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
  • 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.

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.

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

Contáctenos

Tratamientos y Servicios

Cirugía para el cáncer de endometrio

La mayoría de los pacientes con cáncer de endometrio se someterán a una cirugía como paso inicial del tratamiento. Muchos pacientes no requerirán ningún tratamiento adicional después de la cirugía, aunque a algunos se les recomendará quimioterapia y / o radioterapia. El objetivo de la cirugía es extirpar la mayor cantidad posible de cáncer. Por lo general, esto implica la extirpación del útero y el cuello uterino (un procedimiento llamado histerectomía). A la mayoría de los pacientes también se les extirpan los ovarios y las trompas de Falopio en un procedimiento llamado salpingooforectomía bilateral (BSO). En muchos casos, se extirpan los ganglios linfáticos para determinar si el cáncer se ha diseminado más allá del útero. Si es así, el cirujano puede intentar extraerlo en un proceso conocido como reducción de volumen. Si el cáncer de endometrio se diagnostica en una etapa temprana, el cirujano tiene más posibilidades de extirpar todo el cáncer. Si los pacientes son diagnosticados en una etapa posterior, es posible que necesiten más de un procedimiento quirúrgico.

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Quimioterapia

La quimioterapia es un medicamento o una combinación de medicamentos que se usan para tratar el cáncer. La quimioterapia puede administrarse por vía oral (en forma de pastilla) o inyectarse por vía intravenosa (IV).

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Radioterapia

La radiación utiliza un equipo especial para liberar partículas de alta energía, como rayos X, rayos gamma, haces de electrones o protones, para matar o dañar las células cancerosas. La radiación (también llamada radioterapia, irradiación o terapia de rayos X) se puede administrar internamente a través de la implantación de semillas o externamente usando aceleradores lineales (llamada radioterapia de haz externo o EBRT).

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Braquiterapia vaginal

Para la braquiterapia vaginal, se coloca un aplicador que contiene semillas radiactivas dentro de usted para administrar una dosis alta de radioterapia en la parte superior de la vagina. Este procedimiento se realiza en la clínica de forma ambulatoria, pero puede requerir pasar la noche en el hospital.

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Radioterapia de haz externo

La radioterapia de haz externo es uno de los tipos más comunes de radiación para el tratamiento del cáncer. La radiación proviene de una máquina fuera del cuerpo y la administra a un lugar específico dentro del cuerpo.

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Diagnósticos y Pruebas

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.

Examen físico

Su médico le hará una serie de preguntas y es probable que le realice un examen físico. El examen físico incluirá el examen de cualquier área específica de preocupación, especialmente en lo que se refiere al motivo de su visita al consultorio.

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Biopsia del endometrio

Se necesita una biopsia de endometrio para confirmar un diagnóstico de cáncer de endometrio y se puede realizar en el consultorio del médico. Se inserta un tubo delgado y flexible a través de la vagina y el cuello uterino hasta el útero para obtener una muestra de tejido del endometrio.

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Histeroscopia

Un médico inserta una cámara muy pequeña a través de la vagina y el cuello uterino para observar si hay algún tejido anormal en el útero.

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Dilatación y curetaje (D&C)

Si una biopsia de endometrio no es concluyente para el diagnóstico de una paciente, es posible que sea necesario realizar una dilatación y legrado para recolectar células adicionales del revestimiento del útero. Esto se realiza como un procedimiento ambulatorio y puede requerir anestesia general o local.

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Cáncer de endometrio por ultrasonido

Se pueden realizar diversas pruebas de diagnóstico por imágenes para ayudar a diagnosticar el cáncer de endometrio, pero con mayor frecuencia, el cáncer de endometrio se diagnostica mediante una ecografía. La ecografía es un procedimiento seguro y no invasivo que utiliza ondas sonoras de alta frecuencia para examinar el abdomen. La ecografía, también llamada ecografía o ecografía, proporciona imágenes del cuerpo en tiempo real y evalúa el tamaño y el movimiento de las estructuras, como el flujo sanguíneo. También se pueden usar ecografías transvaginales y se realizan insertando una pequeña sonda en la vagina para determinar el grosor general del endometrio.

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Patología

Para confirmar si los síntomas están asociados con hiperplasia endometrial (agrandamiento anormal del endometrio) o cáncer de endometrio, la biopsia del tejido extraído del endometrio debe enviarse al departamento de patología para su análisis. Los patólogos observarán el tejido bajo un microscopio para hacer un diagnóstico final.

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Nuestro Equipo

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.

Lauren J Oshry, MD

Assistant Professor of Medicine, Department of Medicine, Boston University School of Medicine

Gregory Russo, MD
Attending Physician, Department of Radiation Oncology, Boston Medical Center
Clinical Assistant Professor of Radiation Oncology, Boston University School of Medicine

Recursos del Paciente

Endometrial Cancer Clinical Trials

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.

Afiliaciones

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As the principal teaching affiliate of Boston University School of Medicine (BUSM), Boston Medical Center is devoted to training future generations of healthcare professionals.  Learn more about Boston University School of Medicine.