Endometrial cancer is the abnormal growth of cells in the uterus which is the hollow, pear-shaped organ in the pelvic region of women. The cancer begins in the inner layer that forms the lining of the uterus. There are other types of cancer also formed in the uterus called uterine sarcoma which are less common. Endometrial cancer is detected usually at an early stage as it produces frequent abnormal vaginal bleeding which alarms the women to check with their doctors. If the cancer is detected at early stage, surgical removal of the uterus often cures the cancer.
Signs and Symptoms
- Bleeding after menopause.
- Bleeding in between menstrual cycles.
- Watery or abnormal bloody discharge from the vagina.
- Pain in and around pelvis.
- Age- Endometrial cancer mostly diagnosed in post menopausal women in the age group of 55-60.
- Hormonal Imbalance– The level of oestrogen and progesterone hormones can affect the risk of developing endometrial cancer. Higher oestrogen levels without progesterone may increase the endometrial thickness and may lead to cancer. Women at menopause stage under oestrogen hormone therapy are also at high risk.
- Obesity- Women with a body mass index (BMI) of 25 or greater are at major risk for endometrial cancer. As BMI increases, so does the risk of cancer.
- Inherited Genes – Endometrial cancer also has a genetic origin called as Lynch syndrome which often increases the risk of other types of cancer such as ovarian, colon and uterine cancer caused by abnormal mutation in the genes which is inherited.
Endometrial cancer can be detected by various methods. The initial diagnosis is a pelvic examination.
- Pelvic Examination - The doctor will inspect the outer genitals, vagina, uterus and ovaries using the speculum or fingers to detect any abnormal growths or tumours.
- Transvaginal Ultrasound - During the scan a device called transducer will be inserted in to the vagina to generate the video images of the uterus using sound waves. The scan reveals the texture and thickness of the endometrium.
- Hysteroscope Detection - The doctor inserts a hysteroscope through the vagina in to the uterus to examine the uterus and endometrial structure.
- Endometrial Biopsy – The tissue from the uterine lining will be collected and sent to analysis to detect the abnormal growth in the cells. The procedure may be done in the clinic without anaesthesia.
- Surgical Biopsy- In some cases the tissue obtained from the biopsy will not be enough to confirm the diagnosis or the biopsy is not clear. A procedure called dilation and curettage (D&C) will be done to scrape the tissue from the uterus and examined for cancer cells.
Stages of Endometrial Cancer Include:
- Stage I – Cancer confined only to uterus.
- Stage II – Cancer spread to cervix
- Stage III – Cancer has spread to pelvic area lymph nodes and beyond the uterus but not spread to the rectum and bladder.
- Stage IV –Cancer spread to rectum, bladder and other parts of the body.
The stage of the cancer can be determined by Positron Emission Tomography (PET) Scan, Chest X –rays, Computerized Tomography (CT) and Blood Tests.
The treatment for endometrial cancer depends on which stage the cancer is diagnosed.
Surgery is the first option for most of the patients with endometrial cancer which involves removal of uterus, fallopian tubes and the ovaries. Surgery to remove the uterus is recommended for most women with endometrial cancer. The patient will not be able to conceive and give birth to the child after the surgery. The doctor will also inspect the area around the uterus for the signs of cancer and may recommend lymph node biopsy testing to determine the stage of cancer.
Radiation therapy using X rays and high energy protons will be directed to the site of cancer after the surgery to reduce the recurrence. In certain patients the tumour is very large and difficult to remove, in such cases also radiation will be advised before surgery to reduce the tumour size. For high grade cancers and patients who are not fit for the surgery radiotherapy is the best choice of treatment. Two types of radiation will be usually administered
- External Radiation- During the procedure patient will lie on a table and the machine delivers high energy rays to a specified part or multiple places on the body.
- Internal Radiation- This procedure involves introducing small cylinder like objects, wires or seeds for certain time period inside the vagina to kill the cancer cells.
Chemotherapy uses medications to kill the cancer cells. The patient may receive either one drug or two drugs in combination by oral or intravenous route. Chemotherapy is usually recommended to the patients of high grade cancer that spread beyond the uterus.
During the hormone therapy medications are administered which affect the hormone levels. The therapy can be given alone or concomitant with other modes of treatment. Medications to reduce the amount of oestrogen in the body and to increase the progesterone levels will be usually given to balance the hormones and to kill the cancer cells that may grow in presence of high oestrogen.
It is a special medical care given to the patients to provide relief from serious illness by the team of medical professionals for better outcome and speedy recovery to the patients. It may also increase the quality of life after cancer treatment.