Endometrial cancer
Introduction
Endometrial cancer is one of the most common cancers in American women. In fact, about 40,000 American women receive a diagnosis of endometrial cancer each year, making it the fourth most common cancer found in women — after breast cancer, lung cancer and colon cancer.
Endometrial cancer usually begins in the endometrium, the lining of the uterus — a hollow, pear-shaped pelvic organ where fetal development occurs. Endometrial cancer is most common after the reproductive years, between the ages of 60 and 70. Endometrial cancer is sometimes called uterine cancer, but there are other cells in the uterus that can become cancerous — such as muscle or myometrial cells. These form much less common cancers called sarcomas and account for less than 5 percent of uterine cancers.
Endometrial cancer is often detected at an early stage because it frequently produces vaginal bleeding between menstrual periods or after menopause. If discovered early, this slow-growing cancer is likely to be confined to the uterus. Removing the uterus surgically often eliminates all of the cancer. In fact, stage I endometrial cancer is successfully treated more than 90 percent of the time. Unfortunately, not all endometrial cancer can be successfully treated. In these cases, the cancer has spread beyond the uterus by the time it's detected. About 7,000 American women die each year of endometrial cancer.
Signs and symptoms
Endometrial cancer often develops over a period of years. Your first clue that something is wrong may be abnormal vaginal bleeding.
Most cases of endometrial cancer develop in postmenopausal women, whose periods have stopped. However, a small percentage of cases affect women younger than 40.
Signs and symptoms of endometrial cancer may include:
- Prolonged periods or bleeding between periods
- More frequent vaginal bleeding or spotting during the years leading up to menopause (perimenopause)
- Any bleeding after the time of menopause
- A pink, watery or white discharge from your vagina
- Pelvic pain, especially late in the disease
- Pain during intercourse
- Weight loss
Causes
Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes cells become abnormal (mutate) and grow out of control. The cells continue dividing even when new cells aren't needed. These abnormal cells can invade and destroy nearby tissues and even have the ability to travel to other parts of the body and begin growing there.
In endometrial cancer, cancer cells develop in the lining of the uterus. Why these cancer cells develop isn't entirely known. However, scientists believe that estrogen levels play a role in the development of endometrial cancer. Factors that can increase the levels of this hormone and other risk factors for the disease have been identified and continue to emerge. In addition, ongoing research is devoted to studying changes in certain genes that may cause the cells in the endometrium to become cancerous.
Treatment
Surgery is the most common treatment for endometrial cancer. Most doctors recommend either the surgical removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes in the area should also be removed during surgery along with other tissue samples.
A hysterectomy is a major operation, and because you can't get pregnant after your uterus has been removed, it can be a difficult decision for some women. However, surgery is usually the only way to eliminate the cancer or the need for further treatment.
If you have an aggressive form of endometrial cancer or the cancer has spread to other parts of your body, you may need additional treatments. These may include:
- Radiation. Radiation therapy involves the use of high-dose X-rays to kill cancer cells. If your doctor believes you're at high risk of cancer recurrence, he or she may suggest that you have radiation therapy after a hysterectomy. Your doctor may also recommend radiation therapy if the cancerous tumor is fast growing, invades deeply into the muscle of the uterus or involves blood vessels. Brachytherapy is another form of radiation that involves the internal application of radiation, usually to the inner lining of the uterus. Brachytherapy has significantly fewer side effects than conventional radiation therapy does. However, brachytherapy treats only a small area of the body.
- Hormone therapy. If the cancer has spread to other parts of your body, synthetic progestin, a form of the hormone progesterone, may stop it from growing. The progestin used in treating endometrial cancer is administered in higher doses than is used in hormone replacement therapy for menopausal women. Other medications may be used as well. Treatment with progestin may be an option for women with early endometrial cancer who want to have children and, therefore, don't want to have a hysterectomy. However, this approach is not without the risk that the cancer will return. Carefully discuss this treatment with an expert in this field.
- Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells. In some cases, your doctor may recommend chemotherapy for endometrial cancer. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells outside the uterus.
Each type of treatment for endometrial cancer can have side effects. Ask your doctor what side effects you can expect and what can be done to manage them.
Prevention
Although most cases of endometrial cancer aren't preventable, certain factors can lower your risk of developing the disease. These include:
- Taking hormone therapy (HT) with progestin. Estrogen stimulates growth of the endometrium. Replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking synthetic progestin, a form of the hormone progesterone, with estrogen causes the lining of the uterus to shed. This kind of combination hormone therapy lowers your risk. But not all effects of HT are positive. Taking HT as a combination therapy can result in serious side effects and health risks. Work with your doctor to evaluate the options and decide what's best for you.
- A history of using birth control pills. Use of oral contraceptives can reduce endometrial cancer risk even as long as 10 years after you stop taking them. The risk is lowest in women who take oral contraceptives for many years.
- Maintaining a healthy weight. Obesity is one of the highest risk factors for the development of endometrial cancer in most women. You can help prevent endometrial cancer by maintaining a healthy weight. Excess fat tissue can increase levels of estrogen in your body, which increases your risk of endometrial cancer. Maintaining a healthy weight as you age lowers your risk of endometrial cancer as well as other diseases.
Informations obtained from National Institute of Health.