Endometrial Cancer

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
• Spotting
• 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).
• Obesity
• 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.

How Is Endometrial Cancer Diagnosed?

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:

• Physical exam
• Endometrial biopsy
• Hysteroscopy
• Dilation and curettage
• Ultrasound

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 her 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 her overall health.

Staging

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)

For more detailed information on stages of endometrial cancer, visit the staging section of the American Cancer Society’s endometrial cancer website.

How Is Endometrial Cancer Treated?

The treatment for endometrial cancer often consists of a combination of the following treatments, which are often based on multiple factors, including a patient’s age and general health.

Surgery

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

Chemotherapy uses drugs to kill cancer cells. The drugs are either taken orally or injected through a vein directly into the bloodstream. Several chemotherapy drugs can be used to treat endometrial cancer. A medical oncologist will discuss these options with the patient to determine the best treatment plan. Some patients may experience side effects while undergoing chemotherapy treatment. Possible side effects include nausea, vomiting, mouth sores, loss of appetite, fatigue, hair loss, and rashes on the hands and feet. In recent years, chemotherapy treatment has improved significantly and become much more manageable.

References

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