Overview

 

Endometrial cancer is a uterine cancer that starts in the lining of the uterus. The uterus is a pear-shaped hollow pelvic organ where foetal development takes place.

Endometrial cancer starts in the layer of cells that make up the uterine lining (endometrium). Uterine cancer is another name for endometrial cancer. Other cancers, such as uterine sarcoma, can develop in the uterus, but they are far less common than endometrial cancer.

Because endometrial cancer frequently causes abnormal vaginal bleeding, it is frequently detected at an early stage. Endometrial cancer can often be cured by surgically removing the uterus if it is discovered early.

 

Endometrial cancer can spread to the bladder or rectum, as well as the vagina, fallopian tubes, ovaries, and other distant organs if left untreated. Fortunately, endometrial cancer grows slowly and is usually detected early on with regular checkups.

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Symtoms :

Endometrial cancer can cause no symptoms until it has spread to other organs in some women. Endometrial cancer, on the other hand, is usually detected when symptoms, such as vaginal bleeding, appear as the cancer progresses. The following are the most common signs and symptoms:

 

• In nine out of ten women with endometrial cancer, abnormal vaginal bleeding or discharge occurs. This refers to unusually heavy, irregular menstrual periods or bleeding between periods prior to menopause. Unless a woman is on hormone replacement therapy, this means any vaginal bleeding after menopause (HRT). Despite the fact that HRT may cause vaginal bleeding in postmenopausal women, the first episodes of such bleeding should be checked by a doctor to ensure that they are not caused by endometrial cancer. Only 15% of women who experience postmenopausal bleeding develop endometrial cancer.

• Vaginal discharge that varies in colour and consistency from pink and watery to thick, brown, and foul-smelling.

• Urination that is difficult or painful.

• During a pelvic exam, an enlarged uterus can be detected.

• During intercourse, there is pain.

• Weight loss that was unexpected.

• Lower-abdominal, back, or leg weakness and pain. When cancer has spread to other organs, this occurs.

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Causes :

Endometrial cancer is caused by an unknown factor, according to doctors. What is known is that something causes changes (mutations) in the DNA of cells in the endometrium, or uterine lining.

 

Normal, healthy cells become abnormal as a result of the mutation. Healthy cells grow and multiply at a predetermined rate before dying at a predetermined time. Abnormal cells multiply and grow out of control, and they don't die at a predictable rate. The abnormal cells that are accumulating form a mass (tumor). Cancer cells infiltrate nearby tissues and can break away from a primary tumour to spread to other parts of the body (metastasize).

 

Risk Factors

Endometrial cancer is caused by a number of factors, including:

 

• Changes in the female hormone balance in the body. The ovaries produce oestrogen and progesterone, which are the two main female hormones. Changes in the endometrium are caused by fluctuations in the balance of these hormones.

• Endometrial cancer risk can be increased by a disease or condition that raises oestrogen levels but not progesterone levels in the body. Ovulation irregularities, which can occur in polycystic ovary syndrome, obesity, and diabetes are examples. After menopause, estrogen-only hormones with no progesterone increase the risk of endometrial cancer.

• Endometrial cancer can be increased by a rare type of ovarian tumour that secretes oestrogen.

• timing of  menstruation. Endometrial cancer is more likely in women who start menstruating early — before the age of 12 — or wait longer to reach menopause. The longer you've had periods, the more oestrogen your endometrium has been exposed to.

• You have a higher risk of endometrial cancer if you have never been pregnant than if you have had at least one pregnancy.

• Age . Endometrial cancer is more likely to develop as you get older. After menopause, endometrial cancer is most common.

• Obesity. Obesity raises the risk of endometrial cancer. This could happen because your body's hormone balance is disrupted by excess body fat.

• Hormone therapy  used to treat breast cancer. Tamoxifen, a hormone therapy drug used to treat breast cancer, has been linked to an increased risk of endometrial cancer. If you're taking tamoxifen, talk to your doctor about this possibility. The benefits of tamoxifen far outweigh the small risk of endometrial cancer for the vast majority of women.

• A colon cancer syndrome that is passed down through the generations. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is a cancer risk factor for colon cancer and other cancers, including endometrial cancer. Lynch syndrome is caused by a gene mutation that is passed down from one generation to the next. If a family member has been diagnosed with Lynch syndrome, talk to your doctor about your risk of developing the genetic disorder. Ask your doctor what cancer screening tests you should take if you've been diagnosed with Lynch syndrome.

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Prevention :

You may want to do the following to lower your risk of endometrial cancer:

 

Discuss the risks of hormone therapy after menopause with your doctor. Discuss the risks and benefits of hormone replacement therapy with your doctor if you're considering it to help with menopause symptoms. Replacing oestrogen alone after menopause, unless you've had a hysterectomy, may increase your risk of endometrial cancer. This risk can be reduced by taking a combination of oestrogen and progestin. Hormone therapy comes with its own set of risks, so discuss them with your doctor.

 

Take birth control pills if you're thinking about it. Endometrial cancer risk may be reduced by using oral contraceptives for at least one year. After you stop using oral contraceptives, the risk reduction is thought to last for several years. However, oral contraceptives have side effects, so talk to your doctor about the benefits and risks.

 

Maintain a healthy body mass index (BMI). Obesity raises the risk of endometrial cancer, so make an effort to lose weight and keep it off. If you want to lose weight, increase your physical activity while lowering your daily calorie intake.

 

Diagnosis:

 

Endometrial cancer is diagnosed using the following tests and procedures:

• The pelvis is  examined. During a pelvic exam, your doctor will examine the outer portion of your genitals (vulva), then insert two fingers of one hand into your vagina while pressing the other hand against your abdomen to feel your uterus and ovaries. He or she will also insert a speculum into your vaginal canal. The speculum opens your vagina to allow your doctor to examine it and your cervix for abnormalities.

• Sound waves are used to make a picture of your uterus. A transvaginal ultrasound(TVS) may be recommended by your doctor to examine the thickness and texture of the endometrium and rule out other conditions. A wand-like device (transducer) is inserted into your vaginal canal during this procedure. The transducer creates a video image of your uterus by using sound waves. Your doctor can use this test to check for abnormalities in your uterine lining.

• Examining your endometrium with a scope. Your doctor will insert a thin, flexible, lighted tube (hysteroscope) through your vaginal and cervix into your uterus during a hysteroscopy. Your doctor can examine the inside of your uterus and endometrium using a lens on the hysteroscope.

• Taking a sample of tissue to be tested. An endometrial biopsy will most likely be performed to obtain a sample of cells from inside your uterus. This entails removing tissue from your uterine lining for testing in the lab. Endometrial biopsy can usually be done without anaesthesia in your doctor's office.

• Performing surgery in order to remove tissue for testing purposes. If a biopsy doesn't yield enough tissue or the biopsy results aren't clear, you'll probably need to have a procedure called dilation and curettage (D&C). Tissue from the lining of your uterus is scraped and examined under a microscope for cancer cells during D&C.

• If endometrial cancer is discovered, you'll most likely be referred to a doctor who specializes in female reproductive system cancers.

 

Endometrial cancer staging:

 

Your doctor will work to determine the extent (stage) of your cancer once it has been diagnosed. A chest X-ray, a computerised tomography (CT) scan, a positron emission tomography (PET) scan, and blood tests may be used to determine the stage of your cancer. It's possible that your cancer's stage won't be determined until after you've had surgery to treat it.

 

Your doctor will assign a stage to your cancer based on the results of these tests and procedures. Endometrial cancer is classified into four stages, ranging from I to IV, with the lowest stage indicating that the cancer has not spread beyond the uterus. By stage IV, the cancer has spread to distant parts of the body or has spread to nearby organs such as the bladder.

 

Treatment:

Surgery to remove the uterus, fallopian tubes, and ovaries is typically used to treat endometrial cancer. Radiation therapy with high energy is another option. Chemotherapy with strong drugs and hormone therapy, which blocks hormones that cancer cells rely on, are two drug treatments for endometrial cancer. Targeted therapy, which uses drugs to target specific flaws in cancer cells, and immunotherapy, which helps your immune system fight cancer, are two other options.

 

1) Surgery

The uterus (hysterectomy), as well as the fallopian tubes and ovaries, are usually removed during endometrial cancer treatment (salpingo-oophorectomy). You won't be able to get pregnant again after having a hysterectomy. If you haven't already gone through menopause, you will once your ovaries are removed.

 

Your surgeon will also look for signs of cancer spreading around your uterus during surgery. Lymph nodes may be removed for testing by your surgeon as well. This information is useful in determining the stage of your cancer.

 

2) Radiation therapy

To kill cancer cells, radiation therapy employs high-energy beams like X-rays and protons. Your doctor may recommend radiation to lower your risk of cancer recurrence after surgery in some cases. To shrink a tumour and make it easier to remove, radiation therapy may be recommended before surgery in some cases.

 

If you aren't in good enough health to have surgery, radiation therapy may be the best option.

 

Radiation therapy may include one or more of the following procedures:

 

Radiation emitted by a machine that is not part of your body. You lie on a table and a machine directs radiation to specific points on your body during external beam radiation.

 

Radiation is a type of energy that is emitted from within your body. Internal radiation (brachytherapy) entails inserting a radiation-filled device, such as small seeds, wires, or a cylinder, into your vaginal canal for a brief period of time.

 

3) Chemotherapy

Chemotherapy is a method of killing cancer cells through the use of chemicals. You could be given a single chemotherapy drug or a combination of two or more. Chemotherapy drugs can be administered orally or intravenously (intravenously). These drugs get into your bloodstream and travel through your body, killing cancer cells along the way.

 

If there is a chance that the cancer will come back after surgery, chemotherapy may be recommended. It can also be used prior to surgery to shrink the cancer so that it is more likely to be completely removed during the procedure.

 

In the case of advanced or recurrent endometrial cancer that has spread beyond the uterus, chemotherapy may be recommended.

 

4) Hormone therapy

Hormone therapy entails the administration of medications to reduce hormone levels in the body. Cancer cells that rely on hormones to grow may die as a result of this reaction. If your endometrial cancer has spread beyond the uterus, hormone therapy might be a good option.

 

5) Targeted therapy

 

Drugs that target specific flaws in cancer cells are known as targeted treatments. Targeted drug treatments can kill cancer cells by preventing them from exploiting their flaws. In the case of advanced endometrial cancer, targeted drug therapy is usually combined with chemotherapy.

 

6) Immunotherapy

Immunotherapy is a drug that aids your immune system in the fight against cancer. Because cancer cells produce proteins that blind immune system cells, your body's disease-fighting immune system may not be able to fight cancer. Interfering with that process is how immunotherapy works. If the cancer has progressed and other treatments have failed, immunotherapy may be considered.

 

7)Palliative (supportive) care

Palliative care is a type of medical treatment aimed at alleviating pain and other symptoms associated with a serious illness. Palliative care specialists collaborate with you, your family, and your other doctors to add an extra layer of support to your ongoing care. Palliative care can be used in conjunction with more aggressive treatments like surgery, chemotherapy, or radiation.

 

Patients with cancer may feel better and live longer if palliative care is used in conjunction with all other appropriate treatments.

Doctors, nurses, and other specially trained professionals provide palliative care. Palliative care teams help cancer patients and their families live better lives. This type of treatment can be used in conjunction with any curative or other treatments you're receiving.

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