Endometrial cancer is one of the most common gynecological cancers, primarily affecting the endometrium—the lining of the uterus. This article provides a detailed overview of endometrial cancer, its causes, symptoms, diagnostic methods, and treatment options. We’ll also address frequently asked questions to give you a well-rounded understanding of this condition.

Overview of Endometrial Cancer

Endometrial cancer develops when abnormal cells in the endometrial lining of the uterus grow uncontrollably. It is typically classified into two main types:

1. Type 1 (Endometrioid carcinoma): The more common and less aggressive type, often associated with excess estrogen levels.

2. Type 2 (Non-endometrioid carcinoma): Less common but more aggressive, including subtypes such as serous carcinoma and clear cell carcinoma.

Epidemiology

Endometrial cancer is most prevalent in postmenopausal women, with the average age of diagnosis being around 60. However, younger women can also be affected, particularly those with risk factors like obesity or genetic predispositions.

Prognosis

The prognosis for endometrial cancer depends on the stage at diagnosis, tumor grade, and the individual’s overall health. Early-stage cancers have a high survival rate with timely treatment.

Causes of Endometrial Cancer

The exact cause of endometrial cancer is not entirely understood, but several factors can contribute to its development:

1. Hormonal Imbalances

• Estrogen dominance: Excessive estrogen without the balancing effect of progesterone can lead to endometrial hyperplasia, a precursor to cancer.

• Hormone replacement therapy (HRT): Unopposed estrogen therapy increases the risk.

2. Genetic Factors

• Lynch syndrome: A hereditary condition caused by mutations in DNA mismatch repair genes significantly increases the risk.

• Family history: Women with close relatives diagnosed with endometrial, ovarian, or colorectal cancer are at higher risk.

3. Lifestyle and Metabolic Factors

• Obesity: Adipose tissue converts androgens to estrogen, raising estrogen levels.

• Diabetes and insulin resistance: These conditions are linked to increased cancer risk due to metabolic dysregulation.

4. Other Risk Factors

• Early menarche or late menopause

• Nulliparity (having no children)

• Polycystic ovary syndrome (PCOS)

• Tamoxifen use for breast cancer treatment

Symptoms of Endometrial Cancer

Recognizing the symptoms early can improve outcomes significantly. Common signs include:

1. Abnormal uterine bleeding

   • Postmenopausal bleeding

   • Irregular or heavy menstrual periods in premenopausal women

2. Pelvic pain or pressure

3. Unusual vaginal discharge that may be watery or blood-tinged

4. Pain during intercourse

5. Unintended weight loss

It’s important to note that these symptoms are not exclusive to endometrial cancer and may be caused by other conditions. Therefore, medical evaluation is crucial.

Diagnosis of Endometrial Cancer

Diagnosing endometrial cancer typically involves several steps:

1. Medical History and Physical Examination

The physician will review the patient’s medical history and perform a pelvic examination to assess the uterus and surrounding tissues.

2. Imaging Studies

• Transvaginal ultrasound (TVUS): Often the first imaging modality used to evaluate endometrial thickness.

• MRI or CT scan: Used for staging and assessing the spread of the disease.

3. Endometrial Biopsy

A small sample of endometrial tissue is collected and examined under a microscope to confirm cancer and determine its type and grade.

4. Hysteroscopy

A thin, lighted tube is inserted into the uterus to visualize abnormalities and guide biopsy.

5. Blood Tests

• CA-125 levels: Elevated levels may suggest advanced disease.

• Genetic testing: For Lynch syndrome in patients with a strong family history.

Treatment Methods for Endometrial Cancer

Treatment depends on the stage and grade of cancer, as well as the patient’s overall health and preferences.

1. Surgery

• Hysterectomy: The removal of the uterus, often along with the fallopian tubes and ovaries (salpingo-oophorectomy).

• Lymph node dissection: To assess the spread of cancer.

• Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, are commonly used.

2. Radiation Therapy

• External beam radiation therapy (EBRT): Targets the pelvic area to destroy cancer cells.

• Brachytherapy: Involves placing radioactive material directly inside the uterus.

3. Hormonal Therapy

Used primarily for advanced or recurrent cases, hormonal therapy aims to block estrogen’s effect on cancer growth.

• Progestins: Synthetic forms of progesterone.

• Aromatase inhibitors: Reduce estrogen production.

4. Chemotherapy

Typically used for advanced or high-grade cancers, chemotherapy involves systemic drugs to target cancer cells throughout the body. Common agents include paclitaxel and carboplatin.

5. Targeted Therapy and Immunotherapy

• Targeted therapies: Drugs like bevacizumab inhibit tumor blood vessel growth.

• Immunotherapy: Checkpoint inhibitors such as pembrolizumab are being explored for cancers with specific genetic markers.

Frequently Asked Questions (FAQs)

1. What is the survival rate for endometrial cancer?

The five-year survival rate for early-stage endometrial cancer is around 95%, but it decreases significantly for advanced stages.

2. Can endometrial cancer be prevented?

While it cannot always be prevented, reducing risk factors like obesity, managing hormonal imbalances, and undergoing regular screenings can lower the likelihood.

3. Is postmenopausal bleeding always a sign of cancer?

No, but it is a red flag that requires prompt medical evaluation to rule out serious conditions.

4. Are there fertility-preserving options for young women?

Yes, hormonal therapies combined with close monitoring may be an option for early-stage cancers in women who wish to preserve fertility.

5. What is the role of genetic testing in endometrial cancer?

Genetic testing identifies individuals with Lynch syndrome or other hereditary risks, allowing for tailored surveillance and preventive strategies.

Sources

1. American Cancer Society. “Endometrial Cancer Overview.”

2. National Cancer Institute. “Uterine Cancer Treatment.”

3. Mayo Clinic. “Endometrial Cancer.”

4. World Health Organization. “Cancer Fact Sheets.”

Disclaimer: This information is for educational purposes and not a substitute for professional medical advice. Always consult a healthcare provider for diagnosis and treatment options.