Endometrial Cancer

Overview:

Endometrial cancer is one of the two types of uterine cancer. The other type of uterine cancer is uterine sarcoma. Endometrial cancer affects the lining of the uterus, while uterine sarcoma begins in the muscles of the uterus. The former is far more common than the latter. Following are the different stages of endometrial cancer:

Stage 0: This stage is also known as carcinoma in situ, i.e. the cancer is in its extremely early stage.

Stage I: In this stage, the cancer is found only in the womb.

Stage II: When the cancer spreads beyond the uterus (womb) into the cervical stroma, it is known as stage II endometrial cancer.

Stage III: The vagina, fallopian tubes, ovaries and lymph nodes in the pelvic region are affected in the third stage.

Stage IV: The cancer spreads to other organs of the body beyond the pelvic area.

Causes:

The exact cause of endometrial cancer is not known. Experts suggest that endometrial cancer is associated with an imbalance of estrogen & progesterone, i.e. when the level of estrogen is high compared to that of progesterone. The said imbalance causes the endometrial lining to thicken up and provides a chance for cancer cells to grow.

Risk Factors:

• Obesity: Fat cells produce estrogen, such production of estrogen causes imbalance of estrogen & progesterone.
• Estrogen only medications: Intake of estrogen without taking progesterone also results in the said imbalance.
• PCOS (Polycystic ovary syndrome): PCOS can increase the levels of estrogen without affecting the levels of progesterone.
• Naturally high levels of estrogen: In such cases, women often start having periods before the age of 12, and reach menopause only after 50.   

Symptoms:

The most common symptom experienced by women is abnormal bleeding. Following are the symptoms related to endometrial cancer.

Abnormal bleeding related:

• Change in period cycle.

• Bleeding between period cycles.

• Bleeding after reaching menopause.

Other symptoms:

• Pain in the pelvic area.

• Abnormal weight loss

• Abnormal vaginal discharge and spotting.

• Feeling fullness or mass near the pelvic area.

Diagnosis:

In order to ascertain endometrial cancer beyond doubt, endometrial biopsy is done. Other tests include pelvic examination, transvaginal ultrasound and D&C.

• Pelvic examination:Pelvic examination is a routine screening test wherein the doctor examines various organs such as vulva, ovaries & uterus from the outside. The doctor may also use a speculum – a device which helps the doctor to view the patient’s cervix and inspect it for abnormalities.
• Transvaginal Ultrasound: Ultrasound is an imaging technique which uses ultrasound waves to create an image/video of the internal organs of the patient. In transvaginal ultrasound, the doctor will insert the transducer into the patient’s vagina in order to inspect the uterus with the help of the video/image on screen. With the help of transvaginal ultrasound the doctor will be able to determine the thickness of the endometrium and rule out other possibilities.
• Hysteroscopy: Hysteroscopy is a procedure in which the doctor inserts a small, lighted instrument known as the hysteroscope through the patient’s natural orifices, in this case the vaginal opening. This instrument relays images on the screen, which helps the doctor to inspect the inner organs of the patient.
• Endometrial Biopsy:In order to confirm endometrial cancer, a biopsy is required to be carried out. Here, the doctor will try to obtain sample tissues from the uterine lining for analysis. Most of the patients do not require anesthesia.
• Dilation & Curettage (D&C): In case that the results are not clear after biopsy or not enough sample tissue could be obtained after biopsy, the doctor may recommend D&C. Dilation is performed to widen the cervix so as to allow instruments into the uterus. Curettage is the procedure of scraping the walls of the patient’s uterus.

Treatment:

Depending on the stage of endometrial cancer, an appropriate method of treatment can be selected. Usually endometrial cancer is detected early due to the symptom of vaginal bleeding. If it is detected early, a surgery is recommended.

Hysterectomy: Hysterectomy is a procedure in which the patient’s uterus is removed. Therefore childbirth is not possible after this procedure. The doctor may remove the fallopian tubes as well as the ovaries.

Chemotherapy:

Patients having advanced stage of endometrial cancer may be treated with chemotherapy to kill any remaining cancerous cells. Chemotherapy is a form of cancer treatment, wherein, the patient is administrated medicine and drugs through injections, abdominal opening or both.

Other methods of treatment include:

• Radiation:

During radiation powerful energy beams are used to kill cancerous cells. There are two types of radiation therapy, in the first one – the machine is placed outside the patient’s body. In the other method the device is placed within her body.

• Hormonal therapy:

Hormonal therapy is used to bring a balance in estrogen-progesterone levels. It may involve medications either for increasing the progesterone levels or for decreasing the levels of estrogen.

Depending on the stage of endometrial cancer, an appropriate method of treatment can be selected. Usually endometrial cancer is detected early due to the symptom of vaginal bleeding. If it is detected early, a surgery is recommended.

Hysterectomy: Hysterectomy is a procedure in which the patient’s uterus is removed. Therefore childbirth is not possible after this procedure. The doctor may remove the fallopian tubes as well as the ovaries.

Chemotherapy:

Patients having advanced stage of endometrial cancer may be treated with chemotherapy to kill any remaining cancerous cells. Chemotherapy is a form of cancer treatment, wherein, the patient is administrated medicine and drugs through injections, abdominal opening or both.

Other methods of treatment include:

• Radiation:

During radiation powerful energy beams are used to kill cancerous cells. There are two types of radiation therapy, in the first one – the machine is placed outside the patient’s body. In the other method the device is placed within her body.

• Hormonal therapy:

Hormonal therapy is used to bring a balance in estrogen-progesterone levels. It may involve medications either for increasing the progesterone levels or for decreasing the levels of estrogen.