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At Boston Medical Center (BMC), the care of patients with endometrial cancer is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality of life.
As the primary teaching affiliate of the Boston University School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.
BMC’s gynecologic oncologists have expertise in treating many types of female pelvic cancers, including cancers of the ovaries, cervix, vulva, and trophoblast (placenta). Patients with a diagnosis or strong suspicion of cancer are given appointments within 72 hours.
What Is Endometrial Cancer?
Endometrial cancer begins in the uterus, which is part of the female reproductive system. The uterus is a hollow organ that extends in one direction towards the vagina and in the other direction towards the fallopian tubes and ovaries. It is the location where a fetus grows during pregnancy. The uterine wall has two layers: the endometrium and the myometrium. The endometrium is the inner lining of the uterus, where the cancer begins. The myometrium is the outer muscle layer of the uterine wall. Most of the cancers that begin in the uterus do so in the endometrial glands.
Symptoms of Endometrial Cancer
- Abnormal vaginal bleeding
- Other vaginal discharge
Patients with concerns about any of the symptoms listed above are urged to consult their physician immediately.
Causes of Endometrial Cancer
Although the exact causes remain unknown, certain risk factors—things that increase an individual's chances of developing a cancer—have been identified. While risk factors may be useful in identifying high-risk individuals, they do not determine whether an individual develops a disease. Some risk factors, such as diet, are within an individual’s control, while others, such as age, are not.
Some of the risk factors for endometrial cancer include:
- Age: Older women have a greater risk.
- Diabetes: The risk is four times greater for women who have diabetes than for those who do not (American Cancer Society 2015).
- Estrogen hormone therapy: Estrogen hormone therapy has been proven to increase the risk in women who have a uterus. Progesterone drugs are usually given with estrogen to reduce a woman’s risk; this is referred to as combination hormone therapy.
- Family history
- Genetic syndromes: Certain hereditary conditions, such as Lynch syndrome, may increase the risk of developing endometrial cancer. Lynch syndrome is characterized by mutations (changes to a cell’s genetic makeup) in the MLH1 or MSH2 genes. Women with Lynch syndrome have an increased risk of 40% to 60% (American Cancer Society 2015).
- Polycystic ovary syndrome: Polycystic ovary syndrome (PCOS) is a women’s health condition characterized by abnormal hormone levels, which can result in a number of medical issues, including (but not limited to) infertility, menstrual problems, increased androgen (male hormone) levels, and facial and body hair growth. Increased estrogen and decreased progesterone levels associated with PCOS can increase a woman’s risk.
- Using birth control pills: Taking birth control medication is known to decrease the risk.
At this point in time, no screening procedures are in place to detect endometrial cancer. However, patients with a strong family history of endometrial or colon cancer may be eligible for genetic counseling. For more information, patients can visit Genetic Counseling or talk to their physician to request a referral.
Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because it is used to determine the most appropriate treatment options for patients. The stages of endometrial cancer range from Stage 0 to Stage IV.
Stages of Endometrial Cancer
- Stage 0 - Cancer is present only in the surface cells of the endometrium.
- Stage I - Cancer is present only in the uterus.
- Stage II - Cancer has spread to the connective tissue of the cervix but is still contained to the uterus.
- Stage III - Cancer has spread outside the uterus and cervix but is contained to the pelvis.
- Stage IV - Cancer has progressed beyond the pelvis.
(American Cancer Society 2015, National Cancer Institute 2010)
American Cancer Society. 2015. Detailed Guide: Endometrial (Uterine) Cancer. PDF.
National Cancer Institute. 2010. What You Need To Know About™ Cancer of the Uterus. PDF. Bethesda: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services. http://www.cancer.gov/publications/patient-education/uterus.pdf
Treatments & Services
Surgery for Endometrial Cancer
Most patients with endometrial cancer will have surgery as the initial step of treatment. Many patients will not require any additional treatment after surgery, though some will be recommended chemotherapy and/or radiation therapy. The goal of surgery is to remove as much of the cancer as possible. Usually, this involves removing the uterus and cervix (a procedure called a hysterectomy). Most patients will also have their ovaries and fallopian tubes removed in a procedure called a bilateral salpingo-oophorectomy (BSO). In many cases, lymph nodes will be removed to determine if the cancer has spread beyond the uterus. If it has, the surgeon may attempt to remove it in a process known as debulking. If endometrial cancer is diagnosed at an early stage, the surgeon has a greater chance of removing all of the cancer. If patients are diagnosed at a later stage, they may require more than one surgical procedure.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).
For vaginal brachytherapy, an applicator containing radioactive seeds is placed inside you to deliver a high dose of radiation therapy to the upper vagina. This procedure is done in the clinic as an outpatient, but may require overnight stay in the hospital.
External Beam Radiation Therapy
External beam radiation therapy is one of the most common types of radiation for cancer treatment. Radiation comes from a machine outside the body and delivers radiation to a specific location inside the body.
Diagnostics and Tests
Endometrial cancer can be diagnosed at any stage. If women experience any irregular vaginal bleeding, they should consult their physician immediately. Early-stage diagnosis is beneficial because it will improve the outcomes for most women.
If a primary care physician suspects endometrial cancer might be the cause of a patient’s symptoms, they will make a referral to a gynecologist or gynecologic oncologist. These specialists will use one or more of the following methods to diagnose endometrial cancer.
In collaboration with other specialists, a patient’s physician will likely order one or more diagnostic tests and review the results at a weekly Tumor Board meeting. This interdepartmental review process guides recommendations for treatment. In consultations with the patient and their primary care physician, the Cancer Care Center team plans the best course of treatment based on the type and stage of the patient’s cancer and their overall health.
Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.
An endometrial biopsy is needed to confirm a endometrial cancer diagnosis and can be performed in the doctor's office. A thin flexible tube is inserted through the vagina and cervix into the uterus to obtain a tissue sample from the endometrium.
A physician inserts a very small camera through the vagina and cervix to observe whether there is any abnormal tissue in the uterus.
Dilation and Curettage (D&C)
If an endometrial biopsy is inconclusive in diagnosing a patient, a D&C may need to be performed to collect additional cells from the uterus lining. This is done as an outpatient procedure and may require general or local anesthesia.
Ultrasound Endometrial Cancer
A variety of imaging tests may be done to help diagnose endometrial cancer, but most often, endometrial cancer is diagnosed by performing an ultrasound. Ultrasound is a safe, noninvasive procedure that uses high-frequency sound waves to examine the abdomen. Ultrasound imaging - also called ultrasound scanning or sonography - provides real-time pictures of the body and evaluates size and movement of structures, such as blood flow. Transvaginal ultrasounds may also be used and are performed by inserting a small probe into the vagina to determine the general thickness of the endometrium.
To confirm whether the symptoms are associated with endometrial hyperplasia (abnormal enlargement of the endometrium) or endometrial cancer, the biopsy of tissue removed from the endometrium must be sent to the pathology department for analysis. The pathologists will look at the tissue under a microscope to make a final diagnosis.
BMC’s comprehensive endometrial cancer team includes physicians who work in surgical oncology specific to gynecology, medical oncology, and radiation oncology. Each patient benefits from the collaborative expertise of a multidisciplinary group of physicians uniquely focused on their individual needs.
Gregory Russo, MD
Attending Physician, Department of Radiation Oncology, Boston Medical Center
Clinical Assistant Professor of Radiation Oncology, Boston University School of Medicine
BMC offers a number of clinical trials specifically for endometrial cancer patients. Promising new techniques in the diagnosis, treatment, and care of patients with cancer are tested in these studies. The number and types of clinical trials available are constantly changing.