Abnormal vaginal bleeding may be a sign of this type of cancer, but a biopsy must be performed to confirm the diagnosis.
• Causes of endometrial cancer are unknown, but obesity, age, heredity and late menopause or early puberty are closely linked to the cancer.
• Treatment may include radiation, chemotherapy, surgery or hormone therapy.

What is endometrial cancer?

Endometrial cancer, also known as uterine cancer, develops in the lining the uterus (endometrium), where unregulated growth of those cells causes cancerous tumors. Postmenopausal women, usually around age 60, are more likely to develop the condition, which is uncommon in women under age 45.

While other types of cancer may form in the uterus, endometrial cancer is the most common. According to the National Cancer Institute, it accounts for around 6 percent of all cancers in women in the United States.

A uterine biopsy is required to verify the diagnosis of this cancer. Because it can cause abnormal vaginal bleeding, the cancer is often identified at an early stage before it has spread outside the uterus.

Endometrial cancer has a high survival rate if detected quickly. The American Society of Clinical Oncology reports that the five- and 10-year survival rates for women with uterine cancer are 82 and 79 percent respectively.

Endometrial cancer causes

As with most cancers, the cause of this and other uterine cancers is unknown. However, several factors may contribute to a woman’s risk for developing the disease, including the following.

• Hormone factors: A woman’s hormone levels may contribute to the development of endometrial cancer. Among other things, birth control pills, the hormone therapy drug tamoxifen, pregnancy, weight, estrogen pills and polycystic ovary syndrome (PCOS) can affect hormone levels.
• Age: A woman is more likely to develop cancer of the endometrium if she is over 45 years old or postmenopausal.
• Obesity and diabetes: Excess fat may correlate to higher cancer risk by increasing estrogen levels. Additionally, the National Cancer Association reports that women with diabetes are four times more likely to develop endometrial cancer.
• Family history: Women with close relatives that have had the cancer are at an increased risk of developing it themselves.
• Never being pregnant: For unexplained reasons, women who have never given birth have a higher likelihood of being diagnosed with this cancer.
• Menstruation length: An abnormal number of periods over the course of a woman’s lifetime may increase her risk for endometrial cancer. A woman may have more periods if she has an early menstruation – before age 12 – or a late menopause.
• Colon cancer syndrome: Hereditary nonpolyposis colorectal cancer (HNPCC) is caused by a gene mutation passed from parents to children and increases the risk of colon and endometrial cancers.

Endometrial cancer symptoms

Symptoms often involve unusual vaginal bleeding, spotting and discharge. This includes bleeding between periods, bleeding after menopause and discharge without any blood. While abnormal bleeding may be the sign of other noncancerous conditions, it should be reported to a doctor immediately.

Symptoms that are more common in the later stages of the disease include pelvic pain, unexplained weight loss, painful sex and the feeling of a mass (tumor) in the pelvic area.

If endometrial cancer is suspected, a doctor will perform a transvaginal ultrasound (an ultrasound performed internally through the vagina) or hysteroscopy (a thin, lighted tube with camera inserted through the vagina) to view the pelvic region. A biopsy will then be performed on tissue from the endometrium to confirm whether cancer cells are present.

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Endometrial cancer treatment

Treatments for endometrial cancer will differ for each woman depending on the stage of the cancer, the patient’s general health, whether future fertility is being considered and other variables. Treatment options include the following.

Surgery

The most common way to treat endometrial cancer is to perform a total hysterectomy by removing a woman’s uterus and cervix. This may be paired with a bilateral salpingo-oophorectomy, which removes the ovaries and fallopian tubes. A total hysterectomy will make it impossible for a woman to have children in the future, so if fertility is a concern the patient should consult with a fertility preservation doctor before undergoing this procedure.

Some patients may still need to be given radiation therapy or hormone treatment after surgery to kill any further cancer cells.

Hormone therapy

In hormone therapy, medications are used to alter hormone levels in a woman’s body. This is a more common treatment for advanced endometrial cancer.

The primary hormone therapy drug for endometrial cancer is progesterone (or comparable drugs called progestins), which slows the growth of endometrial cancer cells. Other drugs, including tamoxifen, LHRH agonists and aromatase inhibitors, suppress the production of estrogen in a woman’s body to prevent the estrogen from stimulating cancer cell growth.

Chemotherapy

Chemotherapy involves the use of chemicals by pill (orally) or through the veins (intravenously) to kill cancer cells. The stage of the cancer determines the regimen for this treatment and patients may receive more than one drug at a time.

Radiation

Radiation therapy uses X-rays and other radiation to halt cancer cell growth. External radiation is performed using a machine outside the body. Internal radiation involves the placement of radiation-filled devices, such as wires or cylinders, inside the vagina for a short time.

Risks from treatment for endometrial cancer

Patients should discuss treatment side effects with their oncologist. Some risks may include:

• Chemotherapy side effects depend on the drugs being used and may include fatigue, hair loss, proneness to infection, nausea and vomiting.
• Radiation treatments can cause a rash on the skin, fatigue and in rare cases damage to lungs or the heart.
• Hormone therapy side effects may include depression, weight gain, hot flashes, night sweats, muscle and joint pain, vaginal dryness and blood clots in certain cases.